Why Seek Medical Help Then REFUSE Treatment?#453 Part 2

that shit again . So look , let's , let's jump into this question . Ok , we got a question from frequent listener , frequent writer in Jamar , and he says going to send an Instagram link to a reaction about anti-science , slash , anti-modern medicine patients that visit the hospital anyway just to refuse treatment .

I wonder how often you are all dealing with this today versus before COVID or even 10 years ago . Apologies if I missed this discussion on a previous episode from Jamar , so he sent us this Instagram link , alfred , if you can share that part .

You accept the risk for you and your children , hospital and we adhere to the standard of care based on what we diagnose your child with , and you decline the treatment and then you make a real uh , almost to paint the picture that we are egregiously giving you some type of crazy medication and forcing you to come into the hospital in the first place .

That's the part that just doesn't make sense to me . I don't know what the reasoning is . I don't know if you want validation from others in your ilk , but no , you're taking up the emergency room bed for somebody who actually needs it and is there to actually receive the help that we provide . So I never understand .

But as my parents always used to say , wisdom has chased some of you , but you have been consistently faster .

And so he's reacting to that , essentially asking why'd you come into the hospital then ?

I'll start . Can I go first ?

But this had nothing to do with COVID or anything like that . It was pure monetary . But it doesn't happen in my realm at all because most of the no , it doesn't happen in my realm , but I feel like you've told me things like you know people like don't want to get transferred all the time it's very .

it , you go . I don't know if you see that issue . I mean , we see that in OB all the time , all the time .

Right , that's a big one that sometimes people will refuse . You have patients who just refuse tests . You know they don't want to . You know they get to like 40 , some odd weeks , and they're getting to like 41 weeks , close to 42 weeks , and you're like , okay , might want to be induced now . And they're like , no , don't induce me , don't induce me .

I've had that . And you're like , okay , but the risk of a fetal death is higher . As you get closer and closer to like 42 weeks , things like that , they'll be like , no , I've I've had people you know come to me for prenatal care and be like , well , I really want a home birth . I'm like , well , why did you come to the doctor ?

I don't understand why you came to the doctor if you want to do everything at home . Like , I'm not quite understanding . I guess my question is exactly what Jackademic asked is why are you here ? You know , like I'm not mad that you want to do things a different way , like that doesn't bother me at all .

But what is very curious is why are you here fighting with me when you don't have to ? Like you know you don't have to be here . It's not mandatory for you to come to the hospital .

So there's always this kind of relinquishing of blame on them , because if you keep the child at home and the child can't breathe and you say , well , I'm not going to the hospital , there's nobody else to blame but you , that's it .

So why bring the child to the hospital if you're like , well , I don't want any of the treatments , it's like , well , then , she's just sitting here , like she could have just been sitting at home .

Either they're intubated or they're about to die , or they're uptunded . They don't know what's going on , or you know they're drunk and they're refusing things because they're drunk . But even then , when they're legally drunk , they can't make decisions for themselves . Anyway .

It's afterwards where we have some people sign out against medical advice because maybe they want to get home soon , or they you know , like I got to take care of X , y and Z , like we see that a lot in elderly patients , where you know one person who's taking care of their family member , their spouse or what have you you know .

Let's say they're both in like their late 70s or 80s . One person is usually healthier than the other , right or perceived to be healthier than the other . That person falls , maybe breaks ribs , but they still have to take care of the other person because the other person is home by themselves , so like I gotta go home , I gotta get home , right ?

The other thing that we see also where it's just like ah , why'd you guys do this ? Is the dnr . You know the people who have like like advanced directives and maybe they're at a nursing home or a facility and they come in and you're just like , well , it looks as though like you guys have already made a decision that you don't want any aggressive care .

Why come to the hospital ? Those are the type of things that we get , but I have not seen , at least within the realm of trauma , of I'm refusing what you're offering because of X , y and Z . I haven't seen that yet . I'm not saying that it doesn't exist , because if you're a trauma surgeon , you're listening to the show right now .

If you've seen it , write in and let us know .

Maybe she's maybe in her , like she's definitely in her third trimester at this point in the pregnancy , but like early third trimester , and so we test her for diabetes and she rules in right away .

And so we're like okay , well , it looks like you're at least a gestational diabetic , but there's a possibility that either you've had gestational diabetes in the past or you are just diabetic , you know , and you've delivered these big babies in the past , or whatever .

She got so insulted she did not like what we were saying to her , so we , you know , recommended that she start on insulin because her sugars were through the roof . She was not happy at all . Eventually she left . By the time she came back , maybe about a week or two later , unfortunately , her baby had died .

But the question of OK , but why did you come to the doctor if you already knew what your plan was going to be ?

He does very well on social media . He has a podcast where they're trying to debunk medical myths , medical uh , oh , um jocelyn yeah , yeah , and I was like good and I was like this is this will be great .

But I mean , we are at a point where , like even the knowledge that we talk , what we speak , is being questioned , and when we get to that point , like there's no coming back .

Well , what I've noticed also is not only is there issues among patients questioning us , there's even issues among our own colleagues , right where you have your own colleagues who are questioning vaccines and that we do have , and that's the part where I'm like all right , this is going to get crazy now .

for various type of , for various priorities or for various agendas , that is very scary . You know that's really scary because what it does is it delegitimizes the entire . You know our health care , you know what we do and stuff . So I know folks who are going to listen , who who lean on that side .

They're not going to like what I have to say Because I've seen that firsthand of how , even within a service , if you have one person on and they believe certain things that are specifically related to anti-vax or anti-establishment type things , you bring that up to a patient . That person goes off service .

You come on and you talk about tried and true practices , standards of care and all these different things . Now , all of a sudden they don't trust you but you're the only surgeon or know surgeon or your only you know practitioner on call . What happens in that situation ? You know that's a problem . Yeah , I think that's something that I don't know .

There's no answer for that , right , but people are going to feel the way how they feel .

Different people do inductions different ways , right , and we I definitely have seen times when you know , let's say , my colleague might try to induce somebody and you know the person doesn't necessarily make progress at the point at which I come on , and then I might come in and I might do something else , and then they'll ask like , well , why did the other doctor

do it this way , or whatever .

And I always try to smooth things over because the reality is , for something like that , right , for something like induction specifically , it might just be a matter of preference , right , where you say , okay , well , the previous doctor did it this way , it's not wrong , it works for other patients , maybe it just didn't work for you .

So I'm going to try this other way to see whether or not this will work for you . And sometimes it works and sometimes it doesn't , and so in that way it's a preference . Sometimes it works and sometimes it does , it doesn't , and so in that way it's a preference .

What you just mentioned is a huge issue in that what colleagues might be saying is literally like the opposite , Like no , like that doesn't work , right , like that thing doesn't work . You know , don't take the vaccine or whatever it is doesn't work . You know , don't take the vaccine or whatever it is doesn't work .

But my question is if you're telling patients not to do certain things that we know are standard of care in medicine , what else are you offering them ? Because to say , well , no , the vaccines don't work in this , I'm like that's fine , that's fine . But what are you offering them in terms of helping them to protect themselves against

these viruses that might be out there ?

If we start to get more and more folks who are of that ilk , as Jackademic says , you know it becomes very difficult , you know , to even practice standard of care medicine . It will become , you know so . Yeah , it's going to be very difficult . That's an interesting question .

But , jamario , listen , we appreciate you writing in , we appreciate you asking for our opinion and yes , we did see this 10 years ago as well . I don't see it that much . Renee may see it more .

Where you start to have , you know , basically even within that realm , it may not be refusing because they don't , but basically I see sometimes patients start to become very like , almost like they want to treat their care like a la carte right when they're like well , I don't want this , I want that , I don't want that , I want this .

And it's like well , in order to get to B , you got to go to step A first right . In order to get to C , you got to go through A plus B to get you to C first right . Like there's got to be like a standard that we're following . That part can be really difficult . We do see that in trauma at times too where people want to skip a lot of stuff .

Like if you have an issue with a vendor and you want to mediate , you can get an advocate for you . Like I would love to have an advocate who can come in and talk and say , hey , listen , like what happens in a situation where patients are asking for certain things and we don't do it that way , right , we skip certain steps .

Who's in the right , who's in the wrong ? How do you meet ?

Almost like an advanced directive for , like any issue that comes along . Right , like if this , like , okay , so you don't want Tamiflu , correct , I don't want Tamiflu . Okay , if you're . You know , if your child should now go into , you know , respiratory distress , what would you like ?

Right , because we can offer this , this , this , what , what things on here don't you want us to give your child if your child goes into respiratory distress ? So , like a menu , essentially a menu like okay , respiratory distress , I have this for you . No , I don't want this .

I don't want oxygen , I don't want , you know , I don't want a nebulizer , I don't want a non-rebreather , I don't want to .

You know , tell us all the things you don't want , so that that way we know , okay , if you're going to refuse Tamiflu , what else are you going to refuse , so that we're not wasting resources , you know , on things that you don't want done to your child or to yourself . I think that that's fair .