Doctors SHOULDN’T get to “play God” ... AIBU

[MissKittyBeaudelais]

My mum went into hospital as a planned admission, in autumn last year for:-
Medication review
Tests into breathlessness
Physio

Despite admission being arranged by GP, we were told she HAD to go through A&E. She was there around 6 hours and was then placed on a small ward. Whilst in A&E, the Doctor who admitted/examined her talked about end of life and resuscitation. This is standard practice. The Dr. went on and on about what MIGHT occur in the event of resuscitation ie, stroke, fractured bones, brain damage, damage to internal organs etc. My mum insisted that, knowing all this, SHE STILL WANTED TO BE RESUSCITATED. The Dr. continued to push her message and eventually, I asked the Dr. to cease as I felt she was trying to persuade my mum into agreeing to not being resuscitated.

My mum was 79, lived alone, was fully independent and still drove. Her home had two separate staircases and her bedroom was on the top floor. Two days before being admitted, she was shopping in John Lewis for a birthday gift for me and we joked that I hoped it was a suitably expensive and frivolous gift! Remember, she’d gone into hospital for tests. Arranged by her GP. She wasn’t expecting to die. She was put on a ward with MRSA and Norovirus. Ten days later she had got an infection, deteriorated and died.

We requested the medical/nursing care notes as we were not happy with her care. When they arrived, I was really shocked to read the A&E notes in which the admitting Dr stated that both Mrs X and her Next of Kin (daughter) agreed NOT TO RESUSCITATE. I’m fucking furious. I never said that/signed to that. My mother never said that/signed to that. Remember, she was in for tests and physio. She NEVER expected to die. Neither did the family.

AIBU here? Did this Doctor just decide to play God? I remember, when the examination was over, my mum jokingly said “remember Dr, I want anything and everything doing to keep me alive!”

Can a Dr just decide to do this? How does she sleep at night? Ought my Mum/I have been asked to SIGN something to say we agree/disagree?

What would YOU do?

This sounds odd. For a DNR it has to be a signed form and not just written in the notes.

No it absolutely is NOT okay and if you want to take it further head for PALS.

So sorry that you lost your Mum and felt so let down by the health service.

Personally? Complain factually do not get emotional or off topic names dates places the lot

I'm appalled she had to go through a&e she should have gone through MAU or similar

And I'm sorry for your loss

I am so sorry for your loss OP.

As above - PALS, complaints procedure, factual & non emotional, hard as that will be for you right now.

You need to start with a formal request for copies of the alleged signatures that were used to facilitate the DNR notice. When the hospital is unable to produce these, you will get heard.

This is not okay but I do feel it probably goes on more than imagined. We agreed for my grandmother not to be resuscitated, she was 96 and very unwell. Doctor seemed surprised that we 'gave in' to their wishes very easily and suggested that they usually have to try hard to convince families to sign a DNR.
Very sorry for your loss.

A dnr is a form and cannot be just words from the notes. you need to speak to PALs at the hospital to make a formal complaint

Take this to as high up as you can. This doctor, do you have his name on the notes, has to be held accountable.

Hi OP. I'm sorry this has happened to you.
I work as a medical professional and I just wanted to say that a dnr is a medical decision (bring on the flames). You can't request to be for resus although good practice dictates that the patient and family are involved in the decision making process.
Its a tricky situation. It sounds like medically it may have been a justified decision BUT it should have been made clear to you and they definitely shouldn't have written anything untrue in the notes.

They can only resus someone who'd heart has failed. If she caught an infection she would've had whole organ failure probably and even if the notes were down correctly they wouldn't have been able to resus her.

You need the copy of the notes from the last days of her life where the decision was made (and should have been clearly documented), that resuscitation would not be medically appropriate. Someone must have made that decision and it should have been communicated to your mum and preferably next of kin.
The A&E Dr was clearly in the wrong for writing a lie in the notes though. And I would be kicking up a big stink about that.
I’m sorry your mum caught an infection in hospital, they can be bloody dangerous places sometimes.
Do seek answers.

Irrespective of whether or not the decision was correct at the time OP has a valid complaint if the admitting doctor had falsified the entry in her records.

Firstly, I’m sorry this happened to your mum. It’s such a shock when sudden complications happen that seem completely out of the blue.

As someone has previously mentioned the decision to resuscitate is a medical decision and is based on different factors but mainly how likely it is that resuscitation will be successful. A patient (or their family) cannot request/demand resuscitation. They can only refuse it in advance.

However, the notes should not have stated that you or your mother had agreed when you hadn’t. It should have stated something like resuscitation was discussed and a medical decision was made that your mother was not for resus, and you were informed of that.

The issue is more how it was recorded in the notes and conveyed/not conveyed to you/your mum than the decision itself.

I would contact PALS and ask to see their resuscitation policy, as well as giving a list of questions I would like investigated/answered.

OP I’m so sorry to hear this

Both my parents signed DNR forms. I’m not sure if it’s something that varies according to your local health authority? But it was discussed before hospital admissions and not only did they have to sign but I think one of us was asked to be there. I remember because I had to be let in outside normal visiting hours.

I’m sorry you lost your mum.

I’m confused by the “planned admission” by the GP. It doesn’t tend to work like that - a GP can arrange a direct admission which means you may need to transit through A&E or a MAU/SAU (medical or surgical admission unit) as in some trusts they don’t allow direct admissions to wards.

Ultimately a DNAR is a clinical decision, not a family or patient decision, but it is usually made in conjunction with the patient or family.

The doctor should not have recorded false information in the notes.

IME doctors rarely want to play god - they make difficult decisions based on clinical presentations and outcomes. Someone can be admitted in a fit and well state but deteriorate rapidly with multi organ failure, catastrophic infection, cerebral infarct etc.

Are you having a meeting with the Complaints Manager for the hospital?

In the nicest possible way - it sounds as though your DM died from a serious infection. Not a cardiac arrest.

In which case, CPR would not have been appropriate & the end result would sadly have been the same.

By all means, speak to PALS to investigate whether everything possible was done to prevent your DM from acquiring an infection. All wards have MRSA positive patients at some point. All wards have D&V patients, flu patients etc. So A&E really couldn’t have avoided placing her on a ward without infection. However, infection control practices need to be tight to stop these things spreading around.

Lastly, your GP was concerned enough to send DM to hospital to be admitted for tests. That decision is not usually made lightly. This does suggest that she/he suspected an underlying illness of some severity. This could well have been something that had already weakened her immune system leaving her more susceptible to bugs/infections.

You absolutely do need somebody to explain exactly what happened to DM. TBH, they should have explained fully at the time. And any concerns you have regarding poor care need to be addressed also.

I’m very sorry for your loss, and of course there should have been no DNAR in place if nothing had been signed. But on this occasion, it doesn’t sound as though that error in DMs medical notes made any difference at all to her care or passing.

Im so sorry this has happened.

I completely agree that you have not been given the truth here.

My mum died in similar circumstances and I felt railroaded by the medical staff who made decisions that I feel now I should have questioned but I was in a state of shock and trusted them.

Im so sorry for your loss OP.
You should at the very least complain through PALs . If you are alleging medical negligence on the doctors part you will need to show the time line of events in as much detail as you can . I cant tell you where or how to submit this though as I have no personal experience of doing so,

I’m really sorry about your mum.

I agree that you should have a factual conversation with PALS and arrange for discuss with someone exactly why decisions were made and explain about your concerns re incorrect notes.

Its not ok that the decision was recorded that you agreed, however Drs do not have to resuscitate. Its a medical intervention, and medical professionals are not obligated to do it.

Firstly, I'm so sorry for your loss OP.

I would have to say that:
As someone has previously mentioned the decision to resuscitate is a medical decision and is based on different factors but mainly how likely it is that resuscitation will be successful. A patient (or their family) cannot request/demand resuscitation.

Is absolutely correct. I imagine the decision at the time was based on how likely it was to be successful and the prospect of long term recovery.

it sounds as though your DM died from a serious infection. Not a cardiac arrest.

Everyone dies from a cardiac arrest. Different things, like serious infection, eventually cause cardiac arrest but everyone that dies has one.

I'm so sorry to hear about your mum

However this is a common misconception - a DNR is decided by the doctor in the best interests of the patient. It is a medical decision.

Yes agree with above-dnr is a medical decision and the burden should never be placed on family. It sounds like this was worded very poorly. When I have the conversation I make it clear the decision is mine but I am seeking their views. The patient and relatives are not required to sign the form. In the event of family disagreeing with the medical decisions we are legally ok to still sign the dnr however in practice this rarely happens and we do resuscitate against our better judgement. It really isn’t about playing god-resuscitations are rarely successful and even when the circulation is restored the person may never regain consciousness. It’s brutal and we have a medical duty to let you know that. We need to be having conversations much sooner, including in the community. Although you mum did just go in for tests and physio, any patient may develop further issues that complicate things particularly when elderly even if not frail.

None of this is meant to be unkind and I am very sorry for your loss. This is as much about medics being better at the conversations as well as family understanding their wishes are factored in but do not override the decision.

I would speak to PALS as the incorrect information in the notes is not good and it’s incidents like this that prompt learning for us so we get better.

While I understand you are frustrated at going through a&e, often going straight to medical admissions is no better as they have no time targets and often people are waiting in chairs for many many hours to be seen. At least in a and e patients sometimes get initial assessments and observations done as well as treatment.

Yes I know everyone's heart stops eventually @MGC31. I wouldn't be a very good nurse if I didn't. I think the point I was trying to make was also quite easy to understand.