I had a family ask me a strange question the other day. Their mother is in her late 80's and received a very bad diagnose, Cancer that has already spread to several other organs. The MD had spoken to a brother (who is POA) but obviously not the entire family (which is large). The 2 sisters I was talking to were aware of the situation, but were VERY adamant that their mother not be told how bad the situation was. I informed them that I knew the MD had already spoken to the pt, but wasn't sure how much info she had retained. This particular MD tends to use big words, and the foreign accent doesn't help ( very good, caring doc, just in a hurry). This pt is A & O x 3, very aware, and has very definite opinions on her care and treatment. Having said this, she is mildly forgetful in the short term.
As is turns out, the pt had remember what the MD had said, so it turned out to not be a huge issue. But my question is this, What if she hadn't? I have no intention of lying to my pt. How would any of you deal w/the family?
Feb 15, '05
I observed this as a student once. the pt who was in for something else was dx with cancer, and his family was adamant he not be told. they got a dr's order not to tell him. he was a & o x3. no one agreed with this, there was talk of calling the ethics committee, but nothing was ever done. he ended up dying several weeks later, though im not sure from what b/c i was no longer on that unit.
Feb 15, '05
the brother was the poa so it was appropriate for the md to talk w/him.
because of hippa (sp) regulations, the sisters are not legally allowed to be given any information.
Feb 15, '05
If the patient is A&O and making her own decisions about her care, the sisters (or anyone else in the family, for that matter) have no say in whether or not the patient is told about her dx, just as they have no say in any other aspect of her treatment ...
Under the CMS Patient Rights regs, the patient has a right to be informed of her dx, prognosis, recommended treatments and alternative treatments available.
Any time a conflict like this arises, there is always the option of involving the hospital ethics committee. The chaplain's service or social work department may also be helpful in tactfully setting limits with the family members.
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