Discussing patients condition /prognosis

[undecided]

I am a student in Nuc med tech. Since there is no forum for nuc med, I enjoy reading the nursing forum.

My question is , are you allowed to discuss the patient's condition/ prognosis with them? I ask this because as nuc med tech's , we are not allowed to disclose any information. When a patient comes in for a test, I ask them if they know why thier doctor ordered this particular test. If they do not know why, we are not allowed to tell them. There was an inpatient yesterday who was asking the tech why her doctor ordered a cardiac stress test when she was admitted for an unrelated condition. Of course, the answers are in the patient's chart but we are not allowed to discuss it with them. It put the tech in a very awkward position.

There was a patient who came in for a thryoid scan. She claimed to have no history of thryoid disease. She looked like she had a goiter. I asked one of the techs if that is what a goiter looked like and she told me I was not allowed to ask that in front of the patient. ( I whispered it to her on the side and I am sure the patient did not hear).

Another 90 yr old patient came in for a bone scan to rule out mets. He had a history of prostate cancer. He was treated with an implant. When questioned and asked directly if he had any history of cancer, he said no. He

was under the impression that the bone scan was routine. Apparently , his physican never told him he has cancer or was treated for it.

I have to be very careful now what I say to patients. Obviously, I cannot tell them what thier test show or rules out. I would not feel qualified to do that at this point and I would not want the liability. Still, someone should at least tell them why the test is being done. In most cases , they are somewhat aware of thier condition. At least if the doctor has bothered to come in and discuss it with them. I can only give them a very general overview of what the test involves. It puts me in an awkward position .

[sarita279]

I'm surprised no one has responded to your post yet....so I will! I'm used to having most of my posts ignored anyways.

I found your question very relevant to myself. I am a student and I have felt awkward a couple of times telling patients about their conditions. They say that no one told them, or they didn't know etc. I feel like I shouldn't be the one to tell them these things. However, I also wonder if the doctor has explained the condition and/or surgery but the patient is just not retaining the information. Especially when they are so sick.

But I really don't know what the appropriate answer is. I don't want to just pass the buck and say "you have to talk to your doctor about it." If the patient is asking, I think its a great moment to teach them something. If I have the information, how should I pass it on without overstepping my bounds? Am I overstepping my bounds as a nurse if I am telling the patient a medical fact about their condition?

Thanks for any input!

[Jayla]

As a nurse, I feel like education is a huge part of my role. I feel that if the provider has explained something to a pt, but not in a way a pt can understand, OR the pt needs further reinforcement of the information, then this is within the scope of my duties.

However, if the provider has not explained why a pt is being sent for a test, that doesn't seem like something that is or should be my responsibility or within my scope of practice. It sounds like really poor communication on the part of the provider--unless of course, the pt just didn't understand.

If the provider is in the facility with you, can you ask them if it's appropriate to discuss the need for the test with the pt? From the pt's perspective, I wouldn't want a test unless I knew what it was for!

[PamUK]

If a patient asks a question, it is usually because they want an answer. I discuss disease/prognosis/tests with patients and as a nurse, I have a right to do so & have never run into any problems. I am very experienced though and am usually able to answer all of the patient's questions. And I often know more than the junior doctors (I live in the UK & we have a different system)

I work in a cancer centre and we often have relatives asking us not to give the diagnosis/prognosis to the patients. Fortunately, it is a forward thinking hospital, and none of us, including the doctors, will get into that situation. We always discuss difficult situations with the patients first, and if they choose, a relative. But it is very much the patient's choice. If a patient asks me directly, or even indirectly if they are going to die or what their prognosis is, I tell them and if I don't know, I bloody well find out! I feel privileged if a patient asks me these kinds of questions... shows they trust me.

Patients will often ask you what is going on or deny being given info, just to see if you give them more, or different, info than they have already been given. I don't think they are trying to catch you out... just that they think that maybe someone is withholding information.

Who said you are not allowed to disclose any information? Is it simply because you are a student, which I can understand. Are the qualified staff allowed too?

[bellehill, RN]

If my pt is being sent for a test and they don't know why I will tell them. Our doctors round very early in the morning, not a good time for the pt to retain info. If they are waiting on test results or are going to hear a new diagnosis (cancer, pneumonia, need for surgery...) I wait for the doc to tell them. I have no problem calling our residents at night when the patient has some questions that I don't feel comfortable about answering and they will usually come over and talk to them. I also round with the residents on my patients so I can hear what they are told and make sure they ask all the questions they had during the night.