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A Broader Role for Advance Medical Planning

Muriel R. Gillick, MD
[+] Article, Author, and Disclosure Information

From Hebrew Rehabilitation Center for Aged, Beth Israel Hospital, and Harvard Medical School, Boston, Massachusetts. For the current author address, see end of text. Requests for Reprints: Muriel Gillick, MD, Department of Medical Administration, HRCA, 1200 Centre Street, Boston, MA 02131.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1995;123(8):621-624. doi:10.7326/0003-4819-123-8-199510150-00009
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Advance planning for future illness should be broadened from medical care in the event of incompetence to all medical care for the elderly. To plan effectively, patients need an assessment of their overall medical condition: whether they are robust, frail, demented, or dying. They need to understand the kinds of complications often engendered by aggressive treatment, given their underlying status. Given information about their circumstances and their capacity to withstand medical interventions, patients, together with their physicians, need to formulate broad goals for medical care. There are significant barriers to implementing this scheme, but pressure from patients, structural changes in the practice of medicine that create incentives for planning, and educational strategies, including videotaped interviews and role-playing exercises, can facilitate this form of preventive medicine.





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