If an ER patient refuses treatment for medically-irrelevant reasons, what policies do hospitals have for handling such a situation?
http://katu.com/news/local/ohsu-doctor-speaks-about-racism-she-faces-from-hospital-patients
This article in NEJM offers a decision tree on how to handle discriminatory requests by patients
[Dealing with Racist Patients](http://www.nejm.org/doi/full/10.1056/NEJMp1514939#t=article)
Mentally competent patients are free to walk out of the ER at any time. A patient cannot be forced to receive medical care, including care from a physician they deem unacceptable (for whatever reason)
Hospitals, ERs and physicians are not under any legal, ethical or moral obligation to accede to discriminatory requests by made by stable, mentally competent patients.
Fictionalized account of this in Jodi Piccoult’s new book–Small Great Things.
I’m wondering if they would be asked to sign something saying they refused treatment.
If they leave without being seen or treated, yes they are asked to sign that they are leaving against medical advice. However, many will just leave.
The ER may also just reassign them to a different doctor, but they might then wait a lot longer.
^^ Yes, W and I had a bad experience at an ER once (a Mayo Clinic Hospital, of all things). We decided to leave and they asked for us to wait and sign some paperwork. After waiting 15-20 minutes we had enough (it was just the icing on the cake of the poor treatment we received) and just walked out.
I’ve walked out of Emergency before. Why bother telling them you’re leaving? (I drove a mile further to an Urgent Care and got stitched up there which I should have done in the first place.)
I don’t know if it’s still true, but in the past insurance wouldn’t pay the claim if you left a hospital against medical advice.
The central question was of an ER patient leaving against medical advise- AMA. The ER staff is dedicated to your care. If you want to leave prior to being seen, tell a staff member. Most often they will try to address your concerns, explain options or explain the reason for delay, (ex. a trauma). You are free to leave, but as an ER nurse, I always explained the consequences health wise to the patient, documented that info in the record and politely ask they sign an AMA form, if they refused, I documented that as well. I tried to understand their anxiety, pain and any underlying physical or emotional causes.
Regarding patients who expressed that they did not want to be treated by a staff member of a particular ethnic or racial group, it depended upon the emergent nature of the visit. If they needed to be stabilized quickly, the MD and staff would continue to work until a substitute could come in on the case. If it was not acute, the patient was then assigned to other staff as they became available. The idea was to keep the situation from escalating, decrease anxiety, treat the patient as quickly as possible and keep the flow moving.
It certainly helps if a patient who has a medical issue that is not a high priority to not show up to a level I or II trauma ER on weekend evenings, Holidays or snowstorms and expect to be evaluated and treated in 30 minutes. Patients just “hate to bother my MD” by calling them first! If you have something like a simple laceration, ingrown toenail, et and arrive to a full waiting room, ask the triage nurse how long the expected wait time will be. They can usually give a good estimate. Sometimes it is less costly and shorter wait time at an urgent care center.
@sly123 that’s what I thought too but apparently it’s an urban myth.
If you have the luxury of being picky and choosy about who cares for you, you probably don’t really need an ER.
Unless you have some sort of recent trauma (eg I can understand a recent rape victim not wanting a male to examine her), I don’t think the ER should have any moral obligation to accommodate a discriminatory request.
The ER/hospital I always go to is a teaching hospital. When a doctor comes in, several doctors/interns come in. I can’t imagine how much extra time it would take to coordinate which doctors can’t go into X room because of the patient’s discriminatory request.
This issue comes up frequently on my nursing forum. Most nurses who are “rejected” by the patient due to racism are ambivalent. They are offended and hate enabling that behavior. But at the end of the day, many decide that taking care of a racist patient all day isn’t a piece of cake for them anyway, so they are okay to oblige them and take care of patients who actually appreciate their efforts.
“Unless you have some sort of recent trauma (eg I can understand a recent rape victim not wanting a male to examine her), I don’t think the ER should have any moral obligation to accommodate a discriminatory request.”
Male/female caregiver preference is not a discriminatory request. It can be a matter of religious accommodation, and hospitals typically ask if there are any such preferences.
My only concern with a doctor is that they were educated in a quality medical school in the U. S. and speak clear English.
@BunsenBurner so if your religion says you can’t be touched by a Black person, is it no longer discriminatory?
ETA: I’ve never been asked by a hospital whether I prefer males or females. Not saying it doesn’t happen, I’m saying I’ve never experienced it.
I don’t personally know of any religion who would allow ER care AND requires one to continue to adhere to all “typical” social restrictions in a truly emergency situation. The commonly cited one- Islam- does not. With the exception of some fringe groups (I assume), Islamic law puts life above modesty codes.
Again, I’m referring to true emergency situations- not hospital stays, typical doctors that one sees, etc.
Just as discriminatory as when your religion says you can not be touched by a man (who is not your husband) or a woman.
Replace male/female with white/black. While one gets deference the other is considered hateful. We live in a very weird world.
“ETA: I’ve never been asked by a hospital whether I prefer males or females. Not saying it doesn’t happen, I’m saying I’ve never experienced it.”
Unfortunately, I have been through several medical procedures here… In all cases, I was asked if I had any religious objections to be treated by a male or if I had similar objections to blood transfusions. Obviously, I laughed - my surgeon was a guy. But the nurse had to ask.
“My only concern with a doctor is that they were educated in a quality medical school in the U. S. and speak clear English.”
So if you are in an ER you ask the doctor where they went to medical school?
What would you do if you needed emergency care while traveling out of the country?
Language concerns aside (which are certainly valid) and not ER-specific, but I believe there’s been various studies showing that doctors educated outside the US have better patient results.
Ah, here we go:
A 2017 article: http://time.com/4658651/medical-school-foreign-doctors-study/
“But a new study published in The BMJ finds that reputation is far from warranted: Foreign-trained physicians practicing in the U.S. had slightly better patient survival rates than their American-trained colleagues.”
And a 2010 article: http://www.nytimes.com/2010/08/12/health/12chen.html
"Dividing the international medical graduates into those who were foreign-born and those who were American citizens who chose to study abroad, the researchers discovered that patients of foreign-born primary care physicians fared significantly better than patients of American primary care doctors who received their medical degrees either here or abroad. "
I went to high school with this Dr.'s daughter. He went to med school in Italy and couldn’t speak a word of English when he came here. He learned English by watching cartoons. However, one couid barely understand him even years after he came here. I know from first hand experience since he taught a physiology seminar at my private high school that I took my senior year.
Anyone who would refuse to have this doctor operate on them (when he was alive) would be a moron.
Apparently you don’t know that USMLE tests for English proficiency as part of Step 2 CS (Clinical Skills). The point being that those who license physicians think English language skills are very important or the future doctor is not licensed.
https://en.wikipedia.org/wiki/USMLE_Step_2_Clinical_Skills