Tuesday, August 2, 2011

Communicating to physicians goals of care

Goals of care worksheet.

In geriatrics, there are so many issues to consider before deciding what is best for a patient. Nothing is more important than the goals that a patient defines for himself. While the effectiveness of treatments change as a person ages, and social situations and other medical problems can affect what is best, achieving a patient's goals should be the primary aim of a medical plan. The goals may vary based on what type of medical interventions a patient can tolerate, whether they want to live longer vs more comfortably.

The link is to a worksheet that I wrote that I hope will help people communicate goals to their physicians. The concern is that physicians can look at an older person and make two really wrong assumptions: that a older person is too old for certain interventions or that they should be treated like a 45 year old. Neither is right. A person should receive a treatment that is appropriate and that largely depends on what they want and their goals.

Two things missing that have been suggested: spiritual beliefs and some sort of question about where a person, ideally, would like to spend their last days.