Indexing Title: NALUDINOs Medical Anecdotal Report [05-09]

MAR Title: A difference in beliefs

Date of Medical Observation: Oct 6, 2005

Narration:

It was an evening not quite out of the ordinary. There was the constant trickle of patients at the emergency room. We were busy answering referrals from other departments and taking care of our own patients. There was one referral however which would really test my resolve.

It was a case of a 67-year-old patient who was referred by a medical clerk as a simple case of a decubitus ulcer on a patient who was suffering the effects of a previous stroke. I went to examine the patient and what I saw was not a simple case of decubitus ulcer.

The patient looked pale, emaciated, and was foul smelling. On examination of the lumbosacral area, I saw the usual signs of a chronic disease. He had skin ulcers on the sacral area and a fluctuant mass approximately 8 x 7 inches in diameter. The patient had abscess on the sacral area.

I decided that we had to drain the abscess. I went to talk to the relatives and explained the contemplated procedure. Without batting an eyelid, the first words that came out of their mouths were "Jehovah's witness po kami. Sasalinan po ba siya ng dugo?"  I told them that the patient definitely had to have blood transfusion. He had a haemoglobin level of 3.82 mg/dL. They vehemently refused, no argument would make them change their minds. There was nothing I could do but respect their belief. The patient was admitted at the ward of another department and expired on his third hospital day.

Insights (Physical, Psychosocial, Ethical) (Discovery, Stimulus,Reinforcements):

         The practice of medicine is bound by the norms of society. The patient's beliefs dictate the scope of management that can be administered. The term is patient autonomy, the patient has the right the refuse or accept treatment given him.

         There are times when the patient's belief is in conflict with ours. In such cases we must always keep in mind the principle of patient's autonomy. If faced with the same situation, all we can do is try to convince the patient or his relatives that the proposed treatment or procedure is the only choice. If however there are other options we must keep an open mind and exhaust all the other alternatives.

         If they continue to refuse the treatment, thus endangering the life of the patient, what we can do is let them sign a waiver stating that it is their decision and they will take all the responsibility for it.