As hospitalists, we are not only treating the patients in the hospital, we are also comforting, talking and listening to the family members, friends and loved ones who visit the patient in the hospital.
Input from family members can be extremely valuable in making the right diagnosis and formulating a patient-centered goal of care. They can provide information about things the patient did not remember or failed to notice on his own.
I have had several instances when the correct and timely diagnosis was possible because of critical information provided by the family members. I try to talk to the family members and get some collateral information about any patient’s symptoms before I make any major medical decision.
Having said that, there are times when we need to respect the autonomy of the patient. Some patients frankly tell us they do not want us to share any medical information with one or a few members of their family. In those cases, it takes the moral burden off our shoulders as we are simply complying with what the patient wanted.
At these times if that particular family member calls us for information, we simply tell him/her that the patient wanted to keep these things confidential. That can be somewhat heartbreaking for that person, but they eventually respect the privacy of the patient.
Moral and ethical concerns for the physician arise when the patient is not able to tell us whom they would and whom they would not want the information to be shared with.
Sometimes, there are two sides of the family, each telling us not to share the information with the other side. This is when a written power of attorney for health care is something that will help the patient’s interest greatly. It is a simple document that tells us whom we listen to when making medical decisions for the patient when the patient is not able to communicate.
Life is as unpredictable. As physicians working in the ICU, we see evidence of it every day. None of the patients who end up in the ICU in a critical condition planned to be there that day. I think that is why everyone should plan for the unexpected and get a power of attorney for health care document made.
It is especially important if there are any conflicts among family members and you know who would be the best person to look out for your interest. Sometimes, it can be different from a person who loves you the most. It is especially true if you have suffered from a chronic medical problem for a long time. You may be miserable and wishing that they leave you alone and not pursue treatment options that are invasive and painful and only serve to prolong your suffering.
When you assign a person who loves you so much that your demise would literally mean the end of the world to that person, that person may not be in the right state of mind when critical decisions need to be made. It is in your best interest to designate someone who respects you and knows you very well, but would still be able to think and make the right judgment in a stressful situation.
After all, you want that person to be able to use his/her best judgment to predict what you would have said if you were able to talk.
Nabin Sapkota, MD, is board certified in internal medicine and is a hospitalist with the Inpatient Physician Associates of Columbus and is a physician with the hospitalist program at Columbus Community Hospital. His book, "The Secrets of Modern Medicine Revealed" can be purchased online at www.medicinerevealed.com.