Is the patient only the patient? How does the family factor in here? Who counts as family? Relatedly, what obligations does a patient have to a family? The family to the patient? To the community?
Relatedly from 20April14 "House Calls Are Making a Comeback"
http://mobile.nytimes.com/2014/04/20/business/house-calls-are-making-a-comeback.html?referrer=
Relatedly from 20April14 "House Calls Are Making a Comeback"
http://mobile.nytimes.com/2014/04/20/business/house-calls-are-making-a-comeback.html?referrer=
I believe that the patient is only the patient under certain circumstances. When the patient has a life or death situation, the family becomes responsible for a lot of the decisions. Family are the people that are closest and related to the patient. For example, the parents, grandparents, children, spouse. The patient has to respect the family's decisions because the patient is not the only one that is effected.
ReplyDeleteI agree with you Brian. There is always going to be times where the family has to make decisions for the patient and have to put themselves into the patients shoes. At this point, the family can become the patient. I like how you mentioned that the patient has to respect the family's decisions because sometimes the patient cannot make a decision and hasn't talked to the family about how they feel on a certain topic.
DeleteI agree with Chris on the same points. Putting yourself into someones shoes is an extremely difficult. And yes a certain amount a mutual respect must be maintained between patient and family because they may have to in the future that might affect that said patient if he/ she is incapable of making rational decisions on their own.
DeleteIn certain circumstances where the patient relies on their family or close friends in order to make a decision, then the people that are involved factor into the decision-making as much as the patient itself. I feel that the only obligation the patient has to his/her family is to prevent heated conflicts about the decisions and help them determine the best outcome for their given situation. The family, in turn, have the obligation to not let their personal preferences create a heated conflict between other family members or the doctors and respect the patient's final say in the decision.
ReplyDeleteIn nursing, we focus on patient centered care but we talk about how the patient can mean a variety of different things such as the actual patient, the family, the friends, etc. When caring for a patient, you must care for everyone who is close with that patient as well. When I walk into a room to care for a patient I always acknowledge the family but I also make sure to include them in what they want to be included in and what is appropriate for them to be included in. I believe the patient has an obligation to respect the beliefs of the family but the family also has the obligation to respect the beliefs of the patient, and in the end (if the patient is capable of making their own decisions), it is the patient's beliefs and decisions that will count.
ReplyDeleteNicely put. I think you are right, the patient and family both have the obligation to respect one another when it comes to specific beliefs and decisions, but ultimately it is the patient who gets the so called final say. I believe that since it is their life, there choices and decisions should be honored whether someone completely agrees with it or not. Sometimes it helps to talk things out and see what other people think and their reasoning behind it, and you never know, someone may change their decision. All in all, I think that it comes down to respecting one another and going with what that person would want.
DeleteI believe that patient is someone, and those who are effected that are in need of help. That help may be medical, or could even just be opening up a jar, just someone in need of help from another. The family can be considered the second patient, because they are involved, and also are effected. Who counts as the family is blood related with the patient is comprehensiveness, but if blood relatives are nowhere to be found, it would be those closes to the patient, and who the patient gives their trust to. The responsibilities the patient has to the family and to the community, is to be strong, and to keep fighting. The family has the responsibilities to the patient by being supportive and understanding.
ReplyDeleteIn my personal opinion the patient is a person who is in need of the care and skills provided by a physicain and his or her staff, and that the skills, care, or services provided are beneficial to the patient's current situation. I believe that that family should be involved in the patient's care from the beginning, if not the whole family at least some members who are closest to the patient and can make decisions on the patient's behalf if they are incapable of doing so. I would consider any one related by blood or marriage to be family and that as such should be involved in the decisions relating to the patient depending on the degree of how close they were to the patient. In this way I believe that the patient should involve the family the decision making process and convey to them what they believe should be done in the given situation so that there is the least amount of relational damage between the family and the patient, and also so that both can develop an understanding of the information given by the physician and his staff. As far as the patient's responsibility to the community I believe that they are required to to show a certain degree of understanding that the community is only responsible for so much of the patient's care and that after a certain point there may be nothing else that can be done for them to remove pain or initiate healing.
ReplyDeleteI believe that the patient is the only patient. The family can show love and support to the patient and that should be the extent of their involvement. A patient that is going through a rough time or that is very sick only needs to care about themselves. They should not be worried as to how the situation effects the family. They should be worried about getting better. I also think that the doctor should not have to worry about catering to the needs of the family. They should be focused on doing everything for the patient to make them comfortable. It may seem selfish but i think that that is the way things should be.
ReplyDeleteI believe that especially in end of life care the patient may be the center of care, but they are not the only one who needs care. With a family member being lost a part of their family and friends lives is also being lost. This is a very traumatic event and therefore these people also need treatment of a different sense. For many this can be something such as providing palliative care to their loved one in order to see them in comfort at the end of their life. For others this treatment may be elongating a patients life so they have just that much more time with their loved one. With both of these situations the loved ones of the patient would likely also be comforted if they are included in decisions made with the patients. This means maybe not actually making the decisions but being included in the physicians plans for their loved one.
ReplyDeleteA patient's obligations to their family, in my opinion, should be simply to fight as hard as they can and stay around for as long as it is comfortable for them. On the other hand a families obligations to the patient are a bit more complex. in situations where a person is awake and aware family and friends should show their support and be there for the patient. On the other hand, if a patient is unconscious the family should respect their wishes as to what should be done. This means if they have an advanced directive these should be followed.
At UC we focus on "family oriented patient care." If there is a code in the special response unit, unless it's a violent crime, we invite the patient's family, exclusive to the parents if they show up with the patient or whoever rides along in the ambulance with the patient or the person(s) who brought the patient to the ED, family or not) to be present to include them in the process of what exactly is going on with the patient. What the tube going in the throat is, what the medications are and what they do for the patient, what the surgical interventions may be such as a chest tube. We want the family to be informed and feel like part of the process. I don't know yet if it hurts or helps the grieving process should the patient pass away. (Does this make sense?) Basically whoever is present at the time the patient is brought in and the resuscitation process begins. Obviously the people with the patient can opt out of being part of the process.)
ReplyDeleteWhen I bring a patient from the waiting room to their hospital room I bring them alone, then ask the patient (if they are coherent) who they would like to come back and who shouldn't be brought back. I leave it up to them. Each circumstance is different for the individual. Depending on the reason they are there it could be embarrassing. (yes, i have many stories, lol!)
I believe that anyone who feels close to the patient, a best friend, a cousin, an aunt, an uncle, should be included. (I know what it feels like to love someone who is not blood related and feel excluded from the death process.)
Community involvement I think is relative when there is a violent fatality. Just two or three weeks ago I took a 14 year old who was shot and later died to the ER. This impacted me, the police, the family, the hospital staff and the community. It is not exclusive to the patient by any means.
In a case of some one dying, the actual patient is not the only "patient" many family members can be heavily impacted by both the dying process and the death both emotionally and finically. Family typically blood relative (mom, dad, grandparents etc.) but family can also be anyone we deem close anyone who cares for us and we care for them. The patient has little obligations to the family, as they may either be unable to complete them or death may take them before they can do anything. The family has obligations to the patient in the form of care, and post death services this includes carrying out the patient's last wishes. The family also has an obligation to the community to let them know who has past and to tie up the business of the deceased as best as they can.
ReplyDeleteThe patient is only the patient when they are able to make decisions for themselves. If the patient is in a state of mind that they are not physically able to do that then they should have someone else call the shots for them. If the patient is unable to make the decisions for themselves the next closest person should be in line. in some cases this is not always the easiest to pick but you have to believe that the right call is being made.
ReplyDeleteI believe that the patient is the only patient in regards to making decisions for themselves. If the person is not conscious or in the right state of mind to make a rational decision for themselves I do think that it is up to the family to make a decision for what they think the patient would want. For someone to count as family they must be a blood relative or a spouse. Who ever is making the decision must make sure that it is the interest of the patient and their wishes.
ReplyDeleteIt is important to recognize the patient's family as an invaluable resource. Engaging the family is a complex process that can bring satisfaction to both the patient and the physician.One consideration is the role that culture plays in shaping the beliefs, attitudes, and behaviors of the patient and physician. Cultural norms often influence the extent to which families participate in a patient's care. At the same time, they may limit the willingness of physicians and patients to involve the family and explore feelings and beliefs.I belive in this case "family" is anyone close enough to the patient whom both feel comfortable enough to be involved in the health care treatment. This will vary from person to person greatly. However, if the patient is competent, they ought to have final say in all treatment. If not, the family is to decide. Ideally, this is discussed before hand. However, it is important to realize treatment is not exclusive to the patient. Family is valuable as a source of information and as a source of power in some cases.
ReplyDeleteI believe that the patient is not just a patient! A patient could be a mother, father, sister, brother, aunt, uncle, cousin, niece, nephew, son, daughter, ect. Every patient should be taken care of like you want your family to be taken care of. I work in a hospital and i see first hand how some nurses treat patients and it is not always the best. Every patient deserves to be treated with respect and should have a say in everything. Family is a huge part in a patients life. They could be just a friend or a blood relative. If the patient says they are family and want them to be interactive with their healing process i think that the patient deserves that. I do not think a patient necessarily has any obligations to their family. The patient has a right to their opinion and the family does not have to like it or agree with it. I think the family does have obligations to the patient in which they should be their for the patient and respect their decision no matter what because ultimately it is the patients choice. I do not think the patient or the family has any obligations to the community because what the patient and or family chooses is their choice and no one elses.
ReplyDeleteI believe that the patient is not only the patient. The patient should be treated the same way you would treat a family member or friend, that is which respect for their needs and beliefs. The patient is the only one involved in the his or her care usually the family plays a major role. The family can play an important role in helping the patient recover from illness. Family can be responsible for making sure the patient takes medication and family is also important for the patient in regards to emotional support. Because of this i feel that the family of the patient should receive the same level of respect that the patient should receive.
ReplyDeleteThe patient should be treated as human being not just a patient. Family for the patient is people who care about them. Obviously not everyone can be consulted in cases where the patient can make a conscience decision on their own health, so there are "close family". The only obligations of the close family is they have to do what they think the patient would want in extra ordinary situations. The only obligations the patient has to the family is to know that the family loves them.
ReplyDeleteAlthough at first I am tempted to say that the family is just as much a "patient" as the person receiving medical care, I have to stop myself and consider who exactly is included in the family. Does the opinion of only the immediate family matter? Or just the spouse? If it includes extended family, how far does that go? Overall, while I think that the family must be taken into account when either the doctor or patient make a decision, they should not be the deciding factor when choosing what path to follow in medicine. The family has a responsibility to respect the patient's wishes, but I think the patient also has a responsibility to the family to communicate with them and ensure that no unnecessary stress comes about as a result of a patient's decision.
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