In the hospital, I struggle with having such important conversations without the explicit permission of an outpatient physician. On the oncology or cardiology services, patients often present quite sick, and it is useful for me to know a patient's goals of care in the moment. However, I often hesitate to delve too deeply because I don't know the patient's history, treatment options, and prior goals of care discussions. I have also had instances where an outpatient provider scolded me for discussing goals of care without talking to them first. What is the best way for me to keep a longitudinal provider involved? Should I wait to have "the conversation" before speaking to him or her?
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