Dear Nurse,
We are not going to take this old man to the CT scanner. You asked me why and I told you the reasons. He is a 91-year-old nursing home resident. He has a GCS of 3, his right pupil is fixed an dilated, his blood pressure is 212/95 and he has a heart rate of 54 bpm. The paramedics say that he had a dense left hemiparesis when they arrived and now he is unconscious.
I can see that you have a smart navy blue uniform and your badge says that you are the "Acute Stroke Lead Co-ordinator" or something, you are obviously a very important person. You can threaten us with clinical incident forms all you like, but I totally agree with the med reg on this one, going to the scanner would be a pointless waste of time, money and effort. There's no need to quote the NICE guidelines at me, I know what they say, but sometimes you have to ignore the guidelines.
Unfortunately, this man is going to die - CT or no CT - and what we should be doing right now is trying to make his last few hours as comfortable as possible. He needs care and to be allowed to pass away with dignity. He does not need a CT scan.
regards,
Dr M. Anderson
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9 comments:
The age-old problem of the unqualified being put into positions of power. Having a protocol to follow is fine as long as common sense is also used so that unnecessary suffering is not incurred. Nurses should nurse and leave the doctors to make the decisions about what treatments/tests are required.
It's not even 'the unqualified'. There is a distinct lack of understanding in *some* circles about when to draw the line - we've all seen it, at one occasion or another. It would be inappropriate to put this gentleman through what she was proposing. Would it change you/our management? Not a bit. Would it distress him? Yes.
Most importantly, would it be in his best interests? No. In my opinion.
Interesting post - I've come across this a few times and always wondered what others though.
As a friend of mine once said, we should treat the sick, comfort the dying, and never get the two mixed up.
"Nurses should nurse and leave the doctors to make the decisions about what treatments/tests are required."
I disagree. Nurses aren't just passive caregivers. And doctors should make decisions in conjunction along with other healthcare team members as well as family or carers, surely?
Sometimes Doctor doesn't always know best. Having said that I would agree in this particular case Michaels decision was definately the right one.
I have to agree. A patient who is 91 years of age and has OBS like that is clearly on their way out and there is very little that the medical profession could do other than to prolong his suffering. End of life care is all about, as it should be, ensuring that the patient is as comfortable and pain free as possible and that the family (where there is one) have an opportunity to say their goodbyes where possible.
I can see the headlines: 'Ageist medics refuse treatment but brave nurse steps in to save the day'.
I think sometimes it's a matter of nurses not seeing the 'whole picture'. I was called the other day to see a patient with in the terminal stages of his illness, with a GCS of 4/15 and Sats in the mid-80s because the nurses were worried he had dislocated his shoulder. I agreed there was something not right about the shoulder, but did not think there was any point doing an X-Ray, as it wasn't going to change the management. I just gave analgesia and called the MedReg because I felt at that point he should be started on the LCP (and in fact he was).
It's something I've learnt since I was a med student though- you learn not just when to treat, but when not to. Very good point you made above Stuart.
K
As a doctor who first trained as a nurse, I feel that this trype of situation has little to do with "the unqualified being put in positions of power", which is quite frankly and offensive and stupid statement to make. Nurses are not idiots nor are they handmaidens to doctors and I feel that it is very important to acknowledge that. However, I totally agree with your actions in this instance. Doctors/nurses/whoever, there are people who never know when to say "stop" and allow death to occur with dignity and peace.
we all have our SOP so we have to all ways follow the SOP
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