Ethical dilemma at work?

[ok2bme]

I work psych, and at my facility pts may occasionally go off grounds. Upon return, we do a breathalyzer and UDS.

The doctor also ordered a pregnancy test upon return from a woman who is going on pass today. She is teeny tiny, but over the past month or she has started to look like she is pregnant. We have all noticed.

No one has said anything, as this woman is very self-conscious about her weight and has a h/o of anorexia. She is also quite defensive and labile.

The problem is that the doc verbally told the nurses to do the pregnancy test without telling the pt. Hence why he waited for us to do it with the UDS, she would not know that we are also submitted it for pregnancy.

If she is pregnant, we need to know asap. The meds she is on could potentially hurt the fetus, and she would need prenatal care.

But doing it without this woman's permission, consent, knowledge? I'm not comfortable with this.

What would you do? I'm quite nervous to go to work today...

Thanks to all who read and reply.

[Jolie, BSN]

In terms of functioning as a patient advocate, I'd probably want more information about why the physician felt it was necessary to conceal the test from the patient.

Bolding mine.

Thank you for summing this up very succintly.

[leslie :-D]

my initial thought, was identical to jolie's.

and i'm a bit appalled, that a physician would make this request.

folks who have psych issues, can have all the therapy and meds in the world...

which will do little good, if there is no trust.

what the physician is suggesting, is just downright deceitful.

and if this female pt finds out, then becomes suspicious of subsequent treaters, she'll be labeled as paranoid!!

agree, let the doc handle this one.

otherwise, i would much prefer to have a very sensitive 1:1 with this pt.

often, we tend to undermine their capacity, which only serves to further negate any potential recovery.

however it's dealt with, none of this sneaky crap.

leslie

[oryxandcake]

First and foremost you are to provide care for the patient. This means addressing her mental and sexual health. I understand that often sexual health is put on the side - but if she is having sex outside the facility - it should be part of the nursing assessment/education to know if she practicing safely.

Beyond that, like others have posted, trust is imperative. And if the psychiatrist is reluctant enough to put the burden on the nursing staff you should be suspicious!

Consult your policies and if that doesn't satisfy you, go to your head nurse. If that doesn't quell your concerns, ask your health authorities ethicist or practice leader.

I haven't been put in your shoes and understand it is different when you're an inpatient.. but you need to do what is right for the patient - and if you don't know if this is safe, it is better to investigate, then to go along with the status quo.

[Jolie, BSN]

The doc is not trting to "sneak" anyhting. We routinely do pregnancy tests on women in the ER without telling them. What is she is pregnant and she is getting the meds that could hurt the fetus. If the doc continues those meds and you continue to administer them thinking she may be pregnant and she is and the fetus is damaged becasue of it you are opening yourself up to a major lawsuit that you will not win. Better to know than not.

Kyrsha,

I respectfully disagree. This is not akin to a pregnancy test on an ER patient with whom you have no longstanding therapeutic relationship.

If the doc is concerned first and foremost with the possible effects of meds on a developing fetus, he would have taken the most expedicious route and requested a pregnancy test immediately upon developing his suspicions. By delaying testing for a number of days until it can be done in secret, the doc is revealing his motivation to be something other than concern for the fetus, and/or revealing his own shortcomings as a mental health practitioner.

In your scenario of a lawsuit, how does he defend his decision to delay a pregnancy test for several days when that delay puts the fetus at greater risk of injury from exposure to medications?

[canoehead, BSN, RN]

I would shy away from the situation because the doc is unwilling to write the order.

Has anyone been keeping track of her periods? Is she having periods? If she has an eating disorder she could very likely be irregular and periodic pregnancy tests would make sense considering the meds she is on. It's a simple matter to explain why the hospital has to do the test to cover itself legally, and you could even remind her of the hundreds of pregnancy tests (and live births, come to think of it,) that are done in ERs every day. Hundreds of those women swear they can't possibly be pregnant. Approach it as a legal/medical buttcovering for the hospital. and not a personal doubting of her word.