DrVirgo
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A 25 year old male comes in due to a 1 week history of headaches, runny nose, nausea, fever adn general discomfort. His temperature is 100.9F. The physical exam reveals mile meningeal irritation without other findings. The patient is informed about the need for hospital admission and subsequent lumbar puncture; however, he replies with "I refuse to have that procedure!" What is the most appropriate way to manage this situation?
A. Let him go home
B. Force him to stay in hospital against his will
C. Counsel him properly about the risks of having untreated meningitis, let him go and state he can always come back.
D. Have him sigh a paper that says he is aware that he can die if he has bacterial meningitis that is left untreated.
E. Explain him everything over and over until he understands, stays in hospital and allows you to do a lumbar puncture on him
Please explain why!
Thanks.
(neuro 2-13)
Edited by DrVirgo on 11/12/07 - 08:49 PM
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| neuroblastoma
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C. Counsel him properly about the risks of having untreated meningitis, let him go and state he can always come back.
1-Couseling is always important before starting any procedure.
2nd-- always respect patients desire.
3 offer help, always there to help,come back anytime.
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| neuroblastoma
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A.u cant just let him go...without COUNSELING
B.U CANT FORCE OR GO AGAINST PATIENTS
C--is answer
D--cant take such type of consent without proper counseling
E--OVER AND OVER Explanation wont help-cant force --he refused the procedure
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| DrVirgo
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Yes, you're right C is the right answer...
However I have seen a very similar question like this and the answer was:
Admit and treat against his will because meningitis is deadly and he is a risk to others... I don't remember where it was from -somewhere in UW -maybe ethics or Infectious Diseases... so I was wondering what you think...
I agree with everything you say (counsel, respect wishes, etc...), but if the patient is a risk to others, then isn't it the doctor's obligation to treat?
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| neuroblastoma
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DrVirgo wrote:
Yes, question like this and the answer was:
Admit and treat against his will because meningitis is deadly and he is a risk to others... I don't remember where it was from -somewhere in UW -maybe ethics or Infectious Diseases... so I was wondering what you think...
yeah,,,You are absolutely right.. may be the scnerio and the way they asked the question is different.
in this ques,,choice E doesnt fit here
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| neuroblastoma
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this ques might be asking most appropriate next step----> COUNSELING part. explaining again again may be the counseling part also.
BUT in answer choices COUSEL word" is in choice C TRICKY
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| DrVirgo
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Ok, I found the other similar question, here it is:
-This question is from Psych (UW)
A 42 year old man presents to the ED c/o a two day hx of fever o f104 F, headache, and vomiting. PE reveals petechiae, and purpura on his trunk and lower extremities. Exam of his cerebrospinal fluid is consistent with bacterial meningitidis. The patient is told of his diagnosis and th eneed for antibiotics and hospitalization is discussed. The patient refuses to be admitted to the hospital, however, and insists upon being treated at home. What is the most appropriate next step?
A. Treat the patient against his wishes
B. Discuss the situation with the patient's wife and ask that she convince him to accept hospitalization
C. Consult with the hospital ethics commitee
D. Respect the patient's decision and arrange for home antibiotic therapy
E. Obtain a court order to proceed with treatment.
(UW Psych 1-30)
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| darkhorse
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in the first case...its not proven that he has got meningitis...all u can do is counselling...in the second one....its a proven bacterial meningitis...he is a health risk to others...so u have to treat him against his wishes if u have to!
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| cool doctor
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in the second one he has petichia.so this is meningiococcos infection which is highly contagious and a life threatening condition.
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| tamerbashir
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iam with e
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| DrVirgo
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Thats exactly right dark horse and cool doctor... also in the second case they say the need for hospitalization is already discussed, so next step is to treat against his wishes since he is a threat to others.
darkhorse wrote:
in the first case...its not proven that he has got meningitis...all u can do is counselling...in the second one....its a proven bacterial meningitis...he is a health risk to others...so u have to treat him against his wishes if u have to!
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| neuroblastoma
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well, both questions are totally different
first question, asking for the need of procedure(LP) ---So first tell him all risks /benefits of doing procedure
second question is.. LP(CSF) --already diagnosed Meningitis----so u must treat him.
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