Last Updated Nov 2012
I find that most patients are almost too willing to give up their freedom when they are in a hospital. They are too eager to allow us health care providers do whatever a doctor orders, even when they don't want to do it and are scared.
To be honest, this is scary. It shows that fear can drive a person to be eager to give up freedom.
I'll give a couple of examples:
- You go into a patient's room to give a breathing treatment. The patient is scared because he is short of breath. You go to give the breathing treatment and the patient says, "I've had 20 of these already and they don't do any good. Why am I getting them?" You say, "Because it's part of an order set for pneumonia," Or, more likely, you'll say, "Because the doctor ordered it." The patient says, "Oh, if the doctor ordered it, I must need it." Actually, what the patient is saying is "I'm willing to give up my right to choose because my doctor knows what's best for me and couldn't possibly make me do something that's not needed."
The truth is, breathing treatments are useless for pneumonia, and that patient would be wise to use his freedom to choose to refuse that respiratory therapy treatment method. Yet I find it rarely ever happens.
- You have a patient in the Emergency Room who's short of breath with a rising CO2. You are ordered by the doctor to put the patient on a BiPAP. The patient is scared of being short of breath, yet terrified of the BiPAP. The patient refuses, yet the doctor comes in and says, "The patient is a full code and must be put on BiPAP! Talk her into it and put it on! It's for her own good. Either we do this or she dies!" So now you force it on the patient against her will. You, as a health care provider, have intentionally trumped the freedom of that patient "for her own good."
The example here might be replaced with an intubation. A young 25 year-old comes in and is afraid to be intubated, yet he can't breathe. He is obviously a full code, and even if he refused we have to do what's best for that patient. So do we respect the wishes of the patient, or do we sedate him and intubate him against his will? In many cases, I think the doctor would trump the patient's wishes.
- You have a patient with kidney failure who is a regular patient of the hospital. His heart rhythm and blood pressure are erratic and life threatening. Just because his heart rate is high and blood pressure erratic he falls into a category that mandates the unit secretary ordering the sepsis order set. As part of this order set is an electrocardiogram (EKG) and a blood gas.
Surely the EKG is indicated regardless. However, the blood gas is an invasive and painful blood draw and there was no scientific need for it. Surely you can get a pH from this blood draw, yet you can also get it from your normal venous blood draw too as I described here.
As I enter the patient's room and do the EKG and go to draw the blood gas, the patient says, "I've had many of those and I don't want that again." I make sure if he's okay with it, and he says "absolutely." So I tell the doctor and the doctor goes belligerent and tells the patient that if he's going to refuse everything he might as well go home and die. The doctor makes the patient get the blood gas against his will. The patient is pissed and insists he's going to go over the doctor’s head to complain. I tell the patient I wish him luck, but no matter what he says, doctors are treated as gods around here. The patient grows to love me for my humor and honesty. Yet he's irate his right to refuse a procedure was trumped by the doctor.
I think these are the ethical issues in health care that would be interesting to debate. You have most patients too willing to give up their freedom because they think an expert knows what's best for them, and you have the expert who forces his will on the people.
In an eerie way, this sounds Orwellian. In an eerie way, it sounds too much like what is going on in Washington. It seems we have experts in Washington (from both parties) who think they know what's best for
us, and they make rules (laws) for us to follow, like our tax money goes for things we don't approve, and then they force us to comply which strips another freedom. Because many of us don't know any better, we "assume" these experts know what they're doing, yet most of the time they don't.
So at what point are we too willing to give up freedom? I think the answer to that is when we are ignorant. Ignorance breeds fear, and fear makes us eager to give up freedom. The solution to this is education. I think everyone should be taught about health care in school. Everyone should know about what health care providers do in the hospital.
Yet if we kept educating the masses, politicians would lose control, big businesses wouldn't sell so many products, hospitals wouldn't be as busy and they'd all lose profits. Since this is a money driven world, perhaps money is what drives our ignorance and fear. The powers that be -- the elites among us -- want us to remain ignorant.
What are your thoughts on this? Share it with us by leaving a comment below.
About the Author: Rick Frea is a licensed and Registered Respiratory Therapist and author of the Respiratory Therapy Cave. He provides some wonderful content for those in the profession of respiratory therapy, or those seeking to learn more about the profession. He paints a realistic picture of life as a respiratory therapist with a unique blend of irreverent humor, clinical experience, career development and advice for new RTs. He's also a lifetime severe, persistent asthmatic and asthma dad who shares his experiences at Hardluck Asthma." He also writes a weekly column as an asthma expert for healthcentral.com/asthma.
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