Lin Sessions: Rapid Ethical Decision Making in the ED

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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN
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Christopher C. -

I couldn't agree more with Jill Baren when she says that practicing ethical medicine is a way to help deal with issues related to burnout.
For those who are reluctant to change their practice because they're not quite sure how this plays out I can offer the following:
When I have a discussion with a patient about their healthcare decisions I often document something similar to this

"Mr/Mrs. ____ and I had a discussion regarding the risks and benefits of various diagnostic and therapeutic options. They were able to express understanding and were of sound decision making capacity at the time of our discussion. Based on their current value system, along with shared decision making, they have decided too...."

If there are specific things I think should be mentioned I will add them in - for example, "He is aware that by refusing to stay in the hospital for IV antibiotics and I&D by hand surgery there is a chance he could lose his hand and he is willing to accept that risk. As a means of decreasing that risk I have offered oral antibiotics for home along with analgesics and encouraged him to return if there are any new or concerning symptoms or if he changes his mind."

I find that this is far more satisfying for me than making him sign and AMA form. It respects his autonomy and my humanism.

Jill B., MD -

Chris - I think you documentation example is excellent and thank you for sharing!

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