It’s a decision that can challenge even experienced caregivers: How hard do I push if the patient doesn’t want to go to the emergency room?
My March 4th post discussed patients’ competing desires that create decisional conflict.
When patients have the ability to make informed and voluntary decisions, caregivers wrestle with different competing desires:
Wanting the best outcome (which they believe requires medical care)
Wanting to respect the patient’s autonomy, which means accepting the patient’s decision and its consequences.
To make it easier in the moment:
Acknowledge: “It’s your decision.”
State your position: “I think this needs emergency care.”
Explain succinctly WHY: List the benefits of going and risks of staying home.
It may help if you call on someone with a strong positive influence on the patient’s decisions.
To make it easier in the future:
After the crisis is over, arrange a time to talk about the tension this situation causes. Reassure the patient of his/her autonomy. Affirm that your efforts are motivated by desire for the best outcome—and that this same desire causes distress when you see danger in delaying medical evaluation.
Ask the patient to reflect back to you his/her understanding of your concerns. Thereafter, your knowing you were heard might help with your acceptance, whatever happens.
One or two counseling joint sessions with a social worker or counselor may help you develop a plan that works for both of you for this scenario.
NOTE: I’ve oversimplified a complex and highly charged dilemma. It’s a start.