What do I say to a patient who refuses to bring their spouse? You escalate your reasons, calmly, one at a time. The first reason is simple honesty. This is going to be a complex discussion, and the best way for everyone to understand the problems and the solutions is to sit down together on the same day. If that does not land, get blunt and financial. Tell them this is a significant decision and it is good that anyone affected by it is present. For the rare hard holdout, I use an analogy. Would you buy a house, or go [...]