October 11, 2006

Denying care

Posted in Iramville at 12:28 am by Iram

There are two things that I can think of that must be amazingly frustrating for physicians: one would be an unsuccessful treatment that results in poor health or even death, and the other would be a patient that denies care. Today, I had a run-on with the latter. A 74-year-old man came in to the neurology clinic, where I was doing my second round of clinicals today, and announced that he had ceased taking all medication because he did not want to deal with the nausea anymore. He would much rather let his disease take its course, and he had already made all the arrangements to have his children take charge of his property and his life decisions. It was very sad for me to watch because although there are plenty of drugs out there that he has yet to try he was unwilling to even consider anything that listed nausea as a side effect, which is just about every drug currently manufactured. In addition he already is unable to live alone and without any medication his health will probably decline. Thus, he will no longer be able to live in the comfort of his own home and will soon have to be placed in a managed care home to ensure that he has a constant caregiver.

It was a very difficult situation to deal with because as a logical individual (and an economics major), I always feel that I can make a list of costs and a list of benefits and logically figure out what decision to make based on the contents of these two lists. But when patients come in and tell you of such decisions you have to fully respect their right to autonomy and their prerogative to do as they wish with their health, even though their reasoning may not even fit into one of the categories on the cost benefit analysis chart. With my personality in particular I had an even more difficult time watching this whole interaction between the patient and the physician with whom I was doing rounds because I am a very solution oriented individual. When I am told of a problem, I like to hear all of the details and then I will immediately go into problem solving mode to see what needs to be done to make everything better. When I’m not allowed to go into problem solving mode, though, I get frustrated because it feels like there is something that I can do to make somebody’s life better and I’m not being allowed to do it. I understand that patients have the right to make their own health decisions, and would certainly like to make sure that my own physicians respect my right to autonomy, but I wish sometimes that patients could realize how we feel about their decisions after all of the dedication and effort we put into taking care of them.

1 Comment »

  1. Atif said,

    Well, the thing is the patients are entitled to make their own decisions. As doctors or healthcare professionals, you can only do much, and even though, rationally, it may seem that he could live longer if he took the medication and that HAS to be a good thing, if he wants to enjoy whatever of his life he has, there’s not a thing you can do about it. I’m sure he does appreciate all you’ve done for him though – he’d be stupid not to. Anyone who’s been to a doctor knows that the doctor does have their best interests at heart (especially cardiac surgeons – badum-psh!).

    Now the real questions that comes into play is when you have a child, and the parents refuse a treatment that could potentially save the child’s life. IMHO, thats a much bigger concern. This guy had lived his life, enjoyed himself, and made the choice on his own terms – but for a child someone else makes the choice whether or not they live or die.

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