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January 19, 2000

The Hospitalist's Role in Advance-Care Directives—Reply

Author Affiliations

Phil B.FontanarosaMD, Deputy EditorIndividualAuthorMargaret A.WinkerMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Fishbein FellowIndividualAuthor

JAMA. 2000;283(3):336-337. doi:10-1001/pubs.JAMA-ISSN-0098-7484-283-3-jac90010

In Reply: The loss of information during the transition from outpatient care to the hospital creates ethical dilemmas for physicians and patients. As pointed out by Dr Brickner and Ms Drought, discussions about resuscitation status and end-of-life care are particularly susceptible to confusion. A readily available form that clearly documents a patient's wishes could help resolve ambiguities about the patient's goals for care.1 The preferred intensity of treatment form described by Brickner and Drought represents a creative approach. Such a document may encourage physicians and patients to discuss preferences for care and could guide the content of these conversations. Nonetheless, even a thorough and revealing discussion with a trusted primary care physician may not address an issue such as the massive pulmonary embolus experienced by the patient in our case.

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