question of ethics

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Ok,

I have a hypothetical ethics question.

Say a nurse had personal knowledge that a Dr. who is going to be doing a very complicated surgery really has poor results and doesn't yield an acceptable result with the surgery. The surgery is NOT an urgent one, it is an optional surgery. Should the nurse say anything to patient or keep his or her mouth shut and let the patient suffer the result of the surgery?

What are your thoughts?

FYI, just a beginning nursing student, with a purely hypothetical question.

Discuss.

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Specializes in Maternal - Child Health.

It sounds as if you are assuming that 1.) You know the patient's history, condition, reasons for desiring the surgery, and level of knowledge regarding the risks/benefits and 2.) The surgeon has an undesirable "track record" of which the patient is unaware, which may or may not be true.

IMO, it is not your place to insert yourself into the surgeon-patient relationship and offer unsolicited information and opinions, especially based on your limited knowledge of the information they have exchanged.

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To play devils advocate, assume that the assumptions 1 and 2 are true, in that the nurse does indeed know the info you stated.( Did that confuse you? I know it did me! But do you know what I mean, assume that the nurse knows the answers to those questions)

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Specializes in Maternal - Child Health.

OK, if the nurse is well aware of the patient's condition, history, reasons for wanting the surgery, and accurately assesses that the surgeon is a hack, and the patient is not knowledgable of the risks/benefits, I still say keep one's comments to oneself.

Unless the patient expressly asks the nurse, "If you were me, would you have Dr. Smith perform a nose job on you?" the nurse needs to say out of it.

If the patient directly asks the nurse that question, the only appropriate answer would be a simple "Yes." or "No."

It is not our place to insert our own opinions into the physician - patient relationship.

If the patient expresses doubt about the surgery, it would be appropriate to ensure that she understands the risks and benefits, has given informed consent, and has had all of her questions answered by the surgeon. To offer information other than that is to give a personal opinion, which has no place in this situation, and may land one in leagal trouble, if it is viewed as slander against another healthcare professional.

I once worked with a particular OB who I thought was borderline incompetent. During the course of conversation, some patients would discuss why they liked him or why they chose his practice. Their reasons made sense to them, even if not to me. It would have been inappropriate for me to try to persuade them otherwise.

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Specializes in NICU.
Ok,

I have a hypothetical ethics question.

Say a nurse had personal knowledge that a Dr. who is going to be doing a very complicated surgery really has poor results and doesn't yield an acceptable result with the surgery. The surgery is NOT an urgent one, it is an optional surgery. Should the nurse say anything to patient or keep his or her mouth shut and let the patient suffer the result of the surgery?

What are your thoughts?

FYI, just a beginning nursing student, with a purely hypothetical question.

Discuss.

I don't think the patient is the person to share the unreliable performance information with. If there's enough reliable information that the nurse truly feels this particular MD is a quack, and that the MD is lying to patients - there are proper channels to follow. The nurse needs to be strong enough to advocate for not only his/her patients, but perhaps future ones.

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as with any surgery, it's important to check performance of surgeon.

state medical boards, would reveal complaints, disciplines, actions.

leslie

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Specializes in Utilization Review.
It sounds as if you are assuming that 1.) You know the patient's history, condition, reasons for desiring the surgery, and level of knowledge regarding the risks/benefits and 2.) The surgeon has an undesirable "track record" of which the patient is unaware, which may or may not be true.

IMO, it is not your place to insert yourself into the surgeon-patient relationship and offer unsolicited information and opinions, especially based on your limited knowledge of the information they have exchanged.

I agree with Jolie. I think you would be flirting with the boundary of professional inappropriateness if you were to get involved at this point. I think it should be up to the PATIENT to investigate his/her physician prior to any elective procedure.

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This is why all physicians outcomes, hospital stats and nurse qualifications and ratios should be available for patients to review so that they can make good informed choices. We all know of physicians that we would never allow to touch us but we keep our mouth shut when it comes to them PRACTICING on our patients and as far asI am conserned they are my patient for the 12 hours I am charged with their care.

Most of us don't choose our physicians based on anything other than location and availablity or sometimes word of mouth from friend or family.

I have in the past told a family member that they should seek a second opinion and maybe even consider transfering their family member to another facility because the Doctor taking care of them was incompetent. We have a duty as the patients advocate to help them make informed choices including if their Doctor is qualified to provide the best care available. My opinion is if you won't allow them to work on your family member then you should say something to your patient.

What we need is protection so that the nurses can assist their patients in gathering all necessary information so that they can make the best choices when it comes to the hospital, the physician and the nurses. I include my track record in this as well.

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This is why all physicians outcomes, hospital stats and nurse qualifications and ratios should be available for patients to review so that they can make good informed choices. We all know of physicians that we would never allow to touch us but we keep our mouth shut when it comes to them PRACTICING on our patients and as far asI am conserned they are my patient for the 12 hours I am charged with their care.

Most of us don't choose our physicians based on anything other than location and availablity or sometimes word of mouth from friend or family.

I have in the past told a family member that they should seek a second opinion and maybe even consider transfering their family member to another facility because the Doctor taking care of them was incompetent. We have a duty as the patients advocate to help them make informed choices including if their Doctor is qualified to provide the best care available. My opinion is if you won't allow them to work on your family member then you should say something to your patient.

What we need is protection so that the nurses can assist their patients in gathering all necessary information so that they can make the best choices when it comes to the hospital, the physician and the nurses. I include my track record in this as well.

Thanks,I Was wondering if patient advocacy could come into this discussion and I think you raise an excellant point.:yeah:

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I would also like to add this to the discussion, my uncle was hospitalized for months with osteomyelitis of his vertabrae and they did not have his pain under control (his surgeon). At all. The nurse took a quiet minute to tell my mother of the certain pain specialist to contact, along with the warning to not mention that discussion at all to the surgeon or he would have her job. My mother really appreciated the honesty with which the nurse presented and info the nurse gave her, and the result was the pain spec. got involved and my uncle's pain was finally under control. Had the nurse never said anything, who knows how long my uncle would have suffered. In this case, the nurse was an advocate for the patient, which is what I thought we nurses were to do as part of our job. It most likely was not an easy decision for her to share this info out of fear of the egotisitcal surgeon but she did it.:nurse:

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oh lord no. this is one area where nurses have no business being in. we are nurses - they are doctors. let's stick to the nursing stuff and leave the doctor stuff up to them!

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Specializes in Maternal - Child Health.
I would also like to add this to the discussion, my uncle was hospitalized for months with osteomyelitis of his vertabrae and they did not have his pain under control (his surgeon). At all. The nurse took a quiet minute to tell my mother of the certain pain specialist to contact, along with the warning to not mention that discussion at all to the surgeon or he would have her job. My mother really appreciated the honesty with which the nurse presented and info the nurse gave her, and the result was the pain spec. got involved and my uncle's pain was finally under control. Had the nurse never said anything, who knows how long my uncle would have suffered. In this case, the nurse was an advocate for the patient, which is what I thought we nurses were to do as part of our job. It most likely was not an easy decision for her to share this info out of fear of the egotisitcal surgeon but she did it.:nurse:

I am grateful that the nurse stepped up on behalf of your uncle, but I think you are comparing apples to oranges.

Your uncle's nurse did not attempt to prevent your uncle from having his chosen surgeon perform a procedure. She suggested adding another specialist who could help with symptom management.

As I understand the OP, she is considering destroying the patient-surgeon relationship, which I believe to be unethical.

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