What are some practical tips for when a patient's consistently stated goals of care do not correlate with their actions?

First, it's important to remember that most of us have inconsistent beliefs. We both want to lose weight, and we want to eat chocolate cake; we want to get an A, and we want to go to the party. So when we see inconsistencies in others' beliefs, rather than being judgmental, we should get curious. Our job is to understand their behavior. They may be refusing their blood work, for example, because they don't see it's important. Or they may know that the test is important, but just can't bear it because it's too early in the morning. Or they may not understand how important we think it is. "Help me understand is a critical phrase", or "I'm confused because I know you want to live as long as possible. And yet you're saying no to tests that I th...

I agree with Drs. @Dr. First Last, @Dr. First Last, and @Dr. First Last's astute advice about staying curious. To Dr. Wolfe's point, very few parts of a serious illness are within our patients' control, so it's very common for patients to seek out ways of regaining some autonomy. We expect our patients to give us their blood, their tissue, their attention, and their time, so it's only fair that patients should ask for some amount of control over how much they give of themselves and when. :)

One way to stay curious in this sort of situation is to ask, "What could we try doing differently to give you more choices in your care and put you in the driver's seat?" Small things like retiming labs for later in the day can make a big difference, esp...

When a patient’s actions don’t align with their stated goals, I see it as an invitation to explore. Life is rarely linear, and goals evolve as circumstances change. If something feels “off” about a choice, my first instinct is curiosity: What is the patient hoping for with this decision? Have I missed something important? Was I unclear about the burdens or benefits of this intervention?

I might say, "Earlier, you shared that you weren’t interested in pursuing more testing. Could you help me understand what you’re hoping to gain from having this test now? Has something shifted for you?"

It’s less about correcting the choice and more about uncovering the story underneath it.

I agree with Drs. @Dr. First Last and @Dr. First Last. While this can be very frustrating for providers, I agree that this is an opportunity to get curious.

Things that might be helpful are discussing how tests/PT, etc., are going to help them achieve their stated goals.

I would also explore why they are declining these things. Being in the hospital often means losing a lot of autonomy. So this may be a patient's way of reasserting their autonomy or controlling a situation that is frequently out of their control. Perhaps negotiating with them is a way to move forward: trying to set a schedule for PT (assuming PT agrees to this and can accommodate this).

I think it is also ok to point out how their stated goals and actions are at odds wit...