The Patient as a Customer and the Customer is Always Right?
Submitted by GPH on Tue, 2010-03-09 12:00
As a physician you have to be sympathetic and understanding. You also have to be respectful to the patient. A lot has been written about doctors’ responsibilities as healthcare providers and about patient’s rights as healthcare consumers.
What about patient’s responsibilities? Do they have any?
What do you do when the patient is being openly disrespectful and unreasonable?
You are supposed to take the “high road”, yet how much abuse should you take?
My patient was admitted with severe respiratory failure and ended up on mechanical ventilation. Subsequently, the patient developed pneumothorax (air in the chest) and extensive SQ emphysema (air under the skin). Later, the respiratory status improved and mechanical ventilation was discontinued. The chest tube remained in place due to a persistent air-leak (air escaping through the chest tube).
The patient was upset about the fact that the chest tube was still in and there was a facial "change".
SQ emphysema may temporarily change facial features due to swelling and air under the skin. Once the air is resorbed (days to a couple of weeks) the facial features return to normal.
Now, what do you do if you are being yelled at for providing treatment that is appropriate in the situation, even though, it does not fit with the patient’s plans (going home in this case)?
I explained, once again, why the chest tube cannot come out now and, when the patient went on a yelling rampage again, so I left the room. Right or not, sometimes, you have to have some respect for yourself.
Mon, 2010-12-13 12:36
#2
Thank you very much for your comments. Sometimes, you simple have to take a deep breath and keep going since losing patience even with the most disrespectful and obnoxious patient in not an option.
In the hindsight, taking the high road and acting in the patient’s best interests is the only path we can take.
I recently researched medical ethics and the laws of informed consent for an English research paper. As I understand it, the provider has the responsibility of informing the patient of all information relating to their condition as well as treatment options. The average adult and cognizant patient is responsible for choosing their preferred treatment option. The doctor is right in making appropriate suggestions based on medical knowledge, but it is inappropriate to proceed with treatment without the consent of the patient.
In that case it is important to be empathetic to the patient’s needs. It is critical to exercise patience in explaining the function and purpose of the chest tube. It is also appropriate to comfort the patient, by reassuring them that the change/reaction to the treatment is normal and their state will return to normal. The distress could have affected the patient’s sense of comfort.
In the worst case, as a doctor, you have to take out the chest tube and let the patient go home. If they become unstable, experience respiratory failure again, and become incapacitated, then you become the medical authority and you do what you have to do to save their life; which is probably insert the chest tube, again.
Although it may be frustrating you must always exercise appropriate medical care, with consideration to the needs of the patient.