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Extra info for Primary Care Medicine: Office Evaluation and Management of the Adult Patient
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Reconceptualizing advance care planning from the patient’s perspective. Arch Intern Med 1998;158:879. (A slightly different perspective is provided, with an emphasis on the role of relationships in the advance planning exercise. ) 39. Emanuel EJ. A review of the ethical and legal aspects of terminating medical care. Am J Med 1988;84:291. (Discusses issues of competence, use of advance directives, and types of care terminated. ) 40. Gramelspacher GP, Xiao -Hua Z, Hanna MP, et al. Preferences of physicians and their patients for end -of -life care.
In the clinical interview, the doctor often needs the skills of a trained interpreter, not just the help of a family member. With older patients, the need is to assess visual, auditory, vocal, and cognitive functions to determine whether there are factors that might be limiting effective communication and to devise aids and tactics to cope with such barriers. Making Use of Communication Technologies With modern information technologies (especially through the Internet), patients often access information on disease management and obtain mutual support online from disease -specific groups.
Rarely, there may be a conflict between a patient’s wishes and local statutes. For example, some states restrict the withdrawal of nutrition and hydration to terminally ill patients, which potentially prevents withdrawal from some patients, such as those in a persistent vegetative state. The patient should be informed whether such conflict exists. Conflicts related to differences in values between the patient and the physician should be discussed fully so that they can be resolved before problematic decisions arise.