Thursday, November 19, 2009

Standard of Care

Yesterday, my husband, the alien, talked with one of the doctors at the hospital where I was treated after being hit by a car while biking. In particular, my husband was concerned about all the x-rays of my various body parts.

The doctor informed my husband that all the x-rays are "standard of care."

When I was a child, I was misdiagnosed with scoliosis. The doctor who made this misdiagnosis took two copies of every x-ray position "just in case one doesn't come out." Children are at major risk for DNA damage during x-rays because a large number of their cells are in growth phase. I'm sure that taking two copies was standard of care at the time. My parents did not know enough to tell the doctor not to take the extra copies -- that they would bring me back for more if necessary. And as I said, the man misdiagnosed me, so it would not have mattered how many copies he made. He didn't know what he was looking at. And he was providing "standard of care."

My husband does know enough to ask that the x-rays not be duplicated. He was overruled by the hospital. My question is -- does a patient or her family -- have the right to refuse "standard of care"? I should think the answer is yes. The doctor my husband talked to said the extra x-rays were necessary to see if anything had changed. I don't think broken bones change in a few days. But that was his explanation.

Even this doctor agreed that surgery should not have been scheduled without talking to me first. Maybe we are getting somewhere in changing how people are treated at this hospital. But, perhaps surgery is "standard of care" too.

I think we are dealing with rival paradigms. The hospital staff all seem to think that surgery and x-rays and tests are "good things." My paradigm is that the body heals itself, most of the time.

I had no choice about going to the hospital. I was taken there unconscious. Once there, they would not let me go home until I could climb stairs, get in and out of bed and in and out of a chair, and walk around a room. Since they kept me on opiates for the first 4 days, I was unable to attempt this test. When I was finally on non-opiate pain killers, I had gone 6 days with only one meal. I was bruised. I had had surgery. And I wanted out of there more than anything else in the world. I do not know where I got the strength to manage that test. I dread to think what other things they would have done to me if I had stayed.

The doctor my husband talked to says he'll talk to another doctor about how surgery is scheduled and how patients are informed about surgery. He didn't agree about anything else, but he did agree that a patient should make a decision about surgery before it is scheduled. The next step is to get them to agree that just because you get brought to the hospital in an ambulance does not mean you give up your rights to make your own health care decisions.

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