Caring for the elderly imposes financial burdens and strains families. System changes are necessary to mitigate these problems.

Respecting patient autonomy—a cornerstone of professional duty—is not always easily accomplished when managing care for the elderly.

Inquire about the patient’s current living situation. Ask about feelings of neglect or abuse and look for signs (e.g., weight loss, contusions, pressure sores, or poor hygiene) that might indicate an unsafe home environment.

Physicians have a professional obligation and, in many states, a legal duty to report drivers whose functional or cognitive impairments may pose a safety hazard.

There are nonpharmacological approaches to managing behavioral and psychological symptoms of dementia and the difficulties associated with evaluating and implementing these approaches.

Physicians have an obligation to consider a patient’s quality of life when making treatment decisions and should consider giving patients the options of withholding or withdrawing aggressive treatment if that treatment will not restore the kind of life the patient finds meaningful.

U.S. physicians have a duty to treat patients who receive organ transplants abroad and many believe that there are ways to reduce the shortage of organs for transplant in the U.S.

When medical errors have occurred, physicians at different levels of training face various pressures imposed by the culture and hierarchy of medicine, risk management, and malpractice liability systems. Despite these pressures, the preferred course of action, professionally and ethically, is to disclose mistakes to patients.

Health care engineering, if applied to medicine, can transform the health care system for the better.

Learn about the development of the systems for delivery and reimbursement of health care in the U.S. from the unregulated free-market state in 1908 to the complex, highly managed state in which it exists in 2008.