Patient "refuses" procedure

[LittleBearTX]

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I notice a lot of the doctors—residents in particular—like to use the phrase "patient refuses procedure". I wonder why "patient declines procedure" isn't used more often? Most patient can be talked into a procedure when it is strongly recommended, particularly if it is being offered by a competent doctor. If the recommendation is more in the gray zone, what's be wrong with saying "the risks and benefits of the procedure were discussed and the patient chooses to avoid the procedure at this time"? I am routinely frustrated to see my patients—most of which are quite reasonable people—being labeled as refusers of medical care; not infrequently, they are making the right decision. This is not to say that most residents don't have the patients' best interests in mind or that they aren't working plenty hard... I just don't think they realize the harm they can create when certain semantics are used in the chart.

 

[DrAwesomo]

Patients are adults (in most cases). If they don't want it, they are refusing it. Get it?
Not everyone can be persuaded no matter how persuasive you are and how great the benefit is from that procedure. This is true not only in the medical field but also in law, finance, etc.

 

[YankeeCandle1141]

I notice a lot of the doctors—residents in particular—like to use the phrase "patient refuses procedure". I wonder why "patient declines procedure" isn't used more often? Most patient can be talked into a procedure when it is strongly recommended, particularly if it is being offered by a competent doctor. If the recommendation is more in the gray zone, what's be wrong with saying "the risks and benefits of the procedure were discussed and the patient chooses to avoid the procedure at this time"? I am routinely frustrated to see my patients—most of which are quite reasonable people—being labeled as refusers of medical care; not infrequently, they are making the right decision. This is not to say that most residents don't have the patients' best interests in mind or that they aren't working plenty hard... I just don't think they realize the harm they can create when certain semantics are used in the chart.

You dont put things in a chart that are "up in the air".

Saying "patient declines at this time" implies that somebody (else) needs to go in there and talk to the patient.

Saying "patient refuses" implies that you went in, explained the procedure in detail, and they still said no.


I equate the rhetoric here to saying
"hgb dropped to 6.1 - will transfuse"

vs "....transfused 2 units, h/h pending"


I dont know if this makes any sense, but thats the way I see it. One says "work needs to be done" one says "work is getting done".

 

[LovelyBRass]

People write that the patient "refused" because they themselves are frustrated at the declination of a procedure that they have probably spent a long time trying to convince a patient to get. IMHO, it's pejorative and generally has a negative connotation towards the patient.

 

[FutureInternist]

People write that the patient "refused" because they themselves are frustrated at the declination of a procedure that they have probably spent a long time trying to convince a patient to get. IMHO, it's pejorative and generally has a negative connotation towards the patient.

It is frustrating when a patient is refusing a procedure they obviously need. I really don't care about the time I spent "convincing" them, but I do hate the legalese you have to put in the D/C summary or the extra hoops you have to jump through in trying sub-standard treatments which you wouldn't need to do if the patient didn't listen to their cousin's boyfriend who once shadowed a nurse.

 

[YankeeCandle1141]

But nurses know more than doctors. I know that because my girlfriends sister is a nurse.

 

[chessknt]

We have enough to contend with besides the grammar/phrasing police. Write your notes that way if you want, don't tell everyone else how to do it. Thanks.

 

[Gastrapathy]

That is your first post? Did you refuse a procedure and get your feelings hurt when you read a chart? Hard to believe that came from a fellow's first SDN contribution.

 

[efex101]

LOL oh young pup you will learn soon....

 

[anonperson]

I notice a lot of the doctors—residents in particular—like to use the phrase "patient refuses procedure". I wonder why "patient declines procedure" isn't used more often? Most patient can be talked into a procedure when it is strongly recommended, particularly if it is being offered by a competent doctor. If the recommendation is more in the gray zone, what's be wrong with saying "the risks and benefits of the procedure were discussed and the patient chooses to avoid the procedure at this time"? I am routinely frustrated to see my patients—most of which are quite reasonable people—being labeled as refusers of medical care; not infrequently, they are making the right decision. This is not to say that most residents don't have the patients' best interests in mind or that they aren't working plenty hard... I just don't think they realize the harm they can create when certain semantics are used in the chart.

Lol. Would you prefer "Patient thinks they're smarter than everyone else and told the team to f$ck off."

What procedures/tests are they refusing "not infrequently" that they are right about anyways?

 

[gutonc]

$5 says the OP is a nurse on a med/surg floor at a Uni hospital.

 

[Gastrapathy]

$5 says the OP is a nurse on a med/surg floor at a Uni hospital.

Oh, that's it. But since the nurse picked fellow, maybe a unit nurse.

 

[gutonc]

Oh, that's it. But since the nurse picked fellow, maybe a unit nurse.

Good catch. I missed that.

 

[Instatewaiter]

That is your first post? Did you refuse a procedure and get your feelings hurt when you read a chart? Hard to believe that came from a fellow's first SDN contribution.

Agree. Clearly not a fellow

 

[runnergal]

I notice a lot of the doctors—residents in particular—like to use the phrase "patient refuses procedure". I wonder why "patient declines procedure" isn't used more often? Most patient can be talked into a procedure when it is strongly recommended, particularly if it is being offered by a competent doctor. If the recommendation is more in the gray zone, what's be wrong with saying "the risks and benefits of the procedure were discussed and the patient chooses to avoid the procedure at this time"? I am routinely frustrated to see my patients—most of which are quite reasonable people—being labeled as refusers of medical care; not infrequently, they are making the right decision. This is not to say that most residents don't have the patients' best interests in mind or that they aren't working plenty hard... I just don't think they realize the harm they can create when certain semantics are used in the chart.

I've documented for over 200 docs live at bedside.... And I would say somewhere inbetween 60-90% of the time, risks and benefits really were not explained in a way the patient would ever understand. Or with near completion. Or what would/could/is likely going to happen to you long term if you don't follow through with this procedure.
Sometimes some docs would speak on the side of hoping the patient doesn't accept what they are being offered. Again this was mostly all EM so maybe skewed point of view. Docs rarely keep it "real" w/patients these days. No one wants to say the wrong thing, and unfortunately residents are being taught this way.

if you have to speek Blackenese, Mexicanese, Hispanicnese, Ruralnese, Povertynese, Trendynese, Illiteratenese - speak it all so patients can put into life context what you are recommending to them.


(Plz don't attack. If you are a physician that already does the above, That's great)

 

[FutureInternist]

The consent form or talk should be basically....ANYTHING can happen up to & including death. Do you still want to do this?
There's is no way you can go over the risk of each potential adverse effect, explain how that will affect them, what tx we would need to fix it etc etc

 

[devilpup]

Meh, semantics.
"refuse" makes it sound as if the patient is deciding against medical advice.
"decline" makes it sounds like opting out of something elective.
Explaining risk and benefits can be an art in itself--how do you tell someone that the procedure you're about to perform can kill them but they should trust you because of the initials after your name.

 

[Raryn]

*shrug*

Sometimes patient really do simply "refuse" a procedure. I had a patient refuse an NG tube for a week while he had a partial SBO. Said it was just too uncomfortable. Didn't end well. Risks and benefits can be explained ad nauseum, but people are people.

 

[Mad Jack]

Most patient can be talked into a procedure when it is strongly recommended, particularly if it is being offered by a competent doctor.

Patients generally have no idea how competent their physician is, thus the competence of the doctor generally had no effect on how convinced the patient is to undergo a given procedure. That all comes down to the physician's ability to sell the procedure as something that will be overall beneficial to the patient, which is far less dependent on medical competence and far more dependent upon social skills and salesmanship. I've seen clueless but charismatic residents talk patients into borderline futile procedures and talented surgeons fail to convince patients to undergo necessary surgery- it's all about how you handle people.

As to refusing, well, it looks far better on a lawsuit for one...

 

[takeurmeds02]

Meh, semantics.
"refuse" makes it sound as if the patient is deciding against medical advice.
"decline" makes it sounds like opting out of something elective.
Explaining risk and benefits can be an art in itself--how do you tell someone that the procedure you're about to perform can kill them but they should trust you because of the initials after your name.

Well, you came to me because of the initials after my name, right? At any rate, I understand what you're saying.