Another Patient Refusal

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