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?

@CherryPavlova if that was at me, yes I understood all of that already thank you. But the point of this actual post is that the OP is quite rightly upset that details were falsified in her mother's notes. Regardless of whether those details changed anything, a doctor should not be lying about a conversation with a patient.
OP I'm so very sorry for your loss. I too watched my mum take her last breath not very long ago. Please feel free to message me if you want to rant, talk, talk about the sheer horror. Sending hugs

I'm not by any means saying this is the case, but is it possible that your mother did want a DNAR put in place, but felt unable to say this while you were there?

Might she maybe, once you had gone, called the doctor back to say that she'd changed her mind, did want a DNAR and that you agreed?

I think your grief and anger are impacting your ability to see things clearly.

Whilst the medical notes left by the doctor clearly have an error (which is worth a complaint!) you can’t make the leap that therefore this doctor intended to “play god” and essentially was responsible for her death or purposely caused it (as this is what “playing god” suggests)

She passed due to a preventable hospital infection, which whilst awful that this was even possible, it wasn’t the doctor’s fault, intention or error. So any investigation into this will probably state that the “DNR” error in the medical notes did not cause her to die/impact her treatment so your complaint that the doctor “played God” is unfounded.

If it was me, I would raise a complaint. The doctor wrote something that was untrue on those notes. I wonder if they have done this before. I have heard of similar stories . A patient is admitted and health care professionals have written similar DNR things on their notes, seemingly for the main reason that a person is older. What age they consider too old , seems to be down to the individual prejudices of the HCP concerned.

A patient is admitted and health care professionals have written similar DNR things on their notes, seemingly for the main reason that a person is older.

Or maybe because most HCP’s recognise that not only would any measures taken be brutal but in the unlikely event of CPR being successful on an elderly person, their quality of life afterwards is likely to be hugely impaired and they will most probably never leave hospital.

You are probably right but this has been reported on in the press. I think The Telegraph did an article on it.

I'm sorry for your loss OP.

But really I agree with Trixiebelden77. I wouldn't want to be resuscitated to live without my faculties, with broken ribs etc, so would rather be treated by her.

I actually think it would be playing God to keep someone artificially alive when their body has given up.

I'm not sure if all these people whipping up your anger is helping you to process your grief. Yes it's desperately sad when someone who was previously fit and healthy gets ill and dies and must be hard to come to terms with. But this doctor didn't on the face of it do anything so terrible as it wouldn't have changed the outcome at all, as people have made clear numerous times on here, it's a clinical decision.

Do you really want to take all this clinical time to go through a formal complaint, which would be taken away from patients who really need it when the NHS is on its knees? Surely it's better to spend your energies remembering and mourning for your mum.

www.telegraph.co.uk/news/health/elder/8829350/Elderly-porders.htmlatients-condemned-to-early-death-by-secret-use-of-do-not-resuscitate-

www.telegraph.co.uk/news/health/elder/8829350/Elderly-patients-condemned-to-early-death-by-secret-use-of-do-not-resuscitate-orders.html

I am very sorry for your loss. However I do not believe the Doctor was playing God. The outcome would have been the same, only if they had tried to resuscitate the end could have been much more traumatic and your mother would still have died.
As others have pointed out, the decision to resuscitate or not lies with the clinician, patients cannot demand futile treatments and sadly in your mothers case this is what it most likely would have been.
Even if the form had not been written it likely would not have made any difference to the clinicians actions.
I do believe your anger is being directed towards something that in the whole picture that did not cause or contribute to your mothers death. It most likely made your mothers death as peaceful as it could be, given the alternative.
I think that resuscitation is misunderstood by most people and seen as giving up on somebody when in most cases it would be a brutal and pointless thing to do, preventing a peaceful end.
No healthcare professional wants to go against people’s wishes but sometimes a best interest decision is absolutely the best thing to do.
I honestly do not believe the doctor was acting maliciously, and in the course of the shift due to the nature of the work probably will have to deal with other complaints when honestly, was only doing what most healthcare professionals do... their very best for their patients.

TVdinners that article is a brilliant example of the damage the press can cause when they wade into healthcare issues. Such an irresponsible and alarmist piece. It’s what healthcare staff are up against.

Sorry you've been through this OP.
As you clearly state, the issue is that the doctor misrepresented the discussion and outcome of that discussion in the notes.
I do think you should complain to PALS. If nothing else, you'd want that doctor to be aware of the error of their ways and think more carefully about how they document things in the future.

@MissKittyBeaudelais

Aside form the DNR issue, all of the concerns you list are due to underfunding, which is down to the peoples of this country not wanting to pay the taxes required to recruit/retain enough staff, buildings and equipment.
Even the £24 billion promised (after inflation) will only be enough to keep up with demand, there will be no improvements.

Everyone bleats on about our heroic emergency services but ask that they pay an extra 2% in tax and suddenly the talk turns to inefficient management and waste...... no need for extra money if it means i take home slightly less.

Your poor mum is a victim to this attitude.

But if there was another DNAR discussion when she deteriorated was the first DNR form completed?
Patients don't get admitted for non urgent issues - she must have had a concerning issue for the GP to admit as an emergency. There aren't any non emergency admissions in gen medicine any more.

@MissKittyBeaudelais I’m so sorry for the loss of your mum.
I lost my dad a couple of years ago quite suddenly and it has taken me a long time to come to terms with.

In this case, i completely agree that the Dr shouldn’t have misrepresented the conversation with you and your mother. I do think though that those couple of lines in the medical notes wouldn’t have changed the outcome, so whilst it’s upsetting to read, the Dr wasn’t playing God, as you say.

In terms of making a complaint, I would ask myself if it it would change anything. What you would need to go through would prolong the pain that you’re feeling over your mother’s death and realistically, without proof of the conversation, the DR could just say that the entry is factual. You’d probably just get a generic sorry for your upset letter and nothing much would change.

If it was me, I would focus on protecting yourself from now on and trying to come to terms with this, as well as the loss of your mum.

I am very sorry for your loss.

There are two different things here that will be difficult to keep apart but you should try to look at them separately:

The first is that the Dr has written something untrue in your mum's notes. He said DNR had been discussed and agreed to when it had not. You can complain about this but it will be a lengthy process and it will come down to 'he said' 'she said', so it might be very upsetting and not produce any useful result.

The second is this: patients who are competent have the right to refuse any medical treatment or intervention even when doing so may result in grave harm or death (at least in the UK, laws differ in other countries). This is different from requesting treatment. Patients do not have the right to request treatment, treatment is offered by Drs based on a clinical judgment of need. So no one has the right to insist they are resuscitated. Resuscitation is a very violent process with serious risks and a very low rate of success. Because of this it is often judged that attempting to resuscitate would cause more harm than good and therefore is not in the patient's best interests.

OP do you know what her diagnosis following emergency admission was? Was it maybe heart failure it had they not got to the bottom of it before her deterioration with infection

Again, thanks everyone, for your replies. Really helpful.

I know that the process of complaining and whether “we” are up to it, is a tough decision to make. We, as a family, need to give it a lot of thought. I suppose I feel so dreadful about it all because it was me that cajoled her into going into hospital at the suggestion of her GP. I omitted a chunk of info which is relevant because I didn’t want to be judged. It is this...

My mum had private health insurance. She’d had it most of her life through work and then just carried on with it after having “rehab” privately following a car accident where she need extensive surgery to her thigh. Her rehab and physio happened in her local BUPA hospital. I have had a career in nursing within the NHS. I don’t have strong views on private health care, one way or the other really. Now, in this instance, my mums GP suggested that seeing as all of her tests were NAD and she wasn’t an emergency emergency, she could have further investigations privately. He told me he felt they were missing something, with the breathlessness. I assumed he meant cancer (as with my dad). Her admit to BUPA required that she go through the NHS and the plan was to transfer within 24 hrs. We were all OK with this. However, once admitted, she was then captive (for want of a better word) on a ward where there was barrier nursing in place and she couldn’t go anywhere. I have to say that the attitude of the ward was a little hostile. It was as if they thought she were “going private any day now” and left to her own devices. We as a family watched her go downhill so quickly that we barely recognised her, each day we visited. She became confused and we were told “hospitals do that to elderly people when they’re out of their own environment and night/day rolls into one”. It wasn’t that, something was wrong. We arrived one day, and someone had packed her belongings up (not her, she couldn’t have, by then). MUM SAID “they’re moving me” and we were so relieved because I’d never seen my mum so unkempt. Her mouth was dirty. She was still wearing the same nightie she’d arrived in three days before. Anyway, the nurse came and said “she’s not going anywhere, I’ve NO IDEA why she’s all packed up” and then she just went further and further downhill after that.

The woman who entered hospital was not at deaths door. I totally agree that how she was a matter of days later, I would wholeheartedly agreed with a DNAR. And her condition was such that she wouldn’t have understood the question fully anyway.

@weaselwomble - I did read your post and agree it was wrong that the notes were incorrect. I was responding to your point that it might make a difference in another case.

I am sorry OP.

OP, I know you might be ignoring my replies so I’ll say it once more and then go away.

Your mother has been treated appallingly and the first thing I’d question is the hospital admission. The falsifying notes is a separate question which also needs addressing.

I hope you get this looked at and get the explanations.

The propblem here is one of poor communication. I am so sorry your Mum died. The DNR is a totally separate issue. Many families believe they can make decisions about treatment and resus when in fact it is a medical decision which is best taken in co operation with the family. Here is wher I think things went wrong. It sounds like this was a clumsy way to to havr the conversation. I dont thingk the notes were falsified, the decision was dnr. A patient can request a dnr themselves but not to expect resus if it is not clinically justified. Resus is often un successful and can have awful consequences. Perhaps he might have acknowledged the conversation better in the notes but I dont think he did anything medically out of order. Sadly your Mum died of an infection, not a heart fail. I think going down the complaints direction will compound your grief, not help it. If you have a good relation with your GP I would go and see him, not to be angry and complain, but to get a better understanding of what happened. Many many NHS problems are faults in communication

The poor nursing care may be another issue

Why on earth did your Mum go via AE to gain admission to a BUPA hospital, for non urgent tests, that is not how it works.

Your NHS GP would have written to the consultant at the private hospital and his/her sec would have arranged direct admission.

Exactly.
To be admitted via Accident and Emergency rather than being sent straight to AMU with a letter the patient would need to be clinically unstable and seriously unwell.

Perhaps the GP was trying to get theOPS mum admitted as she was unwell, acknowledged that she had private medical insurance and said she could be transferred as an inpatient? It's not really possible to get 'urgent' ED care privately in the UK, there are no private A&Es for example.

When my mum had breast cancer, she sought a private diagnosis as she didn't want to wait. She was advised by the private surgeon he would refer her for treatment via the NHS as the care was the same, with the same surgeons, but private patient get better rooms and more attention.