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Patient Advocate, where does one draw the line?

Posted Dec 23 2008 9:14pm
E mergency departments see a host of patients each and every day with a myriad of complaints, illnesses and injuries. Many are simple problems that are easily mitigated while others are a bit more complex. In the end patients come in, they get treated, and the get sent home with prescriptions, instructions for home care, and sometimes a referral for follow up with a specialist. When the follow up appointment the patient is to have with a specialist is a "bad" specialist should healthcare providers tell the patient to see someone else?

How many times have you heard healthcare providers and other patients say " I wouldn't let them touch me with a ten foot pole"? Perhaps a bad experience that a patient had with a particular provider, perhaps something a bit more. The issue is not so much a provider's "bedside" approach to patients but their level of competence. Surgeons that keep "nicking" the wrong thing in surgery, surgeons that operate on patients and most of them always seem to have infections afterwards or just don't do well, and providers that incorrectly treat patients or make the wrong diagnosis much of the time. We all have stories like these.

As healthcare providers do we tell our patients not to see other providers when we know we wouldn't see Dr. X or have concerns about their abilities? Do we have a professional obligation to advocate for the patient in this way? Do we keep our mouths shut and ignore things? What are the ethics here?

When nurses and physicians, especially nurses are discussing follow up care with patients should they steer a patient away from an incompetent provider? " You probably should have your surgery at this other hospital"..."I think you should get a second opinion"..."I would recommend this provider over that one", and other such statements or more blunt ones. Healthcare providers are supposed to act in the best interest of a patient, but at what point do we stop and draw the line?

This week the very issue fell into my lap. A patient who needed to have surgery was refereed to a surgeon who has questionable skills. Many of the ER staff physicians and nurses alike do not hold this surgeon in high regard. The patient was asking about the surgeon - what's he like? etc. In the end I told the patient to have surgery with another provider or go to another hospital. The patient was very appreciative. I mentioned my conversation to the ER physician and they said they don't usually tell patients not to see other providers. I asked the ER physician if they would let this surgeon take care of him, there was a pause. The ER physician turned and looked at me and said no. I asked the ER physician if he would let the surgeon in question take care of his family members, he said no. I said OK then.
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