>Hi all
>Explained to patient that needs a intercostal drain as a probable potential
>life saving procedure. He adamantly refuses to stay in hospital. Patient
>counseled with wife and patiently explained that he could tension, develop
>V/Q mismatch and in lay language severity of condition explained.
>In spite of efforts of senior medical and nursing staff he signs his own
>discharge and insists on leaving the department. Although at the lower end
>of the standard distribution curve for IQ, he is not confused.
>What would you do?
>Danny McGeehan MB FRCS FFAEM
If he is of sound mind you are obliged to let him go. In my experience of
such patients, when they won't listen to medical staff their family can
sometimes convince them to stay. If all else fails and he is going to
leave without treatment, I would stress that if things get worse he must
return.
Phone his GP and warn of potential problem. Try to get him to reattend OP
clinic, where you can repeat CXR and where, if he is still feeling grotty,
he may have changed his mind about admission and treatment.
(Consider pleural aspiration rather than chest tube?)
Andy Johnston
Senior House Officer
General (Internal) Medicine
Aberdeen Royal Infirmary
Aberdeen
Scotland
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