The patient's apartment is full of books. A whole shelf is devoted to Virginia Woolf. I ask which novel she likes the best and am surprised when she says The Waves, a lyrical book of sensation and consciousness, with hardly a narrative at all. This, I think, is the way to live at ninety‐five.She tells me she wants to die. She can see how things are likely to go. She will fall one morning, and paramedics will be summoned to pick (...) her up. Caregivers will be invited into her home. The pain in her knees and back will worsen. Disability is coming, it cannot be avoided, she says, and it would be better if her life were now simply to cease.I struggle to find a name for this state of thinking. A senior geriatrician in my department tells me that she sees elderly patients like mine all the time. What word does she use for these men and women, I ask? (shrink)

When ethics committees are consulted about patients who have or need court-appointed guardians, they lack empirical evidence about several common issues, including the relationship between guardianship and prolonged, potentially medically unnecessary hospitalizations for patients. To provide information about this issue, we conducted quantitative and qualitative analyses using a retrospective cohort from Veterans Healthcare Administration. To examine the relationship between guardianship appointment and hospital length of stay, we first compared 116 persons hospitalized prior to guardianship appointment to a comparison group (n (...) = 348) 3:1 matched for age, diagnosis, date of admission, and comorbidity. We then compared 91 persons hospitalized in the year following guardianship appointment to a second matched comparison group (n = 273). Mean length of stay was 30.75 days (SD = 46.70) amongst those admitted prior to guardianship, which was higher than the comparison group (M = 7.74, SD = 9.71, F = 20.75, p. (shrink)

Historians of medicine generally credit the hospital standardization movement of the early 20th century with establishing the record as a sign of hospital and staff quality. The medical record's role had already been the subject of intense interest at the New York Hospital several decades before, however. In the 1880s malpractice and insurance concerns caused the administration to attempt to supervise record creation, quality, and access, over the objections of physicians. Contemporary concerns about the uses of the medical record were (...) in play well before 1910. (shrink)

Medical records contain important clues about the history of medicine. These documents, which ostensibly describe the course of a patient's illness, are “unique constructions that allow us to observe the social and technical structure of contemporary healing.” As such, the 21st-century hospital medical record reflects the many components of inpatient care: medical interventions, billing, legal documentation, research, and education. It is comprised of a wide array of elements: professionals' notes; vital signs and other descriptive information; laboratory data and test results; (...) demographic information; orders, charges, diagnostic and treatment codes; and other utilization data. It is well understood that many people share and need this information. Current controversies over records involve not control, but computerization, security, and accessibility. Although health professionals offer input, decisions about hospital medical records have been considered largely an administrative responsibility. (shrink)