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

For example, what do you do when someone requests aggressive, life-prolonging treatments but then is not receptive to elements of day-to-day care in the hospital (e.g., labs, medications, etc.)?
4 Answers
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Hospital Medicine · Icahn School of Medicine at Mount Sinai
Answered on · Updated on

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. Ou...

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Hospital Medicine · University of Washington
Answered on · Updated on

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 patie...

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General Internal Medicine · Northwell Health
Answered on

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 miss...

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General Internal Medicine · University of Colorado
Answered on

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 t...

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