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Perspectives |

Honoring Patients' Wishes for Less Health Care

Phillip Wickenden Bale, MD
Arch Intern Med. 2011;171(13):1200. doi:10.1001/archinternmed.2011.134.
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My patient was a 99-year-old nursing home resident with advanced dementia and very little awareness of her surroundings. She was well known to me, having been a resident in this nursing home for approximately 10 years. While making routine rounds at the nursing home, I was advised that she had developed some discoloration and skin breakdown of her feet. On examination it was obvious that she had developed gangrenous changes in both feet, an ominous sign in this elderly woman. I contacted her niece and nephew who served as co–powers of attorney and discussed treatment options with them. Recognizing the seriousness of the condition and that their aunt had enjoyed almost no quality of life for many years, we agreed that only supportive comfort measures should be implemented.

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Honoring Patients' Wishes for Less Health Care
Posted on July 12, 2011
James Gordon, MD
UW Medicine/Northwest Hospital
Conflict of Interest: None Declared
The issues raised by this always timely homily and the two accompanying short pieces underscores the danger in words and in the titles of publications. Patients never need or want less "care." Only when we stop using such language will patients and families understand that a change in treatment from lights and whistles to palliative care does not imply a reduction, but rather a consensual reorientation of care in keeping with appropriate goals. Editors and writers must stop drafting and publishing titles that seem to suggest otherwise. Words matter.

Conflict of Interest: None declared
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