What Happens When You Decline Care
As an experienced blogger I have never been too keen in sending my readers to other sites to acquire information I can pass on myself. The thing is my job is to inform on issues I deem important for my readers to know, particularly when the information is not been presented in a new way or not presented at all to the people that read this blog. One of those topics that I will send a reader to get ‘more’ information is when it has to do with certain health issues in which is better to hear it from the hoses’ mouth. I am not unique on this, every responsible information site would do the same.
In this instance I will give you an introduction to the topic of when “a patient declines care.” It just so happens that I am very experienced on this field but it is hurtful to write about it, so instead in this case I am just the vehicle for you to learn certain facts about this facet of health care. Actually most people are so ignorant how our health care system works that they would probably get a stroke and die if they knew the ‘code purple’ nitty gritty.
Adam Gonzalez
The management of major vascular emergencies in the emergency department (ED) involves rapid, aggressive resuscitation followed by emergent definitive surgery. However, for some patients this traditional approach may not be consistent with their goals and values. We explore the appropriate way to determine best treatment practices when patients elect to forego curative care in the ED, while reviewing such a case. We present the case of a 72-year-old patient who presented to the ED with a ruptured abdominal aortic aneurysm, but refused surgery. We discuss the transition of the patient from a curative to a comfort care approach with appropriate direct referral to hospice from the ED. Using principles of autonomy, decision-making capacity, informed consent, prognostication, and goals-of-care, ED clinicians are best able to align their approach with patients' goals and values.
Introduction
The priority of traditional emergency department (ED) care is on the resuscitation and stabilization of the acutely ill or injured patient. The ED is a safety net for many patients with an advanced chronic illness who present with critical "crisis" and terminal events.[1-5] The traditional, aggressive ED approach may not suit the needs of such patients and optimal care plans are best tailored to patient goals and values.[5,6] ED clinicians caring for these patients may therefore have to rapidly adapt and shift their focus from a disease-directed resuscitation to comfort care, a challenging task for many ED clinicians who may feel unprepared and untrained for such scenarios.[7-10] We present the case of a patient with underlying chronic illnesses who presents to the ED with a "catastrophic" event and whose values are not aligned with resuscitative ED care. We then discuss a framework that may assist ED clinicians faced with the transition of a patient from a curative to comfort care-based approach.
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