More from David Mendel's Proper Doctoring. I can't say I agree with every single jot and tittle of this selection, but it is thought provoking. See you Tuesday on the other side of the Labor Day weekend - or at least, we get a long weekend in the U.S.A.
The selection follows:
Patients Who Take Their Own Discharge
Patients who discharge themselves rarely come to any harm, and doctors who advise against it tend to err on the "safe" side, as of course they should. When faced with a patient who has summoned up the courage to take his own discharge, against everyone's advice, having signed all those forms, remember that he has had a great deal to put up with, and that he may not have the self-discipline to continue. He may also have motives for discharge which he is unwilling to reveal. Remember too, that you may behave in exactly the same way in similar circumstances. Your natural exasperation at the thought that all the good work may be undone, to say nothing of the anoyance at having your advice rejected "after all you have done," should be concealed. You are paid to treat the whole patient, and it is he who has to suffer the treatment. Practising medicine is its own reward, and the patients owe neither compliance nor gratitutde. It is your duty to make it perfectly clear to the patient if you feel that he should remain in hospital. Your manner must be neither hectoring nor disapproving nor threatening. It should be doctorly: if complications develop because the patient leaves prematurely, you are prepared to treat them. The patient has not "blotted his copy book," and no offence has been taken.
The selection follows:
Patients Who Take Their Own Discharge
Patients who discharge themselves rarely come to any harm, and doctors who advise against it tend to err on the "safe" side, as of course they should. When faced with a patient who has summoned up the courage to take his own discharge, against everyone's advice, having signed all those forms, remember that he has had a great deal to put up with, and that he may not have the self-discipline to continue. He may also have motives for discharge which he is unwilling to reveal. Remember too, that you may behave in exactly the same way in similar circumstances. Your natural exasperation at the thought that all the good work may be undone, to say nothing of the anoyance at having your advice rejected "after all you have done," should be concealed. You are paid to treat the whole patient, and it is he who has to suffer the treatment. Practising medicine is its own reward, and the patients owe neither compliance nor gratitutde. It is your duty to make it perfectly clear to the patient if you feel that he should remain in hospital. Your manner must be neither hectoring nor disapproving nor threatening. It should be doctorly: if complications develop because the patient leaves prematurely, you are prepared to treat them. The patient has not "blotted his copy book," and no offence has been taken.
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