Dr. Gretchen Schwarze: Surgical Buy-In and Best Case/Worst Case

The Surgical Palliative Care Podcast

#013 - Join host Dr. Red Hoffman as she interviews Dr. Gretchen Schwarze, a vascular surgeon, medical ethicist and prolific researcher known for her work focused on surgical buy-in and the best case/worst case scenario. Gretchen is an endowed professor in the Division of Vascular Surgery, Department of Surgery, at the University of Wisconsin School of Medicine and Public Health. She completed a fellowship in medical ethics at the MacLean Center for Medical Ethics. She is a nationally recognized expert in surgical decision making, informed consent, advance directives and end-of-life care and her research focuses on improving communication between older patients and their surgeons so that patients can avoid unwanted treatment and make decisions that align with their values, preferences and goals. Gretchen defines the concept of surgical buy-in and explores how this concept manifests differently for various patients and various procedures. We discuss the ethics surrounding Do Not Resuscitate orders in the OR and the importance of clearly establishing the goals of surgery (prolonging life, improving quality of life, making a diagnosis or preventing a disability) before operating. Finally, Gretchen explains the Best Case/Worst Case decision aid and notes the importance of both eliciting preferences and making recommendations when using this aid. I learned so much from speaking with Gretchen; she helped me to articulate many of the ethical dilemmas I struggle with when taking care of many of my surgical patients.

Articles mentioned:
Surgeons Expect Patients to Buy-In to Postoperative Life Support Preoperatively
A Framework to Improve Surgeon Communication in High-Stakes Surgical Decisions: Best Case/Worst Case
"Best Case/Worst Case": A Qualitative Evaluation of a Novel Communication Tool for Difficult in-the-Moment Surgical Decisions
Risk Calculators and Decision Aids are Not Enough for Shared Decision Making
To learn how to do Best Case/Worst Case, watch a ten minute video here.

To learn more about the Maclean Center Fellowship in Medical Ethics, click here.
To learn more about the surgical palliative care community, visit us on twitter @surgpallcare