Another
Patient Refusal
By
Alan Perry
September
22, 2015
You arrive on the scene and approach the patient,
before you can speak your partner ask “do you want to go to the hospital?” For
many providers out there this has become a standard and acceptable line of
questioning, intended to cut to the chase, but putting emphasis in the wrong
place. I’m sure your partner is adroit at creating EMS reports that describe
these calls in sufficient detail (or lack thereof) to avoid drawing attention.
As a group we have hammered home the message of creating good documentation to
defend against unwarranted claims of poor patient care. This type of event is
one that should concern all of us as professionals, ideally we took this job
and accepted this role because we care for people and want to do what is best
for them. Unfortunately some are compelled to act in this role because of changes
in the work environment, or out of necessity, without the presumed desire to do
this work, creating a serious lack of empathy and/or ethics when dealing with another
person’s health issues. Other explanations might include laziness or burnout.
Whatever the cause, it must be corrected. Patient refusals where the patient
does not express a total unwillingness to go to the hospital without prompting,
encouragement, or coercion should be rightly classified as provider initiated
patient refusals. If we are honest about how often these occur, the potential
and real effects of these refusals to the patient, and our reputation as a
profession, we should all conclude that as professionals our first question to
the patient should not be a decision to refuse. The best approach is always to
gather information, chief complaint, history and vitals so you can at least
form an opinion of the patient’s condition before you even ask if it’s ok for
you to take them to the hospital. A refusal should be the exception, not the
norm.
Be safe, do good work
