Patient Focus

Abstract

As a junior doctor, you are constantly pulled in different directions by multiple competing interests. These include those of your immediate bosses (possibly multiple consultants, a registrar, and an SHO), Educational Supervisors (Clinical Supervisor, Foundation Programme Director), fellow FY1 doctors, other healthcare professionals (nurses, physiotherapists), ancillary services (laboratory, radiology), patients’ relatives, representatives of the Trust (infection control, human resources, information technology), and many others. In amongst all of these is a patient, if not many, for whom all of these individuals are also working. It will not come as a surprise that Good Medical Practice (2013) states early on that you must ‘make the care of your patient your first concern’ and ‘treat patients as individuals and respect their dignity’. In addition, Good Medical Practice requires that you: ● listen to, and respond to, their concerns and preferences ● give patients the information they want or need in a way they can understand ● respect patients’ right to reach decisions with you about their treatment and care ● support patients in caring for themselves to improve and maintain their health. One challenge is when patients reach decisions that are contrary to the best available medical advice. The archetypal case in point is that of a Jehovah’s Witness at risk of life- threatening haemorrhage but refusing a blood transfusion. In such cases, remember that: ● you should never assume what someone’s beliefs are just because they come bearing a particular religious label. It is always right to ask the patient what they believe and what they will accept under different circumstances. For example, some Jehovah’s Witnesses will accept cell salvage and some blood substitutes ● seek advice early, particularly if the stakes are high (e.g. active bleeding). Your own seniors (SpR, consultant, etc.) and the on- call haematology team are good places to start. They may direct you to other resources that you might contact (with the patient’s consent) such as the Jehovah’s Witnesses’ Hospital Liaison Committee ● document all conversations (with the patient and colleagues) carefully ● ultimately, an adult patient with capacity has the right to refuse treatments— however much you disagree and even if this ultimately results in their death.