Do I have a right to refuse taking part in a case?

[TecmoBowl]

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Hi,

Last Friday, I finished my room early but that just meant pink slips into my room! No problem. Except the case they wanted to put into my room was a deathly ill patient (pH 7.02) fulminant c.diff, septic, elderly patient with other illnesses near death. The Surgeons felt this patient was not going to make it and that Surgery would be utterly useless, and in fact, she may not have survived the O.R.

The family REALLY wanted intervention and the Surgeons felt "forced" to take this patient to surgery. Where does this leave us (Surgeons and me)?

Can I refuse to be the Anesthesiologist for a case which will end in a mortality that would probably be tacked on to my record/profile? I want to have a clean file as best as possible and that doesn't mean I'd never to do a bad case (because working at a Trauma Center, I don't have a choice most of the time). In this case, it seems a bit foggy. What are my "rights" in such situations? For that matter, what would the rights of ANY Physician be in such a situation?

I think the answer here is probably a simple and straightforward one, but I can't see it.

Thanks.

 

[9french]

You need to do what is in the interests of your patient. If the paitent would want everything done, and that is expressed to you by his appointed surrogates (i.e., his family), and going to the O.R. is not completely futile, I believe that you would be on ethically shaky ground refusing to do the case due to fear of worsening your numbers.

 

[huktonfonix]

talk to the family. let them know there is a very good chance the patient will not survive the stress of the surgery or post op period due to his underlying conditions. if they accept the risks and the surgeon has agreed to do the surgery, its off to the OR. what was the surgery by the way? (colectomy, Iand D, etc..)

 

[numbmd]

I have recently had a real internal dilemma to this issue myself. I had a patient for a revision of a total hip. 70 years old. EF 20%. Crippling COPD on oxygen. Bed ridden. Cardiologist and orthopod both think guy has a less than 305 chance of making it thru the case. I see the guy in the ccu and say to myself "I gotta find some way to cancel this case. Guy says that he doesn't care, that he has to try the surgery because life like this isn't worth living.

WTF? Everyone is on board all the I's are dotted. All the t's are crossed. Everyone is putting a gun to this guy's head INCLUDING himself.......And they are asking me to pull the trigger.

The guy was so compelling and so pathetic, the case was only booked for 5 hours. I went ahead.

What a mistake.

At one o'clock I asked the surgeon if he could stage the surgery,you know , just take out the old prosthesis. Please!

At two o'clock I pleaded with the surgeon, "You gotta finish soon, guys like these don't tolerate 6 liters of blood loss.

So I'm doing chest compressions at three in the recovery room. Saying to myself, "You knew this was going to happen."

As I'm talking to his family later, I'm thinking to myself that I failed this family, not by my anesthetic care but by agreeing to go ahead with the surgery.

I still think about this and I'm still unsure what the right thing was to do.

 

[Planktonmd]

Here is another point of view:
If there is a surgeon who thinks that surgery is needed or indicated on a dying patient for whatever reason including family wishes, and even if I am certain that the surgery is not going to change the outcome, I will not have a problem giving the anesthetic and doing my best to give the patient the best shot at surviving the surgery, I would just inform the patient and the family that this is a very risky case but I am not god and I don't know what's going to happen.

 

[Jeff05]

as physicians we are trained to not only treat and diagnose, but be the gatekeepers of care and managers of resources. we don't do it anymore - we have left that to families (who are clueless) and administrators (who are also clueless).

i have refused to do cases (as a resident, at that), which involved instrumenting dying patients without ANY benefit. except for the surgeon to bill medicare/family's insistence to do everything.

physicians are AFRAID to really tell the family that things are futile - they don't want a lawsuit, or don't have the interpersonal skills to present alternatives in an effective way, or they just wanna make a quick buck (yea, that happens).

you can be ETHICALLY and MORALLY opposed in participating in medical care that does NOT coincide with your standards. example: if someone doesn't wish to participate in the abortion room - they are excused from that assignment. why should you tolerate other things you find unacceptable.

we spend MOST of our healthcare dollars on the last year of life. the greatest investment with the smallest dividend. this will only change if we, the physicians, say enough. enough to 30 day ICU stays for gomed nursing home patients, NICU for 25 weekers, greenfield filters for dying cancer patients, etc...

Hi,

Last Friday, I finished my room early but that just meant pink slips into my room! No problem. Except the case they wanted to put into my room was a deathly ill patient (pH 7.02) fulminant c.diff, septic, elderly patient with other illnesses near death. The Surgeons felt this patient was not going to make it and that Surgery would be utterly useless, and in fact, she may not have survived the O.R.

The family REALLY wanted intervention and the Surgeons felt "forced" to take this patient to surgery. Where does this leave us (Surgeons and me)?

Can I refuse to be the Anesthesiologist for a case which will end in a mortality that would probably be tacked on to my record/profile? I want to have a clean file as best as possible and that doesn't mean I'd never to do a bad case (because working at a Trauma Center, I don't have a choice most of the time). In this case, it seems a bit foggy. What are my "rights" in such situations? For that matter, what would the rights of ANY Physician be in such a situation?

I think the answer here is probably a simple and straightforward one, but I can't see it.

Thanks.

 

[zippy2u]

Reason #156/more than I care to count --- as to why ya get on down to the ASC club and getcha a job. Don't need no preacher man at the nickel and dime ASC. Regards, ----Zippy

 

[TecmoBowl]

It was a hemi-colectomy on a "terminal" patient that the surgeons tried really hard to discourage the patient's family from having the patient undergo surgery.

Yeah ASCs are great, but I'm not there yet mentally. I'm just annoyed by the state of things. I could go on forever about the sorry state of things you know. It's just a cesspool of rules that we've allowed to surround us, and more importantly we make ourselves sheep ready to be slaughtered.

I'm done in about 10 or 12 years! Anyone want to go into business together?! We should get about a dozen people together, put our resources/brains/finances together and venture onto something. I have a few ideas!

 

[Jeff05]

i'm with you.
medicine for a lifetime?
don't know how people do it.
maybe better when they pay you for it.

It was a hemi-colectomy on a "terminal" patient that the surgeons tried really hard to discourage the patient's family from having the patient undergo surgery.

Yeah ASCs are great, but I'm not there yet mentally. I'm just annoyed by the state of things. I could go on forever about the sorry state of things you know. It's just a cesspool of rules that we've allowed to surround us, and more importantly we make ourselves sheep ready to be slaughtered.

I'm done in about 10 or 12 years! Anyone want to go into business together?! We should get about a dozen people together, put our resources/brains/finances together and venture onto something. I have a few ideas!