How Much Info Should A Patient Be Given?

Tweety, BSN, RN · Mar 10, 2005

I think honesty is always the best policy. Even if it's meaningless information. Even if it is going to upset the patient, even if there's nothing that can be done with the information. I believe they were wrong in not informing you. (I don't read that forum, but I wish you all the best.)

bagladyrn, RN · Mar 10, 2005

Well, I am not to sure what to do about this one. My threads in the ob/gyn forum explain a handful of the issues I have been having with the group that handles my pregnancy. So at my last ultrasound with them, they tell me that the femur is measuring short, but not a big deal. Over the weekend it kind of eats at me, so I demand to be seen on Monday and explained everything. They tell me that the femur length is in the first percentile, but they cannot figure out why b/c everything else is right on. They tell me that they are not even sure it will amount to anything when he is born-BUT if it continues measuring small then they are going to think about inducing me.
Here is the kicker: they tell me that they noticed way back at my 4 month ultrasound that the length was falling behind at every ultrasound since then it has been, but said that they decided not to tell me b/c there is nothing that can be determined or done until he is born.
I think I had the right to know from the start and throughout the monitoring & it was not up to them to decide what I "need" to know about my own child and pregnancy. :angryfire
So what do you think (not about my situation-but in general)? Should patients be told everything about themselves or are there times it is better to withhold?
Just curious. Maybe I will be able to see another point of view about this b/c this was the last straw and I have no faith or trust in these people anymore. I want to switch but the couple around my area that do take my insurance will not take me with all these issues so late in the pregnancy-which I understand.
Thanks for your opinions!

I've been following your threads on the OB page and feel that from what you have posted they are not showing you the respect you are due! They should definitely have given you ALL available information.

My strong suggestion to you is that when you go to deliver have one person (spouse would be good) who is VERY assertive to be with you to ask questions and insist politely upon answers, basically be an advocate for you! You will not be in a place where you will be able to do this for yourself.

NurseFirst · Mar 10, 2005

I've been following your threads on the OB page and feel that from what you have posted they are not showing you the respect you are due! They should definitely have given you ALL available information.
My strong suggestion to you is that when you go to deliver have one person (spouse would be good) who is VERY assertive to be with you to ask questions and insist politely upon answers, basically be an advocate for you! You will not be in a place where you will be able to do this for yourself.

I think Mothers, Mothers-in-law, sisters are good choices. I'm not sure, no matter how assertive the guys are, that they really understand what childbirth is all about. I've been doing my perinatal rotation and I think the husbands, especially of primips, are too excited to even think. Kinda like when they've fallen in love...Nothing against the guys--childbirth is a pretty extraordinary ordinary event!

NurseFirst

CarVsTree · Mar 10, 2005

I think I had the right to know from the start and throughout the monitoring & it was not up to them to decide what I "need" to know about my own child and pregnancy.

Well, I think you answered your own question.

I don't believe they should have kept any information from you and I would tell your doctor so.

peeps79 · Mar 10, 2005

But this is related to telling patients information. It resulted in a 2 Day fight between me and a doctor (chief of Surgery) but I won both the support of the nurses and the patient.

A concerned patient having abdominal surgery (major abdominal surgery) was concerned about not passing gas and her abdomen being distended. I noticed and confirmed that she was right and that we will talk with the MD and see what he says. As I was saying that, he walked right in and started talking with the pt. She became flustered (as some do ) and wasn't asking her important question, so I made sure to mention it to the MD. He did a half assed attempt at looking at her and then said that she wasn't walking enough and using too much pain medicine. He (in front of the patient) accused the nurses of bad care and told her that she needed to start walking more. He had failed to realise that SHE WAS walking often and not using much pain medicine unless she really needed it. He brushed off her concern and then out side, (I followed him outside to talk further with him as I could see he upset her) proceeded to tell me not to give her bad news, that we shouldn't tell her when things go wrong (even though he was very concerned about her abdomen too).

Well, I was LIVID!!! I went back into her room and found her crying because she was all confused over what was going on and what she was 'doing wrong'. I spent 1/2 an hour with her, explaining how her intestines worked, giving her a run down (in layman's terms) of what to expect and ways to help her along and when to be alarmed and when not to. She was an intelligent woman and very dedicated to her health (which is rare where I work) and all she needed was some big picture with little details to complete it.

to Sum up... she ended up having problems that the MD needed to correct, but she was alot more calm about it this time round because she had a little education behind it.

I fully support giving education to patients who are ready to receive it. If I remember correctly, you are a nurse? You certainly would be ready to handle ALL information.

I wish you luck in the future.

mbrester · Mar 10, 2005

I agree with all of you, If I was the paitent or my DH was, I would want to know it ALL. Then I could ask questions. If you don't know, you can't ask.

rjflyn, ASN, RN · Mar 10, 2005

Im going to make a comment about imformation to pts in general and not specific to the original posted. Unfortunately as medical providers we care for pts and families with various levels of education. Sadly some of the people we deal with have very low levels of education and understanding. I have found in the length of time I have worked in healthcare- 17 years now that OB/GYN and ER doctors bare more than their share of the brunt of this.

Having said that alot of the information gets simplified so it can be understood. In this process often times information gets left out. When this happens its our responsiblity as health care comsumers to ask questions when we are in the position as patients and feel we are not getting enough information.

Taking the original posters case for example- as far as I know it is routine to only do one ultrasound during a pregnancy. My fellow board members who are OB/GYN nurses correct me if I am wrong, gently please. Having said that my spouse having a second ultrasound would have made me start asking questions.

Failth you and your baby will be in my prayers.

RJ

KRVRN, BSN, RN · Mar 11, 2005

Rjflyn,

I agree with you. I'm all for pts and parents being fully informed about what is going on. Sometimes though, you come across a pt or family that overreacts or becomes overwhelmed to the point of becoming unable to listen or hear your answers. They may or may not be lower on the intelligence scale. In those cases, sometimes it may be best to shift focus away from less or benign important findings, otherwise nothing constructive comes from it.

Let me also add, Following Faith, that obviously I don't know you and I'm not insinuating that you are a person that overreacts to things or is less inteligent! I'm also not insinuating that ANYTHING potentially wrong with your baby is benign! I'm pregnant myself and I know how it is to worry and wonder about your baby.

I'm just agreeing with Rjtflyn that sometimes it is better not to discuss each and every single finding in any situation if you have a pt or parent that will be overwhelmed to the point of hearing NOTHING you say by doing so.

following_faith · Mar 12, 2005

Im going to make a comment about imformation to pts in general and not specific to the original posted. Unfortunately as medical providers we care for pts and families with various levels of education. Sadly some of the people we deal with have very low levels of education and understanding. I have found in the length of time I have worked in healthcare- 17 years now that OB/GYN and ER doctors bare more than their share of the brunt of this.
Having said that alot of the information gets simplified so it can be understood. In this process often times information gets left out...
RJ

That is a good point and I can see that!

Well to keep this long story short-my son ended up being born Thursday premature. He is in the NICU and so far, so good. I am just glad that both of us are not under those people's care anymore. He has an excellent doctor and wonderful nurses...hopefully all stays well. Thank you all!!!! It was great having a place to dump the worries and thoughts!!!!!

Antikigirl, ASN, RN · Mar 12, 2005

As far as genenerally giving info, it depends on the info, the patient, and situation. Sometimes I don't have the answers for a patient that they need, so I have always been an advocate on how a patient can find out on their own by asking their physician or on-line links, or even books. SO it all depends (some subjects I know oh too well and can explain very well :) ).

As far as your situation..sounds like a bit of the old 'treat the machine not the patient" to me! Ultra sounds are awesome, but a pregant mother is even MORE so and will always be more so! Some folks need to remember..machines are tools, not the definate end all...the foundation is the patient so they need to be addressed first and foremost!!!! I mean, how many ultrasounds have been less that 100% accurate, EKGS, Pulseox...etc!?!?!?

Don't give up and always ask...even if you feel you are being a pain...doesn't matter. Write down your questions so you remember them all and ask for a consult, if they decline or give you the run around, ask for a different MD or another consultant or specialtist! This is your pregancy, not the ultrasounds, staff or MD's..yours...you deserve the info!!!!!

Good luck :)