Recently, I was called to attend two cases which share the similar problems:
Both cases presented with diabetic related complication which were involving severely infected foot which required urgent operation (amputation).
Case 1: a bad case of septic arthritis, After 3 operations failed to cure and AKA is proposed.
Case 2: a bad case of right ankle ulcer, after 1 operation and BKA is proposed.
Both patients are equally determined to keep their foot and equally to fight till the end regardless the price (unfortunate, death is the price to pay).
Both of the patients sign a discharge at your own risk declaration and seek “alternative treatment” elsewhere and finally came to A &E in severe sepsis and at the verge of death.
Case 1 patient died after intubated at the A&E. Case 2, the patient was intubated and was sent to general ward (instead of ICU care). ICU physician will not accept a “hopeless” case.
Question: Are we, the doctors were doing the right thing?
Why we allow the patient and their family made this obviously irrational decision?
After all, there is a 101% definitely treatment and the treatment is the only option and yet….refused by the patient. Furthermore, patient is “IN” the hospital, which mean their wants treatment and should surrendered their right (treatment choice) to the doctors.
It’s time to be be rational.
After all, we are doctors and who else had the rights to do so.
We choose the best option for the patient.
Patient autonomy is stop here. Period.
I sure the patient will eventually accept the fate of losing their legs and yet survive to see their children grow up and getting married. I will even accept that I may get scold and get sued by the patient if he wakes up and realize his leg is long gone. It’s definite worth it.
Too bad, we just don’t push hard enough!!!!!!!!
We just being too nice and it’s unethical to be soft and too chicken!!!!
IT IS EITHER MY WAY OR NO WAY.