Table 1.

Descriptions of the three vantage points used by surgeon S1 to describe case C2

Problem as procedural decision making	Problem as dealing with the medical team	Problem as a moral dilemma
‘Well, it’s complex because it was a large tumor; it was involving a number of different structures that need to be removed. It was undetermined exactly whether it was resectable prior, although I had a pretty good idea. It involved two different surgical teams…and those teams had to kind of play back and forth with each other at different points.’ (S1C2)	‘But the issue around that was a back story … because he was someone who does not have a lot of intelligence, the oncologist said “well we’re not going to treat him with chemotherapy before you operate on him because we don’t think he’s reliable”… and I felt very strongly that that was inappropriate because I thought that treating him with less than the standard of care just because he’s not as smart as the next person is a bad idea.’ (S1C2)	‘On one edge, I’ve written ‘‘the patient’’ and on the other edge I’ve got “the hospital, society, me” and the arrows are kind of going up and down ‘cause I kind of see that as teetering … what’s good for the patient may not necessarily be best for society because I’m wasting a lot of money by admitting him … and whether, you know, because it’s the right thing to do for the patient…but is it really the right thing to do for everyone else all involved?’ (S1C2)