Question: “My patient is refusing some appropriate medical care and services. How do I transition her to the next level of care?”

Story: Margine is a seventy-three-year-old woman with a history of breast cancer, which was known to have spread to her bones and thus be incurable when she received treatment five years ago. This resulted in a fracture of her left hip last year, requiring short-term nursing home placement. She has been living at home. She began intermittent vomiting a few weeks ago, and an outpatient upper gastrointestinal series showed gastritis and a mass outside the stomach, suspicious for malignancy. She refused CT scanning at that time, saying she was “too sick.”