Decision making, responsibility, and advocacy in geriatric medicine: physician dilemmas with elderly in the community.

This descriptive anthropological study explores the nature of physician decision making in the case of old people who reside in the community. Focusing on physician narratives of actual dilemmas, this article contributes toward a phenomenology of clinical medicine and provides examples of how decisions in geriatrics are influenced by professional values, institutional constraints, and cultural forms. In-depth interviews with 40 physicians revealed dilemmas to have three sources: (1) unresolved questions about how much to intervene in patients' lives to reduce risk; (2) structural, moral, and medical limits to patient advocacy; and (3) the problem of assessing vulnerability and quality of life when pondering placement.