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Occasional ramblings by an anesthesiologist/mother (and sometimes her husband).

Wednesday, August 29, 2007

Musings on Inappropriate Behavior

I've been thinking a lot about inappropriate behavior at work, especially in light of a few incidents that have recently (in the last few months) cropped up in my presence. One was based on the behavior of nurses and the other the attitude of an Ob/Gyn attending physician.

The first incident basically amounted to a series of comments made by a nurse about a patient and the patients family after the patient was asleep. It was a young man having a circumcision at later than the usual age in this country. She assumed it was the decision for the procedure was made for cosmetic reasons and then went on a rant against the parents for not doing it sooner. She proceeded to talk about how gross it was to see an uncircumcised penis, and how any parent who doesn't circumcise their son should go look at the 80 year olds at the local VA to see how nasty and infected they can get. When reminded that many Europeans don't, she then made a comment about European's lack of bathing. Maybe I'm a little sensitive, because I've had experience with the other side of the coin, if you know what I mean, but I found her whole attitude inappropriate.

But that's nothing compared to this story.

Female, middle aged coming in for a gyenocologic procedure. A resident noticed the "refused" box is checked with regard to blood products. In a conversation with the pt, she reveals that she is studying to become a Jehovah's Witness and as a result does not want blood products. The attending is informed and proceeds to spend the next 10 minutes lecturing the patient, saying things like "we'll only use blood as a last resort" and eventually browbeating her into changing her decision. I was watching this incident and couldn't help but notice the look on the patient's face. I have no doubt she acquiesced out of fear and pressure from her doctor. Now the argument could be made that the patient was not fully rooted in her beliefs and that's why she changed her mind, but watching the behavior of that attending, I would also not be surprised if the patient was implying that the surgery would be cancelled if the patient did not change her mind. Frankly I was appalled at the attending surgeon's behavior. The odds of the patient actually requiring a transfusion were incredibly low and the discussion was almost unnecessary. It was almost as though the attending wanted what they wanted at all costs. As far as I remember from my ethics classes, a patient has a right to refuse any treatment. And, unless I have a question about their competence I have to respect their wished. Now I might have asked the patient if they were sure about their decision, but what galled me about this is the length of time the attending spent pressuring the patient to change her mind.

Any thoughts?

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Blogger Judy said...

I posted to my blog about JW's in the NICU and in response was left a link to a site which describes their beliefs in regard to transfusion as "moronic". There was quite a bit of other nastiness as well.

It's not the only care decision which inspires such animosity in health care "professionals", but I've seen a lot of self-righteousness on the subject.

Both the nurse and the physician were seriously out of line IMO.

9:55 PM  
Blogger Kristen said...

AAAAAARRRRRRRGGGGGGGHHHHHHHHH! Yes, both totally out of line, no question.

8:23 AM  
Anonymous AmandaB said...

I've thought about your post all day - well at least half of the day. This particular nurse says things to get attention, or just talks and spouts off to whom ever will listen, highly immature and unprofessional. I do believe the doctor was right. JW is a cult, a dangerous cult. They have misinterpreted an Old Testament scripture about eating the blood of animals and applied it to transfusions. The attending may have just been covering himself legally too. If a child of a JW were brought in they would allow them to die before receiving blood. It has happened numerous times.

5:35 PM  
Anonymous muscleman said...

Nurses are well known for making derogratory comments about male
patients and their penis's. I
just think its great when they lose
their job over it. Never met one
that I thought was a true professional.

1:17 AM  

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