REPLY
When To Discuss Advance Directives
Mark S. Litwin
15 March 1993 | Volume 118 Issue 6 | Pages 475-476
IN RESPONSE:
Dr. Neubauer correctly points out that a discussion of advance directives was omitted in the management of this patient [1]. Because the surgery was so minor, it was hard to imagine such untoward consequences and easy to overlook this important part of her care. This illustrates the need for such discussions, particularly with the elderly or the severely infirm, regardless of the simplicity of the planned intervention. In addition to approaching her family about an advance directive, we might also have attempted to discuss the issue with the patient herself. Despite her mild dementia and expressive dysphasia, she might have provided the most important guidance of all. We surgeons would do well to remember to talk to the patient.
1. Litwin MS. Ode to Joy. Ann Intern Med. 1992; 117:337.
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