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WoW! This is the most awkward of discussions I have encountered in a long time. We are charged with listening carefully, examining as necessary and diagnosing. Then explaining compassionately what needs to be done. We are given a privilege of power and must not abuse it. Patients depend on us to be honest and direct. We are powerful and must partner in a special way. The patient then remains in control of their destiny. We may or may not remain their partners, as is often the case in modern socialized medicine. [email protected]