Patients with capacity refusing treatment/care

[emergentmd]

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I am confused by the change in narrative. From what I read from OP. Pt has surgical abd but refuses CT. Surgeon refuses to admit/consult. Hospitalist refuses to Admit/consult. OP inferred surgeon didn't want to see the pt.

If it is a surgical issue, why would any hospitalist want to admit without surgical consult?

If there was a surgical consult and surgeon on board with a note, then sure the hospitalist should admit.

 

[Splenda88]

I am confused by the change in narrative. From what I read from OP. Pt has surgical abd but refuses CT. Surgeon refuses to admit/consult. Hospitalist refuses to Admit/consult. OP inferred surgeon didn't want to see the pt.

If it is a surgical issue, why would any hospitalist want to admit without surgical consult?

If there was a surgical consult and surgeon on board with a note, then sure the hospitalist should admit.

Well, it's easier to dump patients onto hospitalists' lap when surgeons refuse to see them.

 

[rokshana]

Well, it's easier to dump patients onto hospitalists' lap when surgeons refuse to see them.

Sure but the surgeon still needs to come see the pt and drop a note of refusal first.
Would be surprised if the surgeon can refuse a consult… I can see where they say no… but if pushed, either by the ED or admin, they are going to have to see the pt and wrote a note…that usually says“admit to medicine” ( always wanted to write a note that the medical decision was “admit to surgery”…

These types of surgical pts that get refused by surgery for admission come to medicine all the time… but I made them stay on the team and the pt so they still had to see them, when i was a hospitalist.
If i was consulted at the same time, you bet my note said…needs evaluation by surgery to determine meed for surgery.

 

[ScepticSkeksis]

I am confused by the change in narrative. From what I read from OP. Pt has surgical abd but refuses CT. Surgeon refuses to admit/consult. Hospitalist refuses to Admit/consult. OP inferred surgeon didn't want to see the pt.

If it is a surgical issue, why would any hospitalist want to admit without surgical consult?

If there was a surgical consult and surgeon on board with a note, then sure the hospitalist should admit.

I still think everyone is spending way too much time/effort on this theoretical patient. I'm not going to "continue to discuss" with his person. I'm going to document their refusal of treatment, document refusal of hospitalist and surgeon to care for this patient, then get administrator involved. At that point I'm going to go do other tasks until one of three things happens:

1. Patient decompensates and needs intubation
2. Administrator forces hospitalist/surgeon to admit
3. My shift ends and I sign out this dumpster fire train wreck.

 

[emergentmd]

I still think everyone is spending way too much time/effort on this theoretical patient. I'm not going to "continue to discuss" with his person. I'm going to document their refusal of treatment, document refusal of hospitalist and surgeon to care for this patient, then get administrator involved. At that point I'm going to go do other tasks until one of three things happens:

1. Patient decompensates and needs intubation
2. Administrator forces hospitalist/surgeon to admit
3. My shift ends and I sign out this dumpster fire train wreck.

Yup that is what I would do and spend 15 min max doing it. It seems straight forward and some here advocating making the hospitalist admit without surgical participation. If I were a hospitalist, I would accept almost anything but don't see why I would accept a surgical pt that surgery refused to see.

 

[GonnaBeADoc2222]

Daily reminder to do the bare minimum