Drs. Lipkin and Potter make useful suggestions for facilitating advance planning for possible patient incompetence. Dr. Lipkin emphasizes the importance of designating a proxy and suggests an informal method of doing so; Dr. Potter suggests that proxies may perform their surrogate function better if they have access to audiotaped conversations in which patient preferences were being discussed. My major argument, however, is that current approaches to advance planning are too restrictive because they center exclusively on discussions of life-sustaining treatment in the event of incompetence. Although this form of planning is important, I suggest that having previously discussed the overall direction of medical care is beneficial for competent patients who are faced with difficult medical decisions. My claim is that decision making, even by the most "decision-capable" patients, is likely to be inadequate unless the patients have a comprehensive understanding of their overall condition. It is not enough to understand the risks and benefits of alternative approaches to treatment in the absence of a context into which to place the specific decision. Unfortunately, a concise, problem-oriented medical record, updated and kept by patients, as Dr. Potter recommends, although admirable as a means of supplying information to physicians unfamiliar with the patient, is inadequate for this purpose. Simply listing diagnoses will not, in most cases, be sufficient to determine whether a person is frail or robust. Capturing an individual patient's true status—which has important implications for how well that person will withstand medical therapy—depends on functional status, on mental status, and on the severity of the particular diseases, not merely on diagnosis. Moreover, understanding the patient's overall medical status is merely the first step in the kind of advance planning I have in mind. The second step is to come to understand what treatment would be like for the patient, given his or her condition. The third step is for the patient to define broad goals for medical care, based on his or her interpretation of the personal meaning of the information learned in steps one and two.