Written by Anna Karsten
Quick question: are your patients really aware of their medical status, the truth of the condition that they are in? Your answer might be that they are supposed to know and that is correct, but do they? I have come across a number of patients that do not really understand why they are in hospital other than they are sick or hurt. However, one specific case lingers in the back of my mind when dealing with this topic.
The consent of the governed is not consent if it is not informed – Edward Snowden
It was a 16-year old male that got stabbed to his chest on the Friday night and I attended to his care the Monday morning. He developed two pneumothoraces and one haemopneumothorax, additional to that one of the stab wounds extended into his right ventricle of his heart. The injury to the ventricle had to be repaired and the doctor performed a median sternotomy. As I was about to conclude the session with the patient, he asked me why they – the doctors – had to cut his chest open. I was dumbstruck as I did not really think about asking him about it, to be honest. I was more focused on his physical condition and neglected his emotional state. I had to think hard about my answer. I began with inquiring what he remembered of the night he got stabbed and brought to hospital. He told me that he did not really remember much. I had to sit down next to him and subtly break it to him that when he got stabbed not only his chest got injuries but his heart as well. And due to the heart injury the doctors had to operate to repair it to prevent complications and possibly save his life. The tears ran down his cheeks as he began to cry. I comforted him with the fact that he is “okay” now and alive, on his way to recovery. The question kept bugging me, and I thought to myself :”this is enough”. I also want an answer now: who’s responsibility is it to inform patients of their actual medical condition?
Taking into account the injuries mentioned above, it can be understood why he is so traumatised, especially after hearing about the heart injury – that, in fact, one of the vital organs of the body. A pneumothorax, as defined by O’Toole (2013), is the infiltration of gas/air into the pleural space, causing a lung collapse. In this patient’s case, his pneumothoraces were a result of the stab wounds that permitted the entry of air (O’Toole, 2013). A haemopneumothorax on the other hand is the accumulation of both air and blood in the pleural cavity (O’Toole, 2013) and in this patient’s case caused by the stab wounds and the bleeding of tissues. This was managed by putting in ICD’s to drain them. The heart was repaired via the route of a median sternotomy. A median sternotomy involves an incision of the sternum and is then opened to perform heart surgery, where after it is sutured with steel sutures (O’Toole, 2013).
Not informing a patient of these conditions and procedures bring me to patient consent and openness/transparency. Batho Pele requires health professionals to provide their patients with good information regarding the services available to their disposal AND allowing patients to ask questions and responding to them honest and frankly. The patients rights charter ensures that patients need to give consent for any medical or related treatment, protecting both patient and professional. With regards to obtaining minor consent, the process is slightly different to this of an adult (HPCSA, 2008). According to the HPCSA guidelines, children aged 12 years and older are legally competent to decide on medical treatment only (Child Care Act). However, in an emergency where there is no time to contact the legal guardians, health care practitioners consider what is in the best interest of the child and proceed their management (HPCSA, 2008).
The video below discuss the difference it made in a patient’s life after she actually gave well informed consent:
Treating patients that are not fully aware of their medical condition is difficult because part of my job description is education. How can I educate a person if there is no foundation for me to build further on? Going back to varsity and seeking help with regards to this, I was told that it is not my job to break bad news and counsel patients. And I fully understand this, but again, I can’t flourish in my job if another does not do their job. So what do I have to do? Just leave the patient in pain, rejection, depression? No, I will just have to put on my big girl pants and start adulating in my profession. I have to consult the doctor and involve a social worker possibly.
Looking back at the incident and all of the others that followed, I had to make difficult decisions at times. Not only were some doctors not willing to help me in this cause, but I had to consult my clinicians for referrals to social workers because “students are not competent enough to refer patients”. With that being said, I might have made a small difference in one or two wards in one hospital, but it was a start. A start of getting professionals to take responsibility for their profession and what comes with its job description. It was the beginning of patients being able to say: this is my life, my health and I know what is going on!
We need to teach our patients as part of our patient education drive the following:
Health Professionals Council of South Africa,. (2008). Guidelines for good practice in the health care professions: informed consent (booklet 9). Pretoria: HPCSA. Retrieved September 29, 2016 from http://www.hpcsa.co.za/downloads/conduct_ethics/rules/generic_ethical_rules/booklet_9_informed_consent.pdf
Health Professionals Council of South Africa,. (2008). Guidelines for good practice in the health care professions: national patients’ rights charter (booklet 3). Pretoria: HPCSA. Retrieved from http://www.hpcsa.co.za/Uploads/editor/UserFiles/downloads/conduct_ethics/rules/generic_ethical_rules/booklet_3_patients_rights_charter.pdf
Mosby’s Medical Dictionary. (2013).M. T. O’Toole (Ed.), St Louis, MO: Elsevier/Mosby
Russo, R. (2007). Informed Consent [Video file]. Retrieved September 29, 2016 from https://www.youtube.com/watch?v=OhOiSGcbbps
The Department of Public Service and Administration, South Africa. (2014). The Batho Pele Vision [Presentation]. South African Government. Retrieved September 29, 2016 from http://www.dpsa.gov.za/documents/Abridged%20BP%20programme%20July2014.pdf