Blaming “difficult” patients for lack of informed consent

A surgeon asked me to share her story of blaming “difficult” patients for lack of informed consent.

When I was a surgery resident, I saw a severely ill hospitalized man who needed a leg amputation and our attending surgeon and senior surgery residents never adequately explained to him why he needed surgery. Each morning on rounds, they kept asking him if he was ready for a leg amputation. Our patient would cry and say he didn’t want his leg chopped off. . . he didn’t know why it was necessary. The surgery team treated him with disgust . . . labeled him as a difficult patient and just walked out of the room. I think it’s extremely dangerous when doctors label patients as difficult or crazy. Everyone was calling him crazy. He was not known to have psych disorders. . . They said there is no point in even talking with him because he is completely unreasonable. It’s a very normal emotion to be scared about an amputation. Yet calling him difficult and bipolar stopped our team from conversing with him. . . .

Finally he asked me if I could explain why he needed surgery. I promised him I would. I talked to our attending surgeon and told him our patient was open to life-saving surgery; simply that he did not know what the surgery entailed, and that he was refusing because he was scared. I asked if the attending surgeon would talk to him and he said, “No.” He said if I wanted to I could, but then he also reprimanded me for staying in the hospital too long and being an inefficient doctor. At 9 pm, after I was finally done with my tasks, I sat with our patient and brought a copy of his angiogram so I could explain why he needed surgery. It was inappropriate for me as the junior resident to be the one telling him but I did my best . . . He was so thankful I spent time explaining his condition. When he understood the pros and cons and risks of surgery he decided to proceed with amputation the next morning (he could have died from gangrene otherwise). I told my seniors about my conversation. I was never thanked for my work. They just kept calling him “bipolar” for supposedly changing his mind.

WHY do doctors act this way?

With no labor law protection and no mental health care (& punishment if we seek help), some surgeons working 100-hour weeks just go numb from all the suffering. Cut off from our own emotions, doctors make fun of patients who still have emotions as “sensitive” or “crazy.” And ridicule peers who spend time with them as “inefficient.” Dehumanizing others is our defense mechanism—to avoid feeling our own pain. Because If we could feel our pain, we’d be flooded by a tsunami of tears that would incapacitate us. Doctors (over the years) have actually told me they’ve lost the ability to cry, so maybe our cries for help come out as ridicule, insensitivity, and bullying.

“If you don’t heal from what hurt you, you’ll bleed on people who never cut you.”

Full conversation with surgeon here.

Dr. Wible’s article on informed consent

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One comment on “Blaming “difficult” patients for lack of informed consent
  1. Cindy Bode says:

    I understand exactly what you are saying in this article. All too many times I have seen the progression of diabetic foot ulcers from debridement to full-blown amputation. This progression is so avoidable if we only had the time to spend with patients to talk about nutrition and body care.

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