Ethics help!

KatieFRN said:

So I'm wondering what to do in this case. If a patient wants more options of treatment than what their doctor suggests, is a nurse allowed to give information on alternative treatments? The Dr doesn't want to offer or talk about other treatments because he doesn't believe in them.

I'm scared to ask exactly what you're hoping to suggest.

You are always expected to be the patient's advocate. Not the physician's. Responding to a patient's questions and requests is good and right. SUGGESTING these alternatives (outside of recommending a second opinion) falls into a very grey area.

Will there be repercussions from the MD? Probably.

Does your facility have an ethics committee?

Also- is this homework? Because it seems a lot like homework, esp. with this being your first post and all.....

if you're talking about evidence-based treatments, treatments that have proven benefits, then of course you can talk about them because you have science on your side, no matter what the doc prefers to ignore. If you're talking about some dodgy snake-oil trick that you heard works on elderly people in Malaysia (but not sure where you got that from), then no.

meanmaryjean said:

Also- is this homework? Because it seems a lot like homework, esp. with this being your first post and all.....

I'm hoping the RN at the end of her username means she's already an RN and not playing one on TV! ?

I would not offer them alternative treatments, but I would remind them that they have the right to fire a doctor and get one that would offer alternatives. Many patients do not realize that they have that option.

I do home health so it's a bit different, but I have made suggestions to my patient's on questions I would ask if they were my mom or dad. I try to be careful not to step on the docs toes while still advocating for my patient.

Guy in Babyland said:

I would not offer them alternative treatments, but I would remind them that they have the right to fire a doctor and get one that would offer alternatives. Many patients do not realize that they have that option.

I always reminded patients that the doctor works for them- not the other way 'round.

KatieFRN said:

So I'm wondering what to do in this case. If a patient wants more options of treatment than what their doctor suggests, is a nurse allowed to give information on alternative treatments? The Dr doesn't want to offer or talk about other treatments because he doesn't believe in them.

It is pretty easy and straight forward in my opinion.

If the patient verbalizes the wish to get more information/different choices the nurse can tell the patient that he/she can obtain a "second opinion", which is actually pretty common.

Since you are a nurse and I assume this is regarding medical treatment - you want to stay within your scope of practice.

There are different options to obtain a second opinion. If the patient has otherwise a good relationship with the physician, the MD can recommend another specialist and refer out - this seems to be pretty common in oncology or with certain surgeries.

If the patient is concerned about provider bias, they can ask the PCP for a name or call a larger center/teaching hospital / etc to schedule an appointment.

Stay out of trouble. If the physician recommends medication and the patient talks about "alternatives" and you tell the patient that you have heard that magnet bracelets work for cancer - this might become a problem....

Patients may have to obtain prior approval from their insurance for a second opinion - I always tell them to call the insurance and clarify that as well.

I personally am not comfortable with thoroughly explaining the risks, benefits, and alternatives. Because I am not ordering, obtaining consent for, and performing procedures I simply am not as knowledgeable as I am in nursing.

One example early in my career, I cared for a glioblastoma pt who had developed hydrocephalus. It persisted through many clamping trials of his EVD, and so the surgeon was recommending a permanent VP shunt. The son asked me how effective the surgery is. That is absolutely a question he needed a neurosurgeon to answer, and so I advised him to ask the surgeon.

Now say the pt is wanting to know about a minimally invasive CABG. His cardiologist was talking about the big sternal incision, but the pt heard Dr. Oz talk about minimally invasive. I would encourage the pt to ask the CVT surgeon "What are the risks, benefits, and alternatives to the surgery you are recommending? Tell me about minimally invasive: am I a candidate? Why or why not? What are the risks and benefits to a minimally invasive CABG?" It is absolutely his right to have all of those questions answered by the surgeon before he agrees to anything; and if the dr won't discuss it, he can fire that dr. (This is assuming it's not an immediate life and death decision.)

Stay out of that discussion and refer them to their own doctor or the internet. Patients can figure that out on their own without input from the traditional staff whose interventions are being rejected.

Hmm - This is a typical problem that my organization uses to train our Ethics case consultation teams. a situation when it's important to separate the topic from the underlying issue. Seems as though the patient does not have a great deal of trust in the physician. PP's are wise to suggest that the patient ask for a second opinion. An Ethics consult would also be helpful to help clarify what's going on.

Nurses who find themselves in similar situations need to understand the professional/legal consequences for their decision choices. These vary by state. In some states, interfering with the physician-patient relationship is actually a nursing practice violation. My state's unique, we have a legally defined nurse-patient duty (since 1984) that requires the nurse to provide factual information to the patient & act according to his/her professional judgement. Me? I'd still turf it to the Ethics Consultation folks, just to keep the peace & because they would be much better equipped to go head-to-head with the physician.

DeeAngel said:

Stay out of that discussion and refer them to their own doctor or the internet. Patients can figure that out on their own without input from the traditional staff whose interventions are being rejected.

I would never refer a patient to refer to the internet. There is so much incorrect information put out on the internet as facts. Lay people often have trouble distinguishing factual information from total rubbish. Refer patients to medical professionals.