Practical Wisdom, Rules, and the Parent-Pediatrician Conversation

In this article, I explore a tension between one of the aspirations of the standard algorithm for decision-making at the bedside and what will often actually happen at the bedside. The aspiration is to avoid physician paternalism, but the algorithm has had the effect of limiting the scope for the exercise of the physician's capacity for practical wisdom, and yet clinical practice often requires the exercise of that capacity. Against this background, I examine the content of shared decision-making in pediatrics. I do the following: point to a feature of the standard algorithm for patient and surrogate (and so also parental) decision-making, make an analytical point about the use of rules versus individual judgments, and examine the elements of the patient-doctor conversation or, in the pediatric realm, the parent-doctor conversation.