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Vital ConversationsImproving Communication Between Doctors and Patients$
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Dennis Rosen

Print publication date: 2014

Print ISBN-13: 9780231164443

Published to Columbia Scholarship Online: November 2015

DOI: 10.7312/columbia/9780231164443.001.0001

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One Size does Not Fit All

One Size does Not Fit All

(p.31) 2 One Size does Not Fit All
Vital Conversations

Dennis Rosen

Columbia University Press

This chapter assesses the advantages of tailoring medical care to meet the needs of the patient in accordance with his or her values and preferences, in real time as well as through advance planning. The process of negotiation between physician and patient allows the patient to mold the treatment that the physician proposes into something that conforms to his own belief system and values. It also forces the physician to acknowledge and address ahead of time concerns of his patient that might otherwise pose significant problems to his adherence to the treatment. In terms of end-of-life care, patients create advance-care directives to make rational and well-thought-out choices about their care. Conversations about end-of-life care decrease the use of aggressive treatments in the last thirty days of life, including hospitalization and intensive care-unit stays; thus, saving considerable expense to the health-care system and society.

Keywords:   medical care, physician-patient negotiation, end-of-life care, advance-care directives, aggressive treatments, health-care system

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