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?

Ah i see OP, my confusion was that i couldn't understand why a relatively healthy older lady was admitted to hospital via AE for routine tests.

My FIL has some sort of swelling in his throat, to the extent it almost killed him one night up at the pub when food got lodged there, went to AE, sent home, then ENT outpatients 2 days later, balloon stuffed down his throat to reduce swelling, back home 4hrs later.

If it were me, i'd be v angry not only at the DNR debacle but that your mum, without surgery, died from a preventable infection, that would have happened regardless of what the AE Doctor wrote.

The situation you faced is nothing like what my Mum had after her stroke, everyone was so kind and understanding, esp in regard to the DNR discussion and end of life care.

A DNR was added to my nanas notes. She didn’t sign it. It was added when she was diagnosed with mesothelioma. We found this out after she died due to the asbestos link and court case. They don’t always ask and pals didn’t care.

@Jasjas... I AM angry. I’m also very scared. When I was working in the nhs I thought we were short staffed, struggled to get equipment (shared a lot, between wards 😐) but NOW! Jesus, it was like a mad house. I’ve had some health issues in the past few years and I’m now very scared that I might have to be IN a hospital. It’s bad enough having a condition but it never used to be that you died because ...

It was the weekend and there weren’t enough staff
You waited too long for an ambulance/theatre slot/bed
You caught an infection and died which was in no way related to your admission
You ended up with sepsis because a pressure sore developed. Swabs weren’t sent/antibiotic treatment not given at correct times.
No one checked your urine output and you were quietly in retention and unable to tell them.

Fuck me. No wonder people would rather avoid admission at any opportunity.

@Davincitoad ... love the name!

You’re right about no one really caring. On my ward, staff greeted patients/relatives with a smile, introduced themselves. Didn’t happen on MAU. They constantly got her name wrong; it’s such a little thing but it really upset me and my family.

Also upsetting that we had to mither for her death certificate. It seems they were having difficulty finding a dr who’d actually sign the thing. The Dr. who treated her on a 12 hr shift period and was in attendance up to the last minute of her life, would not sign it. All SO upsetting.

What was on her death certificate? What did she die of?

I have worked on a care of the elderly ward before, and we put DNACPR's on patients if we thought it would be futile, e.g. heart failure cancer, something serious that means the person is unlikely to return to a reasonable standard of living.

If there was a reasonable chance, then a DNACPR was not applied, regardless of age. So an 85 year old who'd just had a heart attack that had a high chance of going into a cardiac arrest that could be successful shocked, etc.

A DNACPR is a medical decision. Patients have the right to accept or refuse treatment, not to demand it. It is only discussed with patients and families as part of good practice, as people often think it means the doctors are 'letting them die' or 'giving up.'

I'm sorry about your mum. Anger is a stage of grief, but it doesn't sound like anything was done wrong.

“ Anger is a stage of grief, but it doesn't sound like anything was done wrong.”

It sounds as if lots of things were done wrong and now the news re the death certificate. OP once again, I’m sorry you went through this.

So sorry for your loss OP.

I never understood how a DNR is playing God though. The reverse is true.

If someone's heart has stopped, God's made that decision. Resuscitation is interfering in nature surely.

Lots of posts here missing the point.

Yes, of course whether resuscitation should be attempted in the absence of a DNR is a medical decision.

However, if a DNR is in place it is not the decision of the medical staff - the patient has already stated they do not want resuscitation efforts.

Did these notes prevent staff from attempting to resuscitate in a situation where resus could have been effective? Unlikely. Still, it’s not acceptable for any medical staff to misrepresent a patient’s wishes on something so fundamental (or indeed anything at all) in their medical records. That’s abhorrent.

Blimey I can't understand why so many people are missing the actual point. It might not have made a difference in this case, no. But that doesn't mean that it won't make a difference on other cases elsewhere if the doctor is falsifying notes.

@Deathgrip - a DNR does not mean the patient has requested no resus. It means a doctor has made a decision that it is in the best interests not to resuscitate.

@weaselwomble - the reason people are saying it doesn't make a difference is because whether the patient agreed or not the DNR would stand. Of course there is no excuse for incorrect notes. But the patient agreeing or not wouldn't affect the DNR.

Just thinking from a slightly different perspective....I wonder if it may have been a mistake in the documentation rather than the doctor playing God. If I had just had a conversation with a family about resuscitation and believed the outcome to be that they had agreed with the decision not to attempt CPR the first thing I’d do would be to formally record that on a ReSPECT/DNAR form as well as document the conversation in the notes. I wonder whether, given that that doctor apparently didn’t do the accompanying form (as it sounds like you had to nag to get it formalised when the time did come), they actually meant to write the ‘not’ bit of their entry, or whether they were distracted by something and made a mistake. Fortunately in the absence of a proper form documenting the resus decision it is vanishingly unlikely that the free hand entry in the notes would have been acted on. I wonder whether the learning point for the doctor here may be to double check what they’ve actually written once they’re done.

Sorry for your loss. I hope you get the answers to you questions/concerns from the hospital.

Did you actually read my comment? The OP is upset that the notes have been falsified. That's the point everybody is missing, and it being irrelevant to the outcome doesn't make it OK.

Her cause of death was Hospital Acquired Pneumonia. I think it’s a catch-all.

Hospital notes do get falsified
I made a complaint (which was upheld) about my Dads care in hospital just over a year ago
I could prove it as had photographic evidence that his drug charts had been altered
4 months ago same happened again - Dad was in hospital with pneumonia - care charts showed different to reality including meds administered - I had been there with him and had proof
Sadly he died a few weeks after and I have to let it go or it would destroy me further

It means she caught a chest infection in hospital, as many sick and frail people do.
It’s not a catch all. You need to be reasonably sure why someone died to fill out a death certificate, otherwise it needs to be referred to the hospital.

If she caught the chest infection in hospital, what was she admitted with? Was it a heart problem?

Also, I understand you are grieving, but as a nurse surely you know that people with MRSA and norovirus get admitted to hospital (because they are unwell, where else would they go?) and that precautions will be taken to stop other people catching them?

Your OP made it sound like your mum caught an infection from the people with MRSA, when in fact she was in poor health and developed pneumonia. People will read this and be scared to go in for treatment in case they ‘catch something’, as a former nurse surely you know it is common place for people with infections to be present on a ward, and is certainly no reason to complain?

Referred to the hospital = referred to the coroner

I just read on your previous posts that she was in heart failure. This would have been why she deteriorated so rapidly. CPR would not have been in her best interests, as her heart wasn’t working properly. If the heart stops and is restarted with CPR, it is damaged. An already damaged heart will not be able to take it, and so it will be futile.

I’m sorry for your loss, it sounds like your mother’s deterioration was quick. Have you thought about bereavement counselling? It might help you work through your feelings of anger and sadness

I think it is you that misses the point. The decision to resuscitate or not is a clinical decision made in the best interests of a patient. A patient can sign an advanced directive saying they would not want to be resuscitated and the medical team must consider that. They are not obliged to follow it, in law. The DNACPR is something different and is not about patients saying they refuse resuscitation. It is a clinical decision form recording a decision that resuscitation is not appropriate at the time the decision was made. Some have a review date but most don’t. They are never about the patient consenting or otherwise. A patient signs to say it has been discussed, nothing more.

Ok, so my point with the Dr. and the whole DNAR is this...

The admitting Dr. Asked the question. She received a reply, in VERY clear terms. She then wrote in a legal document that she had discussed possible outcomes and we understood and agreed to DNAR.

The fact that in the end it’s a clinical decision made by the doctor, is irrelevant.

There is no playing God.

What treatment is offered is a medical decision.

I resuscitate people for a living and I would never, ever seek for my mother to be resuscitated at that age.

I’d feel better if the notes had said “DNAR discussed with patient & NOK. Patient not in agreement”. Yes, it’s irrelevant. But to say she and I agreed is not true.

She didn’t have heart failure. At no point did I suggest that. She’d had many investigations all NAD. It was an “unknown”. I didn’t say she died from MRSA/Norovirus. I said, she sat on a ward and deteriorated and, because she was seen as fairly well, she was just left until one morning when, found to be very breathless she was put on an NIV and was dead 3hrs later.

@trixiebelden77 well, there’s my answer. A previously fit and well woman, independent and self caring, dismissed “at that age”. I hope I’m never under your care.

I’m so sorry you lost your mum, in my experience it is so much harder when you weren’t expecting it.
Only you know exactly what was said in that initial conversation with the doctor and whether there is any way she could have mistakenly believed that you agreed with the DNR. Falsifying medical records is unacceptable and you should complain if that is the case.
However, given that your poor mum deteriorated and died so quickly from an infection it seems that it was probably clinically justified and you should never have been objecting to the DNR in the first place. I’m a nurse and I see this all the time at work - elderly patients who would never survive a resus in any meaningful way are shocked and appalled when the doctor recommends a DNR. There are lots of fragile elderly people who manage just fine at home but a simple infection or fall ends their life. I now live overseas and if the patient doesn’t agree with the DNR they are resuscitated against medical advice which is always, quite frankly, horrific. It is a blessing that in the UK that the decision is not the patient’s.

I meant to add: I think the discussion RE the futility of resuscitation should be a gradual, ongoing discussion with the GP prior to hospital admission when appropriate. It is horrible that the first time someone hears that their health is too poor to warrant it is when they are already at a hospital.