When to speak up

As we were rounding this morning, the patient we saw was clearing getting quite agitated. He was suffering from an exacerbation of myasthenia gravis (MG), and to compound things he has a wife at home with muscular dystrophy. Unfortunately, as physicians, we often focus on the "important" things - items/diagnoses that will kill you. Then, we work on other more symptomatic relief. Yet this patient was not at all concerned about his muscle weakness or difficulty walking - he wanted, above all, to be able to eat! See, his MG had made it difficult for him to even swallow food, and at one point he was even choking on liquids. Despite our best intentions, he felt his concerns about not being able to eat was not being attended to - rather our focus on his over-all well being was clearly getting annoying to him. We figured that the diet could always be changed to accomodate his dysphagia, but for him - food was the main reason to live. In the end, we finally did get there - a compromise was made (no dietary restrictions given - he would choose himself which foods he thought he would be able to eat given his fluctuating severity of dysphagia), but for quite awhile as we stood in his room I felt like saying something - some to smooth the waters and try to act as an interpreter to get him to understand our perspective and vice versa. Instead, I bit my tongue. I didn't want to speak out as the attending was talking with the patient, and I also didn't want to appear to imply that the attending was not making a connection with the patient's true concerns. Sometimes, I get a feeling that they do it on purpose - they do not wish to address those concerns for a specific reason, perhaps because they feel it will steer the conversation towards a route they'd rather not explore or discuss. Othertimes, I think it's just plain mis-communication, often under the umbrella of traditional medicine. It's times like these that I have to consider - just how much of a patient advocate should I become? Do I jeopardize my own educational career to further this patient's interests? What about my own? In general, a happy patient is one who will increase your educational stature/grade/performance, but not if it comes at the cost of irritating an attending. What to do?