Constraints on hospitalists and surgeons and restricted orthopedic admission criteria can exacerbate patients’ distress that comes from clinicians’ disagreements.
AMA J Ethics. 2023;25(12):E873-877. doi:
10.1001/amajethics.2023.873.
Dr Peter Steen joins Ethics Talk to discuss his article, coauthored with Drs Nubia Chong, Maria Mirabela Bodic, Ludwing Salamanca, and Stephanie LeMelle: “What Should Students and Trainees Learn About Patient-Centered Documentation?”
The physician must help patients understand that all options—further testing, surgery, no action—carry risks and benefits. Disclosing the statistical probability of injury and other possible outcomes might help, but it can also hinder the process.
After assessing the reasons for a patient’s unrealistic hopefulness in the face of clear understanding, a clinician may believe that significant harm will come to the patient if he or she does not acknowledge the seriousness of the illness.
Requirements for informed consent are relatively vague and the exceptions are few, so it is in the physician’s best interest to inform patients about proposed treatment options, ascertain that they understand their choices, and secure their consent.
One strategy is to determine “triggers” that alert the primary clinician that the patient has a high symptom burden or difficulty coping with the diagnosis, prognosis, or treatment plans and should be offered palliative care services.
If a patient’s feelings become sources of resistance to treatment, clinicians need to know how to address these feelings’ influence on the therapeutic capacity of patient-clinician relationships.
AMA J Ethics. 2017;19(5):436-443. doi:
10.1001/journalofethics.2017.19.5.ecas3-1705.