At 19:07 15/03/2011, you wrote:
>a daughter claims that her mother is incapable of making an informed
>consent as she has dementia and further claims that talking to the
>pt is pointless "as she can appear rational one minute and not the
>next so talk to me and not her". You ignore this and talk to the pt
>who indeed appears quite lucid rational and appropriate. daughter
>now wants her sedating and sectioning. i refused and now have to
>answer a complaint from the daughter. would you have done anything different?
>Incidentally pct's never expunge a complaint from ones file even if
>one is not found to be at fault. They code complaints by type eg
>clinical or attitude and add them up over time which can trigger an
>investigation. Thus one can be cleared but still found effectivelyto
>be at fault merely becos
> pts have complained. is this right? is it a breach of human rights?
In some senses I have been on both sides of the situation you
describe, ie as doctor and relative.
The question really revolves around the competence of the examination.
Best case (from various points of view) daughter is entirely wrong,
Mum just has a bit of age related memory deterioration or nothing at all.
Worst case (again from various points of view) Mum's mental state
does fluctuate significantly. Daughter had tried to indicate how a
doctor might notice this and doctor had ignored this. After daughter
complains Mum is further reviewed, daughter's assessment of Mum's
mental state is fully correct and justified, and Mum is in need of
proper psycho-geriatric assessment and management.
Of course even in the latter situation the extent to which you would
sedate, section or anything else is a separate matter of clinical judgement.
All that said twice now (within 10 years) we have had problems in the family.
On the first occasion a relative was "written off" and was going to
be binned, when actually with the right care they were able to return
to a fully independent life for >5 years, while on the second
occasion there was some difficulty in getting the services to realise
just how ill someone was.
As to the second point, I don't think it's illegal, but we may all
draw our own conclusions about whether it's fair.
Julian
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