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?

I would take it a step further back and consider what the GP was doing. No one gets admitted to a medical bed in the current NHS for investigations and physio without there being some symptoms to justify the request for a medical bed . There must have been some suspicion of a problem or a test result for the admission to be agreed. Perhaps you could ask the GP what they suspected was wrong.

Sorry for your loss.
Definitely go to PALS & complain about the lie the dr made.

Sorry your mum passed away but 79 is a good age and old people do sometimes die unexpectedly. Hope you get to the bottom of it.

I work in Paeds but all our GP referrals go through a&e to be triaged and assessed, then they may go to the children’s assessment ward which is the equivalent of MAU, where you would then get admitted to a ward if necessary. As far as I’m aware you can’t go from GP to ward. Not in any Trust I’ve worked in at least.

OP absolutely go to PALS, I would be tempted to take it further than that.

At the time your mother was completely able to express her wishes and this should have been documented accordingly. Regardless of what the doctor get was best interest, they falsified notes.

GP admissions are sent through A&E to be eyeballed before going to the ward. This is to stop very unwell rocking up on a ward that may not have a doctor there all the time. But it shouldn't take 6 hours!

A DNR is a signed form, a copy stays in your file and one you carry. Possibly different as an inpatient but my Mums was done at the hospice. To my knowledge it is not a decision to be made in a rush.

Ask for a review if you have concerns.

In the area I work in the DNR forms have been replaced with "respect" forms.

www.resus.org.uk/respect/

Here are FAQ which cover various scenarios

www.resus.org.uk/respect/faqs/

Here is a blank form

www.bsuh.nhs.uk/library/wp-content/uploads/sites/8/2019/02/ReSPECT-Form-v2-writable-3.pdf

Did your mother have one of these? It makes it much easier to see the level of treatment the patient wishes for.

I’d be furious with the A&E doctor. I’m so sorry for your loss op.

I would also be furious about the Norovirus and MRSA risk. Has this now been completely normalized in the UK now? Is it just accepted that any time an elderly person goes to hospital they might die from an infection unrelated to their original illness just because our hospitals don’t have the resources for good enough infection control? It’s absolutely terrible IMO. Everyone should be more angry about the state the NHS is in. Why is everyone so complacent? Why aren’t people taking to the streets in anger? All of us are at risk of losing loved ones or their own lives due to nothing more than our politicians (and to some extent the British public) not giving enough of a shit about the NHS to turn things around.

Sorry for the rant OP but I’m really angry for you and the loss of your mum, and the loss of a thousand other beloved mums who die due to our poor healthcare standards. If anything this upsets me more than the DNR thing which, while wrong, probably didn’t play a part in her death.

@BeepOpsiePie people regularly take to the streets in anger but unfortunately it doesn’t actually lead to more funding. Things will only get worse as private companies cherry pick profitable services to deliver like elective orthopaedics and the nhs is left to care for what’s left with minimal resource. The conservative government probably doesn’t help but realistically labour didn’t do us any favours with the PFI deals either. Ultimately the nhs needs a complete overhaul to sort things out AND a funding injection.

Beep “ Is it just accepted that any time an elderly person goes to hospital they might die from an infection unrelated to their original illness just because our hospitals don’t have the resources for good enough infection control?”

I think it’s accepted generally, one of my friends died for similar reasons after being admitted and he was only 35.

Sadly we found out after that his admission was also questionable.

Re Norovirus, would rooms help with reducing the spread?

@Jomarchsburntskirt. I do take your point. However, let’s see how you might feel at 78 and a half, when you’re still independent and planning a trip to Italy and you get breathless and a young Dr says “well, you’ve had a good innings ...DNAR”.

Not having a go at you, just saying that I used to think 60 was old til I reached 58.

BeepOpsiePie I think you’re overstating the risks. NHS Acute trust’s have a MRSA /MSSA and C.Diff targets which must be met to achieve payment goals. Most have fewer than five cases a year of MRSA, for example. Something like 35% of the population carries MRSA at any time. Most people aren’t harmed by it. Often elderly people acquire it from relatives but it has a more serious impact because they are frail.

Norovirus is usually bought in by thoughtless visitors. It’s got a rapid spread rate so may have spread before the first person can be isolated. It’s not necessarily about poor infection prevention and control practice in the hospitals- which is probably better than its ever been.

@Beep.... thank you. There’s much to be very angry about. I just have to choose my battles. However, the Dr writing the total opposite of what we indicated is right up there!

@CherryPavlova. To be fair though, there was one Zimmer frame, used by all patients. I saw it being passed about and my mum insisted it be wiped with her Detol wipes before she touched it. She had a footstool which she shared with the lady next to her depending who was sitting out.

That’s very unusual about the zimmer, physio are normally quite picky about patients having their own, set to correct height etc so that may also be worth feeding back

That’s very strange. A DNR is a signed legal document, not just a comment in the notes.

When my grandfather went into hospital towards the end of his life, we had to bring in the DNR certificate, as the nurse on his ward told us that unless she had seen it in person, they would have to attempt resuscitation if his heart stopped.

I'm so sorry for your loss. I would definitely go straight to PALS and potentially a solicitor

Sorry I don't know why there's a cup emoji.

@farmertom...am just having a cuppa, so that’s fine!

Sorry for your loss, OP

What ever the Dr wrote in the notes,and if incorrect is obviously wrong,no staff you have would have taken action on it.They would look for and old Dnar form(from prior to this admission,) or a new Purple RESPCT for which is done early on a hospital visit about how the patient wants to be treated and as part of that whether they are for revisitation.
Patients wishes are taken into account but as you found in the end treatment can be adjusted as the need arises.
I know it is hard but good for your Mum that you were with her when she died and relieved that you didn't have to see her resuscitated.
Qn a seperate note hospitals are dangerous places full of vulnerable people.There are also hundreds of visitors,entire families all over the wards as they were not in the past.Most routinely ignore all the hand gel and notices asking them to use before entering a ward and then amazed when norovirus takes hold and spreads so quickly.MRSA is not so common but when these do occur patients are not moved to or from affected areas,which is why the ops mother was stuck where she was.

This is fucking horrific, I’m so sorry OP. I think a lot of people are missing the point, the doctor LIED on the medical notes. There is ZERO excuse for that.