Tuesday, 16 November 2010

Somewhere Inbetween

I'm going to ask you a few questions:

Can a doctor ever refuse to treat a patient?

Is it the same for a paramedic?

Can there ever be mitigating circumstances?

What would you do when your conscience tells you one thing, whilst the rules tell you another?

I'm going to ask you to read an article from a German news website. Not my normal reading, but it grabbed my attention via another site.

Then go back and have a look at an old blog post.

And then, once you've had a while to think about it, to come back and comment on what you think.

I'm not asking for judgement, just opinion. Right, wrong, or somewhere inbetween?

Finally - be honest: what would you have done if placed in such a dilemma?


Anonymous said...

Agree with your approach - be the bigger person!!

Fee said...

Tricky one. In my professional life I occasionally have to deal with customers I wouldn't otherwise choose to meet, but have to accept it as part of the job.

In the German case, it's an extreme example. I could witter on, but at the end of the day I have some sympathy for the doctor, while still feeling like his actions are at the top of a slippery slope.

So, to sum up, my behind is staying on this fence, thanks. No, it's not at all uncomfortable.

Pie said...

I think the German one is fair enough! He did not attempt to harm the patient, he just said honestly that he personally could not perform the surgery, and got another surgeon to do it. Had he tried to stop the patient getting surgery or caused harm in any way then there is a problem, but as it stands, he should not HAVE to treat someone who he is not comfortable treating. And I [like to] imagine that if it was an emergency situation and there was no one else, then he would have done what was required for the patient.

With the "new EMT" situation - brilliant! You were the bigger person. It makes me angry that people are so rude and racist, but you did absolutely the right thing, and hopefully put them in their places a bit at the same time :)

Anonymous said...

It's a bit of a conundrum. I think there will always be exceptional circumstances, but should you choose to refuse to treat a patient, you have to be ready to accept any criticism that you open yourself up to.
Personally, I think the way you handled the lady with the broken arm is the best way to do it, and some might say that embarrassing them in such a way speaks louder than a flat refusal to treat. Being the bigger person is what I would consider to be the right thing to do.

oneunder said...

The moral maze, love it.

The Dr was wrong.

I believe that there is a fine line we all have to walk every day. Do we treat people differently because they do not believe the same as we do?

On one occasion I was called to a hanging at a prison. On the way in I was informed that the patient was a rapist. To me rape is a form of torture. This raises the question do I attempt to save the life of a man who, in my eyes, has committed a crime worse than murder or do I just let him die? Easy, my job in this situation is to try to save a life.

Like every ambulance person I know I have been abused because of the colour of my skin, my gender, my perceived faith, perceived sexuality and the fact that I am wearing a uniform. Does this change the medical treatment my patient gets? No, I may not be as friendly to them as other patients but the medical treatment is based on their needs not their beliefs.

Having said that, I have thrown more than two patient off of an ambulance for abusing my crew mate based on faith and colour of skin. On both occasions they were informed before hand that if they continued their behaviour they would be thrown off.

Few patients will be remembered the next day but I have to live with me every day. I judge myself by my own morals not the morals of others.

Anonymous said...

The German doctor was completely in the wrong. As a doctor you have to treat the patient in front of you. Even if they were a Nazi war criminal (which this man wasn't) or a terrorist. And then you hope that the law deals with them appropriately. Yes, it can be difficult to put your feelings aside and if there is an option to then transfer their care then maybe you should do so to make sure that the care given is the best possible but bottom line is that you can't decide who to treat based on anything apart from their medical situation. Kol hakavod for your handling of the patient with the broken arm.

Matt_G said...

I'm half Jewish so have sympathy for the German doctor but I think he should have gone ahead. Wonder if he could have made the scar just a little bit Star of David shaped though?

Faking Patience said...

I don't think that you can refuse to treat your patient. I think your example of what you did with the two ladies is perfect, offer them treatment or refusal, and put the ball in their court, if they have a problem with you. I have had plenty of patient be rude to me because I am female, and they get the same level of care anyone else would get, but not any of the small talk, or anything else nice I usually do in the back with patients who are nice to me (asking if they are comfortable/ trying to make their ride more comfortable...).

Now, in some cases, I can see offering the patient another ambulance for transport, but it wouldn't come of the patient being rude to me. If the patient can't speak english, but we have someone working who is available who can speak their language, or we have a religious person who is only comfortable with someone of their own gender seeing/ touching them, then I can see offering another ambulance, if one is available.

Just Me said...

This is extremely difficult for me. As I was reading these posts, ugly memories were rearing their heads. If you would have asked me this question ten years ago I would have said the German Dr. was right and you were crazy. I would have lost my mind. Now though... It's different. I'm different. I think having to deal with so many different patients has shown me that we are all people when it comes down to it. When we take on a career in the medical field we choose to do our best for our patient, whoever that may be. I think the German Dr. should have finished the surgery and then maybe gone and had a follow-up visit with his patient. Perhaps it would have made his patient realize something? And for you, as a brand new EMT - I have nothing but respect for how you handled that situation. With class, and it taught them a lesson. Bravo.

L said...

If I was in a situation where I wasn't comfortable treating a patient but others around me had no problem with them I would stand back - even if I was better equipped to deal with the patient - in order to protect the guilty and the innocent.

If I know my treatment might not be up to scratch because of some kind of prejudice surely it is better for someone else to do their very best for that patient. Obviously in a life or death situation or if there was no one else there it's a no brainer that you would treat them - it's not our job to judge.

I would like to think that the German Dr worked on this basis - the story doesn't give the reasons behind having that tattoo and I would assume the Dr didn't know either. It could be innocent and if the Dr had continued he may have put an innocent man at risk by not acting to the best of his abilities. At the end of the day, that patient did not suffer (or at leas there is no evidence in the story to suggest he did), and neither did the Dr.

Surely it's a similar situation to some Drs not prescribing the contraceptive pill or not performing abortions? But that appears to be acceptable.

Your story tho, is direct abuse. I don't think I could have kept such a cool head but I would have liked to have seen their faces afterwards!

Pie said...

If the German doc wasn't 100% comfortable treating the patient and there were others who were, then I think it's better for everyone that he did what he did - transfer his care to a doctor who was more comfortable with the patient. I think that is giving the patient better treatment and I think that is providing a better workplace for the doctor!

It is, however, different in emergency situations, or if you are the ONLY ONE who can do a certain thing. And I like to think that the German doc would have performed the surgery had there been no one else available to take the patient.

Perfectly reasonable!

minimedic said...

"First, do no harm."

This article didn't explain the reasons behind the tattoo (there's a chance that the German wasn't a Nazi) or the urgency of the operation, but part of me wonders if the Jewish doctor felt that he couldn't provide objective medical care on someone who aligned themselves with a group responsbile for the systematic imprisonment and murder of six million Jews like him.

With this in mind, perhaps he transferred this patient's care to someone who he felt could provide more objective care?

I echo the responses of many others here, though: if you're the only one that can perform a procedure, then you should.

Your response to the racist, rude patient was perfect, by the by. Way to be the bigger man.

Paul said...

The Doctor was wrong. Turn the situation around, had it been the doctor refusing to treat the patient because they were Jewish it would automatically be considered unacceptable. That said, the Dr did ensure that the patient was treated, hopefully had no other Dr been available the original Dr may have reconsidered his position.

Racism is unacceptable. If someone wants to refuse treatment because of their views that is their own decision. Just don't waste further resources on pandering to it.

Sam said...

A couple of other commentators have already said basically what I think, but here's my $0.02.

In an emergency, or in a case where immediate medical action is required, I think that a medical professional has an obligation to provide that care. However, this is secondary to the professional's ability to provide that care, and in the case of the German doctor, I think that if he thought he would be unable to operate objectively then he did the right thing in handing over to someone else.

Similarly, from your story, if you had turned the patient over to your female colleague, I would have thought that was right too. In treating the patient as you did, I think you went beyond what you could reasonably be expected to do (and well done!)

At the end of the day, if you can't (or think you can't) provide the patient the best care possible, you should turn them over to someone else.

L said...

Paul, I think even if the situation were reversed and the patient was Jewish the Dr would be within his rights to hand over treatment to someone else (providing it's not an emergency, there is someone else to perform the procedure etc).

If he continued to treat that patient and there were complications or the patient died there would be a lot of questions. I think it would be far more traumatic for those involved in the treatment, the patient and the patient's family than a change of Dr.

Nicki said...

As an EMT in NY State, I have a duty to act and refusing to treat a patient no matter what can result in my certification being revoked and God-forbid, if the pt. suffers because I have not acted, then I will surely get sued and will lose. I do not know if the doctor has the same duty to act. I tend to believe that the docs can refuse any patient but I could be way wrong. It isn't a matter of what I think is ethically right or wrong. Legally, I don't know if the doc did anything wrong. He had another qualified physician finish the procedure. Additionally, the patient may have not received quality care if the doc had a real problem. I don't know if I could properly operate on someone if I had feelings as strong as this doc did in this case. I think it was in the patient's best interest to have a different doc operate on him.

By the way...awesome job with that call!!!!!!!!!!!!!!!!!!! I have had people tell me they don't want me to treat them. I reply that they can't pick and choose the ambulance crew just as I can't pick and choose my patients. But I would be happy to sign them off AMA if they refuse treatment.

Shell1972 said...

OK Medic refusing to treat NO WAY, that's what we sign up for , not to pick and chose but to treat everyone that calls us , regardless.
Dr. havin a reason to refuse treating a pt, maybe -maybe not , I tend to disagree with it but I suppose there could be some circumstances. However in this case they were already in the OR when the tat was discovered, regardless at that point then he should have continued. To walk out on a surgery already in progress, F**K NO !!!!!!!!!!!!!!!!!!!!! Not ever, unless he falls over of a MI or CVA or somethin extreme.

Anonymous said...

I had a sort of similar-in-reverse situation a few years back.
I am gay, my same sex partner listed as next of kin and was taken into hospital for an emergency but non-life threatening operation.
The Dr on call was of non-british origin, and on reading my notes, made a derogatory and what would be considered by most to be homophobic, racist and sexist comment about me and my illness in a not-english language. A language that I happen to understand, though not speak fluently. This made me feel extremely vulnerable and uncomfortable being in his care. I really did not know how to handle the situation. In the end I asked if perhaps a different surgeon could perform my surgery. I guess I was probably the one labelled as wrong, and I still don't know what would have been the best way to react.
Either whch way the care I received was fine, and I was on my way home a few days later.

Spook, RN said...

A friend likes to joke that "Even hookers get to say no - we don't have that option".

I've had a patient apologize profusely when we undressed him to hook him up to the heart monitor - he was covered in white supremacist tattoos and slogans.

He explained that he'd gotten them done when he was young, misguided and quite foolish.

He was nothing but nice and polite to me (non-caucasian), my pod partner RN(hispanic), my tech (korean) and the ER doc (Chinese).

People can - and do - change.