A team meeting has been convened to discuss discharge options for Jack. Dr. Edelman decided to ask Craig Stevens, the primary care provider, to attend. Jack and Penny will join them after the team has had a brief discussion. Linda Speakman, a social worker, is chairing the meeting.
Complexities of care of the elderly
This scene is similar to the last scene in “Communicating with adolescents,” and some of the exercises in that module apply here as well. You might want to review those exercises and see how they apply to this module.
A major difference between the two modules is that in “Communicating with adolescents,” the patient has more family support than Jack does. In addition, Jack will require substantial support services to be provided, and he will have to pay for some of them. Despite these factors, Jack insists on returning home.
Given that patient safety is the primary concern, and resources are limited, what other considerations play a role in discharge planning? Given the scarcity of resources for community health care, to what extent should the discharge team be influenced by issues of resource allocation? If this case were in your province or territory, what resources would be available for Jack? Readmission/failed discharge due to lack of support is another potential concern.
We encourage you to review the following resources which address the issue of leaving against medical advice:
- Alfandre, D.J. (2009). “I’m going home: Discharges against medical advice.” Mayo Clinic Proceedings 84(3): 255-260.
- Etchells, E., Sharpe, G., Dykeman, M.J., Meslin, E.M., and Singer, P.A. (1996). “Bioethics for clinicians: 4. Voluntariness.” Canadian Medical Association Journal 155(8): 1083-1086.
If you require further reading, we have prepared a PubMed search with additional resources.
Reflective exercise 4
The team was able to agree on a suitable discharge plan for Jack. For each person around the table, list the compromises they made to find a workable and mutually acceptable solution.