That 2x2 table is only a portion of how good decisions are made. A patient may desire a therapy (e.g., dialysis) because, well, that's what you do when your kidneys fail. A physician may recommend a therapy (e.g., dialysis) because, well, that's what you do when someone's kidneys fail. But both have totally overlooked whether those prefe…
That 2x2 table is only a portion of how good decisions are made. A patient may desire a therapy (e.g., dialysis) because, well, that's what you do when your kidneys fail. A physician may recommend a therapy (e.g., dialysis) because, well, that's what you do when someone's kidneys fail. But both have totally overlooked whether those preferences link up with any meaningful goal for the patient.
Very often in my palliative care practice people tell me, "Of course I want to live!" Yes, and with what trade-offs are you willing to pursue that goal? You allude to it a bit in that conversation about the statin being well-tolerated. If it weren't well-tolerated, presumably that would be a more involved conversation. That conversation would be a negotiation of the trade-offs in pursuit of a particular value or goal. But when you substitute a preference for a value, chaos ensues. People start ordering medical care piecemeal, instead of as a care plan in pursuit of a goal.
That 2x2 table is only a portion of how good decisions are made. A patient may desire a therapy (e.g., dialysis) because, well, that's what you do when your kidneys fail. A physician may recommend a therapy (e.g., dialysis) because, well, that's what you do when someone's kidneys fail. But both have totally overlooked whether those preferences link up with any meaningful goal for the patient.
Very often in my palliative care practice people tell me, "Of course I want to live!" Yes, and with what trade-offs are you willing to pursue that goal? You allude to it a bit in that conversation about the statin being well-tolerated. If it weren't well-tolerated, presumably that would be a more involved conversation. That conversation would be a negotiation of the trade-offs in pursuit of a particular value or goal. But when you substitute a preference for a value, chaos ensues. People start ordering medical care piecemeal, instead of as a care plan in pursuit of a goal.