Doctoring poses so many challenges and sometimes can be quite sobering. Long considered the art of healing, medicine, has retained some of both characteristics (art and healing). Some argue that medicine has changed with its insistence on productivity, efficiency and accountability. We are called to provide care, crossing our eyes, (pun intended) and dotting our tee's, ensuring that forms are completed, protocols met, and watching out for litigious patients. We must be sincere, dedicated, courteous, educated, caring professional listeners and healers. The list goes on and on.
But, what happens when a patient refuses your recommendation, in the face of potential danger? What if the patient is a child, newborn? What if the parents are making a decision that could be self-serving for them, yet dangerous for their child? What if the parents feel that they should be the ultimate decision-makers? After all, that is their child.
One or two cases come to mind: A newborn who required admission overnight, basically for observation and the parents wanted a second opinion and another newborn whose mother was so adamant about her child not being admitted to the hospital. The latter required emergent surgery and the mother later felt grateful. The former's parents felt infringed upon despite multiple explanations about the possible risks for sending their newborn home.
So what do you do? How does one explain to a parent that a 24 hour inpatient observation would rule out potential dangers but discharging the pediatric patient home could be dangerous? What if you've spent ~ 5 hours explaining and the parents are still insistent on going home? Well, New York State law forbids parents from signing out their children from the emergency room against medical advice (ama). Meant to protect the minor child, some parents view this law as an infringement on their rights as parents. There are child protective laws and agencies that at least try to enforce these rules.
It is challenging, because one can understand a parent's right to seek care elsewhere and a second opinion. No, I am not rigid to the point of excluding parents' rights. I think the parents usually know best about their children. I don't believe in the adage, my way or the highway. Second opinions can be necessary.That is the parent's right, if the child does not have a current emergency. (Note: I use the word current here, although redundant, because emergency for some can be conditions that have been present for some time). Listening to parents is paramount in obtaining a diagnosis and providing care. Establishing a rapport is important, but an urgent care or emergency room setting doesn't really allow for "instant" bonding or relationship building. Remaining objective is key. I try to spend time, sitting and talking with parents and patients, explaining the diagnosis, treatment options and potential outcomes. Indeed it is sometimes challenging, often time-consuming, but necessary in many cases.
At the end of the day, isn't providing the best medical care one can and when necessary protecting the child what matters? Should the doctor or other healthcare provider abnegate this responsibility just to please the parents? The choice is obvious, is't it? Well...tell me what you think?
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