Case Study: Physician Discretion versus Patient Choice

Given that the patient or their relatives may have opposing ideas to those of the medics, is it ethically permissible for the medics to stick to their original plans despite the client giving valid alternatives?

I was on the nighttime shift when a 12-year-old boy was brought into the ER after being injured in a bicycle accident. The boy's parents later claimed that he began demonstrating obsessive behavior after losing a close buddy in a vehicle accident. For months, the youngster had avoided family excursions and even refused to be dropped off at school by his parents, preferring to cycle to school. He would always close his eyes whenever he saw a speeding car. And the parents suspected that this compulsive behaviour might have led to his loss of concentration while on the road. My colleagues concluded that the boy was suffering from the Obsessive-compulsive Disorder (OCD). The patient had suffered an elbow fracture, an ankle sprain and several bruises around his chest and stomach. He had also lost blood through a piercing on one of his thighs that had gone beyond the skin into the muscle. It was recommended that he should be put on a Fluoxetine medication after he is taken off the Hyperbaric oxygen therapy. The parents indicated that the boy had developed complications when on multiple medications in the past and they feared that the situation may worsen. They also noted that his long hospitalization may completely drain their savings.

Psychological

I felt sorry for the boy and his family because he was to take medications for two different conditions recurrently. My opinion was that the boy needed emotional support and counselling during and after the treatment to deal with OCD. The medications were likely to overwhelm his system which was also dealing with the injuries. Treatment of the injuries sustained from the accident could have gone on uninterrupted but the mental problem would have been solved through alternative means. The boy had lost a close friend and now had to stay away from his family and the rest of friends for at least five weeks due to the combined medications that had to be monitored closely by a medic.

Socioeconomic

The length of hospitalization was stretched meaning that the family had to bear a heavier financial burden. The extra medication that could also have been substituted with other intervention also led to a rise in the costs incurred in the treatment process. The family has also been pushed out of the OCD treatment process. However, it would be important if the parents and siblings would have been involved since they understand the boy and have lived with him since the condition set in.

• family dynamics

The family showed willingness be enjoined in the OCD intervention. The parents indicated that they had given the boy all the support including granting him his wishes to avoid cars. A family-centered intervention on the boy’s OCD was a viable alternative. The parents talked to me and indicated how they felt frustrated that the medics resorted to drugs rather than involve them. They felt that the medication was unnecessarily expensive and strained their incomes.

Critique

The main issue in this case was lack of a patient-centered system where the family is also involved in the decision-making process. The cost of hospitalization and medication since the boy had to stay under the watch of medics who monitored how the drugs for the two conditions worked. There was need for a patient-centered service provision system where the patient and their kin is actively involved.