Patient A comes in for elective surgery (TAH BSO) and is in pre-op. Anesthesiologist sees patient and does the normal pre-anesthesia talk. Patient refuses Versed, is willing to have anything else instead, but refuses Versed verbally as well as writing this refusal on the consent form. Anesthesiologist says ok, fine. Anesthesiologist comes back with the pre-op sedative and injects it into IV. Patient starts to calm down a bit, and then asks the Anesthesiologist (who is wheeling her off to the OR) What was the drug she was given, A-man answers Midazolam, very quickly, mumbling. Patient is heard saying, "But, but, but" then she's out.
Is this legal? Is this ethical? Is it a patient's right to refuse a particular drug? I always thought that it was.....
I think that this goes back to patient choice. I chose NOT to be incapacitated and I chose NOT to have the surgery if the block and pain meds was unsuccessful. I was very clear about it! To have the CRNA decide unilaterally to negate my choice is somewhat like rape. I said no. I and others feel violated when our choices are disregarded. There has been a great deal of talk about how arrogant the CRNA's can be, and mine is an example of how that works. The CRNA says that he knows what is best for his patients and apparently nothing can dissuade him. I don't think that this is how you would like to be treated, is it? I am sorry that disagreeing with a course of treatment causes some to think that the patient must have a mental problem. It is simply a matter of respect.
I completely agree it's wrong, but I'm just curious...what's the patient going to do, sue? For what? Psychological damages? I thought you don't have a malpractice case unless you can first demonstrate injury...?
It is not a matter of respect but a matter of the lack of patient education. Patients who are armed with a little knowledge and place extreme and offensive constraints on their professional CRNA are fools. So many conditions were placed on the poor CRNA that if it were me, I would have told the patient to take a hike or find someone else to placate their neuroses. The unpredictability of patient responses, changes in surgical conditions, and untoward reactions to medications should always insure the CRNA has a way to best serve the interests of the patient and surgeon without patient preconceived (and somewhat bizarre) ideations about what constitutes their God given right to have whatever they please. Axillary blocks do not always work throughout an entire surgery and may not stop tourniquet pain, leaving the fool patient screaming due to the tourniquet. But if "pain medications only" (whatever that means) can be given, the patient in such a situation would find themselves being given more and more narcotic until they were effectively receiving a general anesthetic.
Yes Virginia, there is a Santa Claus, and sometimes Santa can be your best friend when allowed to do their job as a professional. Those patients that attempt to handcuff their CRNAs with outlandish and naive self-predetermined anesthetic plans (especially when they themselves are not a CRNA or MDA) probably should try another country for their medical care. The arrogant and ill-conceived attitudes of patients that want to direct every aspect of their health care are simply foolish. I would suggest a pharmacy student that can diagnose their own fracture as being adequately set could surely take a Percocet, then use their home Black and Decker drill to pin the fracture. You really don't need the medical profession.
In reference to an absent anesthesia provider when a straight local is preferred by the patient and there is no reason the procedure cannot be done in this fashion...so much the better. However, in some institutions the policy may state that anesthesia must be in attendance regardless of the type of "anesthesia" given. I think in many ways this is in place for the convenience of the OR staff. A circulating nurse cannot help keep the patient still or speak words of encouragement and get the surgeon and the scrub techs what they need all at the same time. It can get a little hairy. In my opinion...what makes it hairy depends on which surgeon it is
The OR is a tough environment and it's getting tougher everyday. I agree with pain doc on his/er comments on patients trying to plan their care without having all the relevant information to make those kinds of decisions. The key phrase is "Informed Consent". This could mean anything to anyone. People have their own definitions of what that means...including health care providers and the definitions keep changing depending on the convenience factors at hand. I would suspect it to be entirely possible that the afore mentioned "arrogant CRNA" was acting on expediency as we all try to do in the OR. What Mr. SetHisOwnFx doesn't realize is that the CRNA knows the surgeon he is working with is like. In a way to sedate the pt is to sedate the surgeon! These guys get VERY cranky if the pt starts moving and writhing about on that very narrow OR table to the point that the surgeon cannot possibly put that screw or pin exactly where it needs to go for the best outcome for the pt. When I have a pt like Mr. SetHisOwn...I recognize quickly what I am dealing with...a person who has done some homework, read the books and is now convinced of everything he believes. While I applaud pts who educate themselves, which is an increasingly good idea, I must point out that no amount of self education can accurately give you the whole picture...the reason being...you have no actual flying time in the OR...we spend hours in there..we see it all...the unexpected ALWAYS happens...so while we try to respect the wishes of our patients when possible it is VITALLY important to realize there is a vast difference between being 'involved' in your own care and being RESPONSIBLY involved. My dear Mr Fix it...be educated...but for heaven's sake be wise with your knowledge...do NOT fight the people who are trying to help you. They really do know more than you do. There is nothing wrong with discussing options, however be very careful about trying to take control where you have no experience in good plans gone bad. You know what they say...He who tries to be his own counsel in a court of law has a fool for a client..well...I don't believe you to be a fool..but, perhaps a little foolish. Generally someone like you I would try to be very patient with and explain some of the realities that most people who come for surgery do not know and are not emphasized well enough in educational forums. Be Blessed and Be Careful...Good Wishes for the future...and Happy New Year!
sis...surgical awareness is on the increase...maybe because versed is being refused..I don't know..but I do know that where I am Versed is the DOC. For anesthesia providers it is heavily relied upon. I think anesthesia has become somewhat Versed dependent themselves...lol. They are very comfortable using the drug, it appears to be a drug of convenience because of its properties...it is just a great drug to accomplish thier objective of anesthesia plans.
StikTie and paindoc very well said. I simply could not be bothered to take the time to write what you guys explained to neveragain. The anesthetic plan can change rapidly depending on what is going on especially after incision. Here you have a person who is in pharmacy school, who is now applying to nursing school as stated in his/her post above who is trying to dictate the anesthetic plan. What gives? One cannot be a jack of all trades! If I have to do a MAC on a pt and the pt refuses to acknowledge that should the need arise i may have to convert to a general then simply put they can do their own anesthesia since they know better me what is needed.
This is comparable to Jehovah's Witness's refusal of blood, what's next?...it would have to be legal refusal forms for certain medications. Scientologists for example, would refuse benzodiazepines, (remember they are not neccessary). But they also refuse music in the OR!!??? gotta draw the line somewhere man!!!!!!!
Boy I wish the CRNA HAD told me to take a hike! I would have been more than happy to sign out AMA! I expected to be allowed to do so... I would have been a lot better off without his ministrations. By the example of the aggressive posts on this subject, I believe there is a problem, and the problem is not mine. I am merely stating that I own this body and I don't care how much education you may or may not have, you are not me. I shouldn't have to be a paindoc in order to have some say so in my own treatment. I am astonished that a patient who objects to Versed being stealthily administered can create such animosity. Now I know why my own CRNA was so bad. He obviously felt that he was vastly superior to his patients and having a patient set bounderies made him ANGRY! FYI most of my nurse friends will not allow Versed to be used on them.
Thank you all very much for an enlightening look at medical professional thinking. I was hoping that the problem I had was not a pervasive one. Perhaps I am missing the whole point of "informed consent." From a patient's point of view it means that the patient gets to decide what procedures, if any, the medical professionals get to do! When I get back to work I will look into it. Perhaps stronger legislation is in order. One does not need to have a complete medical education to decide what treatment is acceptable. The information to make this decision is a required part of "informed consent." That's the law, here at least. I had no idea there was such a deep resentment of this. Like I said, it's been very illuminating... Thanks again.
FYI most of my nurse friends will not allow Versed to be used on them.
Huh? Why not? I give Versed all the time for conscious sedation, also, most of my vented pts are on Versed gtts. If I need some sort of sedation in the future then I'm all for it. Bring it on! I've never heard of any "nurse-friends" refusing this med. Weird!
So which is it? Pharmacy or Nursing school? Or are you in both...? :uhoh21:
I queried 13 nurses yesterday and asked if they would allow versed to be used on them....all said yes except for one, who said only if the videotape were turned off :-)
neveragain
40 Posts
I think that this goes back to patient choice. I chose NOT to be incapacitated and I chose NOT to have the surgery if the block and pain meds was unsuccessful. I was very clear about it! To have the CRNA decide unilaterally to negate my choice is somewhat like rape. I said no. I and others feel violated when our choices are disregarded. There has been a great deal of talk about how arrogant the CRNA's can be, and mine is an example of how that works. The CRNA says that he knows what is best for his patients and apparently nothing can dissuade him. I don't think that this is how you would like to be treated, is it? I am sorry that disagreeing with a course of treatment causes some to think that the patient must have a mental problem. It is simply a matter of respect.