Indexing Title : BCDEVEZA's Medical Anecdotal Report [05-06]
MAR Title : Making the Right Decision
Date of Medical Observation : June 2005
In a Physician-Patient relationship, the physician always has the last say. He/She decides what's best for the patient. But, as what is stated in the RIGHTS OF THE PATIENT, he/she can refuse the necessary treatment if one desires to.
In my tour of duty, I was caught in a situation where a patient ALMOST refused treatment. He was a 27 year old male who sustained a stab wound in the 4th intercostal space, midclavicular line, left. A good Samaritan brought him to our emergency room without any companion. We took his initial vital signs and were stable.IV line was inserted. Physical examination of the chest revealed decreased breath sounds on the left lung field. He was not dyspneic. I then requested for a chest x-ray which showed hemothorax on the left. I immediately referred this to my senior and we decided to do CTT. We informed the patient about this and he agreed, but we mentioned that we still need a written consent. He could not give this. As I was writing in the doctor's order sheet, I remembered that he was brought alone. From whom can we get the consent and how can we do the CTT without the materials. Unfortunately at that time, our stock of chest tubes were already used and were not yet replaced. Something has to be done so we can procure the chest tube. I searched for an identification and luckily I found one. I gave it to the security people and they were able to contact his wife. As we were waiting, we closely monitored him. After several hours, the wife arrived and I immediately asked her to buy the tube. As everything was being prepared, the wife approached me and asked,"Ma-aadmit po ba siya?Gaano ba kagrabe ang kondisyon niya?" And so I explained to her the present condition. While I was explaining, her husband interrupted us and said, "Ayaw kong magpa-admit at ayaw ko ng magpalagay ng tubo. Masyadong malayo dito at mahihirapan lang ang asawa ko. Lilipat na lang kami." The patient is actually from Antipolo and his concern was the travel his wife had to take when he is admitted. I explained to him the consequences if he decides not to have the chest tube and he would sign a waiver if he choose to transfer to another hospital. He was persistent with his decision.I referred this to my senior resident. He gave his explanation and said he will not allow him to transfer under such condition. We then left the couple to decide. After a while, the wife approached us and said, "Sige po doktor, payag na po siya." We proceeded to do the CTT and luckily, he survived.
Insights (Physical, Psychosocial, Ethical, Discovery, Stimulus, Reinforcements)
Making a decision is never easy, specially if it entails the life of a person. Several factors will come into play and in the end, you have to consider each and every one of them.
Decision making, on the part of the physician and on the part of the patient, will sometimes be tested.More often than not, it will create a conflict or contradiction because each one has his/her own concerns. There will always be some form of resistance on the part of the patient specially if one finds inconvenience to what the doctor is proposing. But, as good physicians, we should anticipate that things like this do happen in practice and it's just a matter of giving the right and truthful explanation for them to get the real picture. After all, doctors are here to save the life of patients, not to take it away from them. It all boils down in MAKING THE RIGHT DECISIONS.
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