168 Chapter 9 considered the nature of the cases themselves to be an important criterion to determine whether MCD was worth the time it takes. Some noted that team members felt a certain ‘fatigue’, especially when the case under discussion was not recognizable to everyone or when it had the same characteristics as a previously discussed case. “Here we go again, another patient who has characteristic X.” - Individual interview with a clinician Others who had not experienced this themselves could imagine it might happen to them in the future. “You cannot organize a moral case deliberation for every patient, so you need to constantly weigh whether it is a worthwhile time investment. So far, we have only discussed cases that offered us new insights, but I can imagine that sooner or later we will reach a saturation point.” - Individual interview with a clinician These different experiences show that what participants see as ‘the same’ or ‘similar’ was often ambiguous and unclear. Insufficient follow-up Some participants mentioned that there was insufficient follow-up after MCD. The MCD sessions frequently produced new insights and signals, but it was unclear what follow-up actions were being taken if any and who should be responsible for following up. For instance, one difficult request which had long been expressed was discussed in an MCD session, but subsequently kept coming up in regular team meetings and yet no action was taken. “And more in general, when we do reach some kind of conclusion, there’s often no concrete follow-up. And that’s a shame.” - Individual interview with a clinician “This caused some irritation. We talked about this case in a moral case deliberation, so we knew we should see some kind of an outcome, but we still did not know what the outcome would be.” - Individual interview with a clinician Perhaps taking time to deliberate is all that really counts, and not this particular method? Most participants said taking more time to deliberate a case was worthwhile and that it helped them deal with moral challenges in their work. Some asserted that it was not the particular method (in this case, MCD) that had made the difference, but merely the fact that the team was taking ample time to deliberate a case.