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sunny2
Forum Elite Topics: 51 Posts: 373 |
47 year old sebastian carlos pestana comes to the emergency department by himself with three day history of fever-101, headache, nausea and vomiting, with petichiae and purpura on his trunk and legs, CSF result shows bacterial meningitis, carlos is then told that he would need hospitalization and antibiotic therapy...hearing this he gets annoyed and wishes to go home rightaway as he has to attend wedding of his dear daughter mellisa O'neil, he insists upon being treated at home. What is the most appropriate next step: 1.Respect patients decision and treat as per his wish 2.Treat the patient against his wishes 3.Refuse to treat him 4.consult with the ethics committe 5.Ask his wife and kin to make him understand 6.Arrange for a family meeting and try to have a decision 7.give him time to think over 8.explain all the consequences and ask him to visit you tomorrow 9.let him attend the wedding and then decide 10.leave him alone
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GDS2008
| Forum Senior Topics: 9 Posts: 128
2. Treat the patient against his wishes (beacuse he has N. meningi infection) and if not treated and allowed to go home will be a threat to others. Obviously, in such cases U have to treat patients regardless of their wishes (public health safety is more imporant)
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study_ing
| Forum Fanatic  Topics: 179 Posts: 2261
i wud agree with GDS. ithink nisserial meningitis wud classify as an emergency
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frank100
| Forum Guru Topics: 47 Posts: 548
yes, he cannot refuse hospitalization because this is an emergency, but he is free to decide if he wants to get treated or not. so, hospitalize him and put him in isolation is obligated, but treatment is not an obligation. The question does not say anything about his hability to take desicions on his own, so I consider he is capable to take desitions. sunny, you´re trying to push us to pick (2), but treating someone against his wishes, is never a good option. *you need at least 8 days for culture (definitive diagnosis), and for suspicion you need a clinical presentation. AND for CSF results you need at least 24 hours, so when the CSF was ready he must have spent, at least, one night in the hospital plus antibiotics only for the clinical suspicion...so I think sunny presented a perfect world were labs are ready STAT. so elimination time!!! 1. respecting patients desicition would be harmful to to rest of the town, since he wants to go to a public social meeting. 2. You are "evil" and you want us to pick this one, but it is never the anwer. 3. you never refure to treat a patient. the closest to thi one is "not to treat" but "refure to treat is a NONO... 4. ETHICS COMITEE is lazy, and never want to work, so is never an answer, unless the problen is extremely tricky. 5. sound good, since you (as a doctor) failed to convince him, maybe his family will. 6. a family meeting can take time, and a quick desition is need. 7. this one is unconclusive, because: how much time will he require? 8. suggesting going out of the hospital with a diagnosed meningitis is not a good option. 9.no 10. no my answer: option 11. persuade him to stay in the hospital and get treated, because this is an emergency and outside the hospital he is dangerous and what he has is highly contagious.
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frank100
| Forum Guru Topics: 47 Posts: 548
maybe (5)
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GDS2008
| Forum Senior Topics: 9 Posts: 128
I agree with you frank, but man that is not one of the options right......I mean U cannot argue with the questions makers to include a particualr option. On the exam, we are bound to pick the best answer, so just pick one man.
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sunny2
| Forum Elite Topics: 51 Posts: 373
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frank100
| Forum Guru Topics: 47 Posts: 548
I hust did!! I picked (5). but of course is wrong....but I go fot this one....
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icemaiden
| Forum Senior Topics: 9 Posts: 117
8
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cbenitesch
| Forum Senior Topics: 10 Posts: 137
We need to determine if the guy is a competent patient or not... I think is competent, so he can refuse the treatment, so the next step could be plan subsequence treatment, enlist the family, call other health care member. But ethics say "All competent patients have the right to refuse or discontinue treatment as this will not harm other parties... I´ll go 6. I´ll make sure he will not leave the hospital until family come!!!...
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tolito
| Forum Junior Topics: 119 Posts: 2136
ok. guys. i never was good at these pt dr things. can someone please help out with a few of the conditions where you treat a patient against his wishes???
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juanma0
| Forum Senior Topics: 10 Posts: 148
I go with GDS2008´s initial answer, 2. This patient poses a threat to himself and all close contacts (which will need prophylaxis if N. mengitidis is confirmed), he has to be treated. There is similar case in Kaplan where the man has TB and is involuntarily commited for treatment.
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sunny2
| Forum Elite Topics: 51 Posts: 373
Answer is : 2 agree with GDS2008 explanation.--meningiococcal meningitis ( clue was : Rash ) Patient have the right to refuse treatment except when doing so would pose a threat to the health and welfare of others. frank100, wife and kin are not present in the question scenario and you would not want him to go out . In this question in choice 8, if I would not have written "ask him to visit you tomorrow " then perhaps the best next step would be this answer as according to the protocol you have to First try to convince him by whatever it takes on the scene in the hospital and only then If he keeps on insisting that you detain him and treat. Tolito, I believe Infectious dieseases and some psychiatric problems are the ones which may give you the right to detain the patient against his wishes for the welfare of others. Guys, it's very easy to go wrong on these types specially in that adrenalin rush of wrapping those 9 hours 
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