tag:blogger.com,1999:blog-7326725956609171637.post65379389291042364..comments2024-03-01T00:43:24.860-08:00Comments on sick girl speaks!: Right to Refuse or a Ruse?Tiffanyhttp://www.blogger.com/profile/01295361245286822597noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-7326725956609171637.post-9095717173645691282008-10-22T21:21:00.000-07:002008-10-22T21:21:00.000-07:00There is an interesting dialog over on Medscape on...There is an interesting dialog over on Medscape on a similar topic about when it is OK to "do nothing" in medicine. <BR/>http://medscape.typepad.com/thedifferential/2008/10/is-doing-nothin.htmlMidlife Midwifehttps://www.blogger.com/profile/03405697747288370189noreply@blogger.comtag:blogger.com,1999:blog-7326725956609171637.post-31645404111093018452008-10-17T21:38:00.000-07:002008-10-17T21:38:00.000-07:00those terms are filled with a whole lotta red tape...those terms are filled with a whole lotta red tape and unnecessary bureaucracy in my opinion because it's as if you're damned if you do and damned if you don't. Ugh!Genevievehttps://www.blogger.com/profile/03224168980608089968noreply@blogger.comtag:blogger.com,1999:blog-7326725956609171637.post-5950948189933809142008-10-10T18:28:00.000-07:002008-10-10T18:28:00.000-07:00I think part of the problem is a good definition o...I think part of the problem is a good definition of "non-compliant". Is that the end stage cancer patient who declines experimental treatment? Or is that the overweight, heavy smoker, diabetic who refuses to make any lifestyle changes and to take their medications as prescribed? What about the patient who doesn't take their medications as prescribed because they can't afford them? <BR/><BR/>I always write "patient declines" rather than patient refuses. You bet I chart that a patient has been adequately counseled on the benefits of a certain medical treatment, but I am always very careful that I don't state the patient is non-compliant if they chose not to do that treatment. <BR/><BR/>It does get tricky. If crap happens (yes, a very technical medical term) there are people who will sue for malpractice, even though they were the ones who didn't follow medical advice. Unfortunately, that makes it horrible for all the rest of us, patients and doctors alike. Many providers will write "non-compliant" to cover themselves if something does go wrong. <BR/><BR/>And I have to admit, it is very frustrating when you have those patients who come in with health issues, you spend your time counseling them, getting all the prior authorization, scheduling follow up appointments, and then have that patient blow you off, no show, and don't take the medicine as prescribed. Then they come back as an emergency appointment because they feel terrible and want you to immediately fix it for them. <BR/><BR/>Personally, I don't have a problem with a patient who tells me they have weighed the options and tell me they chose not to do something. I do have a problem with the scenario above. If you have no intention of following through on medical care, tell me. Then we can discuss what you are willing to do. But if you aren't willing to even think about anything I suggest, why come to me in the first place? <BR/><BR/>From a patient perspective I have backed up family members who chose not to pursue further treatment. I have chosen myself not to accept treatment. I've helped family members decline all medical care other than palliative care at the end of life. Yes, you can get a lot of grief from providers, friends and family members for making those decisions. <BR/><BR/>In a perfect world, we would all take responsibility for our own decisions. If I chose to refuse something, I am accepting the consequences. If I chose to accept care, I also chose to accept the consequences. Unfortunately many people want the right to choose but don't want to accept the consequences. That goes for both patients and providers. <BR/><BR/>I don't know the answers to this puzzling problem. Better definitions, better counseling of providers in ethical decision making, avoiding labels, patients who are more honest about why they don't follow through, more acceptance of responsibility, tort reform for malpractice? Maybe a combination of all of the above.Midlife Midwifehttps://www.blogger.com/profile/03405697747288370189noreply@blogger.com