Hospital Discharge as a Locus for Curiosity, Affirmation, and Advocacy.

Overview

Acknowledging the "dignity of risk" in hospital discharge planning requires a determination to work towards serious change in the livability and healthfulness of our communities, balanced with a positive affirmation of patients' resourcefulness and enmeshment in networks of coping and care. Unfortunately, when clinicians err single-mindedly towards either extreme, we can perpetuate harm, either by unwitting reenactment of structural power dynamics already present in patients' lives or by failures of curiosity that miss opportunities to uncover resources and supports. This article explores two clinical vignettes involving patient-doctor discordance over hospital discharge preferences in the context of patient risk. By shifting these scenarios away from principlist conflicts between the physician's duty to act beneficently and yet uphold patient autonomy-narratives which center the clinician as primary ethical agent-this article recenters the patient as chief protagonist undertaking the dignity of risk. Through conceptual explorations of structural competency, strengths-based approaches to individuals and communities, and the notion of abundance as a catalyst for imaginative redesign of health (in)equities as we currently find them, this article envisions patient "risk" as an activating state, one capable of inspiring the clinician to undertake a historically and socially informed, structure- and solution-oriented practice.