Medical Anecdotal Report
Indexing Title: PCORACION’S MAR [15-04]
Title: An Unusual Patient Request
Date of Observation: February 2015
Tag: Physician’s right to refuse a patient’s unusual request
Category: Professional/Ethical – Reinforcement
A gray-haired, plump woman in her late fifties approached me at the emergency room. She was holding a prescription in her hand. I thought it was a patient who had a query about her medications. To my surprise, she asked me to write a prescription for a surgical instrument, FORCEPS. She added, “Pakilagyan po ng size. Iyong kasing laki po halos ng ruler.” (Please indicate the size, the one that is as big as a ruler.) I was perplexed. I asked her what she needed it for. She said that her back was itchy all the time and she wanted something to scratch it with. I was even more baffled by her retort. I pressed with more questions like, why would she want forceps when there are commercially available products designed specifically for the purpose she needed, where did she get the idea that forceps can be used to scratch ones back and why didn’t she consulted a dermatologist for her itching. She adamantly claimed that she just wanted something to scratch her back and that she has tried several objects to do it but were unsatisfactory. She further claimed she came across the forceps while she was at Bambang and she did not want to consult a dermatologist because she knew nothing was wrong with her back. I tried to make sense of it all. I had a gut feeling that there was something that I was missing. I said to her, “Maam, ang forceps po ay isang instrumento na ginagamit pang-opera. Hindi po dapat ginagamit iyon na pangkamot dahil baka masugatan pa ninyo ang sarili ninyo at lalo pa kayo magkaproblema. Marami pong nabibili na iba’t ibang gamit na pangkamot sa likod. Pwede po kayo tumingin sa mga mall, sa palengke at grocery stores. Masmaganda din po na magkonsulta kayo sa dermatologist para po matulungan kayo sa pangangati ninyo sa balat.” (Maam, forceps are surgical instruments that are used in operations. It is not good to use it to scratch your back because it might injure you and cause more harm. There are a lot of available products that are specifically designed for scratching one’s back and you look for them in malls, markets and grocery stores. It is also better that you consult a dermatologist to help you with your skin problem.) She frowned saying, “Ok po.” (Ok) then left.
(Physical, Psychosocial, Professional/Ethical)
(Discovery, Stimulus, Reinforcement)
Physicians will encounter a lot of patient requests. Some are valid because they are about medical records, treatment plan, payment and so on. However, there will be instances where the requests or demands are invalid. We give in to these requests at times because of our nature of wanting to please and satisfy our patients. Compromise is done by some because they don’t want to lose the rapport they have established with the patient.
We have been taught about patient’s rights and physician’s rights and responsibilities during our days as medical students. We know that these are the foundation of a physician-patient relationship. In my patient interaction, was the refusal of her request legally acceptable? According to the American Medical Association (AMA), physicians cannot refuse to care for patients based on race, gender, sexual orientation, or any other criteria that would constitute invidious discrimination, nor can they discriminate against patients with infectious diseases. In this regard, I did not violate anything. AMA further states that physicians are ethically permissible to decline a patient when: 1.The treatment request is beyond the physician’s current competence; 2.A specific treatment sought by an individual is incompatible with the physician’s personal, religious, or moral beliefs; 3.The treatment request is known to be scientifically invalid, has no medical indication, and offers no possible benefit to the patient.
Since the request is known to have no benefit to the patient, its refusal is permissible. Though this is just but a minor issue, one should always keep the abovementioned statements in mind. It will guide each of us when we have potential patients and patients whom we have entered a physician-patient relationship with.
ROJoson’s Notes (17jan4):
Just to repeat:
Physicians are ethically permissible to decline a patient’s request for medical treatment when:
1. The treatment request is beyond the physician’s current competence;
2. A specific treatment sought by an individual is incompatible with the physician’s personal, religious, or moral beliefs;
3. The treatment request is known to be scientifically invalid, has no medical indication, and offers no possible benefit to the patient.