A couple a things stick out here:
1. The pt. called the MD at home--why? Was their relationship personal as well as professional, was the MD 'off duty'?
2. The MD advised the pt. to go to the ER for proper treatment, and from a quick search I found even offered to meet her there. This implies that the MD was indeed 'off duty'...and makes me wonder where his liability is in simply explaining the possibilities. It seems this is a bit of a "good samaritan" situation, except that the pt. called the MD at home, the MD didn't just come across someone needing help.
3. Should the MD *NOT* have explained the possibilities at the ER? If he had been vague and said "they'll run some tests" would she have been too afraid to go due to the fear of the unknown?
As for the title of this post, "Nursing Protocol" I'm confused? As nurses we're often asked for medical advice, and if I, as a nurse, had a call from someone like this, I would have responded "Please call the ER/triage nurse at your local hospital" And to the question that is bound to follow "Do you think it's serious/what do you think is wrong with me" I'd reply I don't know, this is why you need to have the proper evaluation but a physcian qualified to interpret the test results and order appropriate treatment--but as your friend/neighbor/family member, I'll be happy to hold your hand while you get checked out."
This physician also recommended the pt. to seek appropriate treatment, and attempted to avoid treating her over the phone--although he did give her possibilities he did not have the ability to have her sign a form that said she was not going to follow his advice and was aware of the consequences.
Section 8.08 of the AMA Code of Medical Ethics addresses duty of disclosure: "The patient's right of self-decision can be effectively exercised only if the patient possesses enough information to enable an intelligent choice."
Balance this with the fact that she was asking the MD to treat her over the phone
and had she had gone in, with nothing worse than gas but had a full workup, she may have sued him for malpractice anyway!
Quote from J.R.theR.N2b
i just finished reading on the internet details on a court case, marsingill v. o'malley. some things were mentioned in the discourse that i would like some clarification on. a lady (marsingil) called her physician (o'malley) at home with complaints of nausea, bloat, abdominal pain, inability to burp, and constipation. dr. o'malley said he could not evaluate her over the phone, but if she felt bad enough to call him at home at night she should go the emergency room. she questioned the doctor as to what might happen at the er? doctor stated they would probably take x-rays and insert a nasogastric tube to relieve the pressure in her stomach. she had previously had nasogastric tube inserted, and on hearing she would likely receive this procedure again, ended the call, telling the doctor that she thought she could now burp and felt better and ended the call. patient's husband later found her unconscious on the floor and summoned ems. it was discovered that she experienced an intestinal blockage which caused her to go into shock, from which she suffered brain damage and partial paralysis. when her family filed a lawsuit, one of their expert witnesses testified the doctor's actions fell below the standard of care, stating that a competent physician who wanted to encourage a patient to seek emergency room treatment would not have offered the possibility of being treated with a painful procedure of inserting a nasogastric tube. i guess the crux of my question concerns E.R. ethics and protocols. what would have occurred in the emergency room when patient got there? if she refused insertion of nasogastric tube, they could not force her, is that not correct? i know there are certain instances in er protocol where patient is considered not competent to make medical decisions, and treatment could then be forced on her. would this be one of those times? are N.G. tubes really that awful? i decided to go ahead and ask this question as it really has very little to do with the lawsuit per se. thank you very much.