Treatment Requested VS Treatment Needed

HyzenthlayLPN · Nov 2, 2017

I am not an ED nurse but I often deal with patients and families whose treatment preferences conflict with their care teams plan of care. In that situation, I educate the patient/family and they get to choose. That does not mean that I believe a doctor should give a treatment that is clearly contraindicated. As medical professionals we have a duty to "do no harm". So, when the patient/family has the relevant information, we offer the treatment plan and they can choose to accept or not.

I hope I am being clear? Patients always have the right to refuse treatment but we do not have an obligation to give them treatment that will cause harm, even if that is what they want. If the patient's preferred treatment isn't harmful but possibly less effective than the proposed treatment, I say let them try their way.

Guest374845 · Nov 2, 2017

There's "shared decision-making" in which a physician can offer several treatment options and tailor it to the patient's liking within reason. Then there's every new parent that wants their kid to get a CT scan for a head bump. I like it when we have several options to offer a patient and they can choose. I don't walk around with the thought of pt satisfaction scores in the back of my mind, but those are times that leave no doubt that my pts are satisfied. It's the people wanting non-emergent MRIs and such who get to me, because you know they are just going to turn around and ding you, no matter how right you are about why you can't or won't do x, y, or z.

Editorial Team / Moderator · Nov 5, 2017

I can't say yes or no to the poll. What if the patient comes in asking for appropriate treatment? It happens.

EthicalRN60 · Nov 5, 2017

Thank you for taking time to respond . I really appreciate all the feedback I have gotten. You are correct , sometimes the requested treatment is appropriate, however I would hope that this would be in line with what the provider was also offering in the plan of care . I think I am referring more to the abuse of narcotic pain medications in the ED as well as in the ordering of unnecessary radiological exams on demand "Just to keep them happy " Despite the education of increased risks of exposure, it amazes me how many parents are willing to increase their childs risk of developing a serious illness later in life . "I still want that CT " The issue of patients demanding narcotics is another whole issue in of itself that has become a systemic problem that I personally have found to be an Ethical issue . This is not to say that pain is not to be treated , as nurses we are trained to alleviate suffering but again , we also must "do no harm " Ethical RN60

**canoehead, BSN, RN** · Nov 12, 2017

Patient satisfaction linked to higher health-care expenses and mortality

nurse2033, MSN, RN · Nov 12, 2017

I hate to nitpick but there is no nurses' oath. I happen to agree with "do no harm", but it is not an oath that nurses take.

Guest219794 · Nov 12, 2017

Hello to all ! I'm new to the Forum so , Please excuse if I make some mistakes here , I will learn . I am I very experienced RN with 26 plus years in ICU , CCU , ED , Trauma and Management , currently working as a Charge Nurse in the ED . I choose to complete my career back at the bedside , in the ED , my first LOVE . I am tasked with a writing assignment for Ethics , and have chosen the topic as stated above . I find this extremely challenging with the implementation of all the " Patient Satisfaction " changes , including immediate bedding , 10 min door to doctor I have to ask myself are we actually doing the right thing for our patients . I have seen so very many changes our the years , and some not for the best , gone are the days when the ED doctor could tell the pt that the narcotic they are requesting for their migraine headache is contraindicated and could cause rebound headaches or that the knee pain they have is because they weigh 400 lbs. "don't make the patient unsatisfied our scores will be low" . I have interviewed several nurses and physicians I work with but would love feed back from other professionals on this ethical issue . As nurses and physicians we all took an oath to " do no harm " , Beneficence and Maleficence ! HELP Ethical RN60

I am confused about the question. As an experienced nurse, why are you asking if we are doing the right thing for our patients? Hopefully that is rhetorical.

No.

Unnecessary scans, drugs, and procedures are, by definition, harmful. And, as you well know, we do it all the time.

I work with smart, hard working docs who are decent people. They are boxed into a situation in which in order to do their job, they have to practice a certain amount of bad medicine.

Example: When a kid comes in with a just bump on his head they know the risk/benefit of a CT clearly shows that the right thing to do is not to scan. And, if it was a kid in their own family, they would not scan. But, the path of least resistance is to do the scan. And I have not heard of docs being called into admin for ordering too many tests.

When administrators make decisions intended to garner market share, I don't think medical ethics are a chief consideration.

As far as I can tell, all the research shows that this trend of allowing PTs to order what they want a la carte is expensive and harmful.

I would be interested to hear if your research shows otherwise.

EthicalRN60 · Nov 12, 2017

Yes , Absolutley it was rhetorical . Thank you canoehead for the link it shows exactlly what I have been saying here . This is a problem that is not going away. My fear is that as hospital emergency depts begin with reimbursment based on pt sayisfaction scores it can only get worse