Guidelines for proceeding with a plan of care when family members have conflicting opinions about the patient’s wishes and the patient does not speak the same language as her physicians.
The current Medicare operation—reimbursing medical goods and services to a growing number of people without basing the reimbursement benefit on the actual cost of the services—is unsustainable, but there are some possible remedies.
Physicians should recognize that patients’ beliefs may cause them to have non-medical explanations for their illnesses and that shared explanations should be negotiated if treatment plans are to be successful.
Physicians should demonstrate compassion when the parent of an ill child asks the physician for his or her personal opinion regarding the parents' choice to continue experimental treatment when the prognosis is not good.
Physicians who treat children with Down's syndrome should ensure that their parents fully understand the children's capabilities and long-term prognosis and counsel them on the appropriate actions to take regarding their children's care.