From “I'm not staying!” to “I'm not leaving!”: ethics, communication, and empathy in complicated medical discharges

Approach to working with at-risk patients expressing a desire for discharge

“…This could include reviewing with the patient the purpose of the admission, associated treatment and overall goals of care, and risks associated with going home 1,2,8 ; working with Mr M. to understand what is most important to him, his reasons for wanting to go home, his concerns about ongoing support in the home, and his reluctance to modify his home for safety; and exploring ways to address his concerns and needs (eg, treating any substance use withdrawal, room change, day pass). [1][2][3][4]8,15,[22][23][24][29][30][31] This can help with navigating discharge options with the patient and inform revisions to his care plan so that having him stay during the discharge planning process is more agreeable to him (eg, incorporating goals and activities that are meaningful to the patient). 1,2,20,[22][23][24]29 Patient-centred communication strategies can assist physicians with having these sometimes challenging conversations.…”

“…[1][2][3][4]8,15,[22][23][24][29][30][31] This can help with navigating discharge options with the patient and inform revisions to his care plan so that having him stay during the discharge planning process is more agreeable to him (eg, incorporating goals and activities that are meaningful to the patient). 1,2,20,[22][23][24]29 Patient-centred communication strategies can assist physicians with having these sometimes challenging conversations. 12,19,20,29 It is important to look for family members or friends who can help reinforce the rationale for the recommended treatment plan and address the patient's concerns and needs (eg, care of a family member or pet).…”

Response to “Emerging Roles of Virtual Patients in the Age of AI”

“…21,22,23 Good practice in complex communication is therefore inseparable from the ethical practice of medicine. 24,25 Ethics and communication have both proven challenging to teach, however. 26,27,28,29 With its capacity for standardized presentation of materials, distributed learning across institutions, and fine-grained uniform assessment, AI-enabled VH simulation can help address the variability of current undergraduate and graduate ethics education.…”