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?

OP is it possible your mum had an undiagnosed UTI? The hospital sounds awful.

I totally get it if you can’t face investigating this though.

I definitely think that you should raise a complaint regarding the “agreed DNAR” entry left by the doctor in the notes. It certainly needs to be clarified why the doctor added that commentary when your mum listened to all the information and did not agree. You can also emphasise that you feel that the doctor wrote your mother off based upon her age although she was otherwise healthy. And that you’re worried about how this may impact other patients, could this lead to an untimely death as the patient didn’t consent etc

However I think you may struggle to show that in your mum’s care, the medical staff involved did not fight for her life. I don’t know the facts of course, but it’s likely that PALS/Ombudsman will look at the incorrect “DNAR” in her notes as unrelated to her care (a separate issue as it didn’t impact the treatment she was given). Particularly because her illness and deterioration was unexpected.

As a junior doctor and medical student, I have seen some very poorly communicated discussions regarding DNAR. Doctors have to make difficult decisions quickly and with limited information presented to them. The A&E doctor is absolutely in the wrong to incorrectly document your agreement to DNAR. But as people have stated already, it is ultimately a medical decision. It seems the decision itself was potentially questionable given your mother's good health prior to admission. But this is difficult to fully determine without seeing your mother's medical notes. Whether or not you wish to pursue the incorrect documentation/DNAR with PALS is your decision but I feel would probably be of benefit to you.

In regard to the issues you had with the death certificate- it can be difficult finding a doctor who treated the patient to sign the certificate. They may not be on shift, may have moved department, busy on calls etc. Legally, it has to be signed by a doctor who has treated the patient not just any doctor who has time so you can probably see the issue here.

You are using very inflammatory language OP.
‘Contagion’ ‘fight for life’

Resusiction success rates are about 10-20% in people who stood a good chance of being resuscitated. As you know, as you were apparently a nurse. Sudden breathlessness that requires urgent admission is likely to have a serious cause, heart failure, pulmonary embolism, pneumonia. Why would you mum have immediately returned home with you if she had realised how ill she was? Would she not have wanted any treatment?

To be honest, I find your comment about ‘sending money abroad’ offensive. The NHS is struggling due to the ridiculous expectations of the British public, who apparently expect seriously unwell people to be resuscitated at all costs. I have been at arrest calls that were completely inappropriate, I’ve actually felt an elderly ladies to cage collapse under my hands doing chest compressions while we tried to figure out what the situation was. Completely, utterly horrific, for the patient, for me, for her family. Instead of slipping away peacefully surrounded by family, she passed in chaos, while her weak ribs collapsed under the pressure. From what I remember she had dementia and cancer and it was not in her interest at all to be resucitated, but she’d only been in for a day and a decision hadn’t been made. THIS is why DNAR forms are done.

It sounds like you don’t like the NHS very much. Bit unusual for a former nurse who presumably worked in the NHS and saw what it’s about, and how much people put into helping people in need for free, but fine, think what you like.

To cage =rib cage (stupid autocorrect)

I'm sorry for your loss,

A lot of what you say here doesn't add up, either through the omission of medical staff or not being understood.

I can't imagine a GP sending someone in for a few tests and physio, especially through A and E when usual practice is admission with a doctor's note through MAU. It seems to me the doctor was very concerned about how unwell your mum was.

DNAR as others have said is a medical decision as it would be cruel to expect families to make it. It's now routinely discussed with anybody who would be unlikely to have a good outcome from resuscitation due to a national push on improving outcomes on CPR and using it appropriately. I know from experience previously we used it much too often. HOWEVER it should have been documented in the notes that the discussion was had, and that your mum understood it was a medical decision. Not that she agreed to a DNAR.

Sadly when an area is restriction due to norovirus physios can't attend as they usually would , this may be why there was only the 1 frame. HOWEVER it should have been thoroughly cleaned between uses.

I'm really confused over your mum being left dirty and in soiled clothes. Personal care is the most fundamental of patient needs. When it's busy on a ward staff prioritise this over a lot of other things. Are you sure there wasn't a medical reason why they didn't let you shower her? IV antibiotics running or an infection risk that meant she couldn't use communal facilities?

Either way I'm not trying to defend anyone, just explain a few things that might help. If you feel up yo contacting Pals go for it, it's not about bollocking it's about you receiving an understanding of your mum's care and how she passed.

But Alexander a DNAR form was not done. Taking the decision at the time of arrest not to resuscitate is completely different from writing in a patient’s notes that they do not want to be resuscitated.

It’s alarming to me how many HCPs on this thread are minimising this.

The OP is not saying her DM should have been resuscitated, at no point has she said this.

Greyandcopper Sue the shit out of them.

Deary me, I see the Hard of Thinking are here.

This thread has so many comments that are classic Mumsnet / inflammatory / daily mail / scared of doctors.

*But Alexander a DNAR form was not done. Taking the decision at the time of arrest not to resuscitate is completely different from writing in a patient’s notes that they do not want to be resuscitated.

It’s alarming to me how many HCPs on this thread are minimising this.

The OP is not saying her DM should have been resuscitated, at no point has she said this.*

Minimising what? You seem absolutely determined that the A&E doctor was some sort of evil liar, based on nothing at all.

Let me ask you this: An A&E doctor sees an elderly, frail lady who looks like she is dying in A&E. SHe feels she is dying an is suitable for a DNAR, bt instead of just writing one decides t discuss it with the family, in the interest of openness. The patient and family don't seem like they agree with it. She has the option of writing nothing in the notes, writing the truth or randomly lying, knowing that relatives often request notes, they are often a source of complaint. She decides to completely lie for no benefit to herself, as she works in A&E and will never see the patient again, putting her career at risk for literally no reason at all, for a patient who is dying anyway, when she doesn't even need to write ANYTHING.

Yeah, that makes loads more sense than the actual wording of the notes being something like: 'DNAR discussed with family, futility explained.'

Also, she absolutely wold have had a DNAR as she was recognised as needing palliative care.

Do you not think it is likely that the OP is struggling with grief and looking for someone to blame for her mums unexpected death from natural causes? Why are you so keen to find a conspiracy? Do yo struggle with paranoia generally?

@Deathgrip is absolutely right. That is the key point. The doctor wrote things that were not true on a patients notes.

@Deathgrip is absolutely right. That is the key point. The doctor wrote things that were not true on a patients notes.

Just reread this Taking the decision at the time of arrest not to resuscitate is completely different from writing in a patient’s notes that they do not want to be resuscitated.

IF THERE IS NO DNAR FORM RESSICTATION WILL BE ATTEMPTED, by the resus team wh do not know the patient. It will take several rounds before they have the full story, at which point the patinets chest may have completley caved in if the have brittle bones, like my poor lady. Only a valid DNAR stops this happening, THAT is why they are put on. Then if their heart stops beating the nursing staff can feel confident not to put out an arrest call.

It doesn't matter whether a patient wants to be resuscitated or not, it is only done if appropriate. Just like you can't walk int &E and demand to have a kidney removed, or some IV antibiotics because that is your preference.

Doctor wrote patient and next of kin agreed to DNR and recorded that in the notes. OP says DNR was discussed but they made no such agreement to it. Which version is correct ? I don't know.

The DNAR form wording says something like: Discussed with patient.

Not 'patient agreed,' just 'discussed with'

If the patient doesn't have capacity, there is a seperate section on the form saying 'Discussed with nearest relative.' NOT nearest relative agreed not to resuscitate.

I imagine the ED doctor either filled out the DNAR form in this manner, or documented her conversation (which is unlikely - A&E notes are not really meant for this). I imagine the OP has read this an interpreted it as the doctor writing that the patient and her family fully agreed.

Sorry, forgot to mention there IS a section on the DNAR if a patient doesn't want to be resuscitated, but this is different to futility.

My understanding was that this was recorded in the notes and not on a specific DNAR form, but perhaps I am mistaken. However, wherever it was recorded I don't think phrases about agreeing to things should be included if that is not the case.

This is the DNAR form. As you can see, there are different sections.

You would perhaps also write in the notes, and document the discussion and any objections. Sometimes people are very angry about it, and then you have to work out what to do. If the person is stable you would perhaps leaving the form for a different time, but if someone was dying then they really would need a DNAR.

I've a new GP playing God with medication I've been taking a decade, A DRE in A&E I didn't consent to. I've several other examples but would be extremely outing. I'm convinced some go into the profession for control/power trip.

So sorry for your loss, definitely contact PALS.

??

OP said it was documented in notes that they had both agreed to DNAR, but she did not say there was a respect form DNAR written, therefore resus would have been attempted if required.
Very surprising that a qualified nurse, especially a senior sister which OP says she was at one point, would want resuscitation on a relative. I would not want it on myself and I am still of working age. When I go, let me go peacefully, please. We are all going to go eventually, and I'd like it the quiet way.

You can see the doctors on here starting to close ranks as usual.

You don't need to be a medical ethicist to realise that writing notes that directly contradict what patients and their relatives has told you is wrong. This has nothing to do with the fact that any medical treatment is the ultimate decision of the doctor.

Sadly old people are often treated like they are worthless in acute care settings, despite guidance that care should be based on health and outcomes, not age. I know of numerous elderly relatives and friends who are in good health who have been ignored, railroaded into certain courses of action and even denied treatment by hospital doctors who seem to think that anyone over 70 in a hospital is not worth NHS money. Most recent example was my fit, healthy MIL who fell and damaged her knee ligaments in the garden. She was told that she would not be given corrective surgery due to her age which massively negatively impacted her quality of life and meant that relatives were having to give her low level support where she didn't need it before. Luckily she had the funds to go private and after the surgery she has been back to her old self for the last few years living totally independently.

Business and short staffing are often blamed for this but I struggle to see how it can completely explain such high-handedness.

You can see the doctors on here starting to close ranks as usual

Hardly surprising seeing as we only have one side of events here.

Sadly old people are often treated like they are worthless in acute care settings, despite guidance that care should be based on health and outcomes, not age

Not my experience.
My mum was treated with care and respect as she died, first in a main hospital and then in a community one (as was the family)
My aunt is 78, in remission follow cancer treatment, getting fantastic care both in hospital and with her GP.

Just do not understand why first a GP and a private consultant pushed OPs mum through AE to get a bed in a private hospital for routine tests, when she was relatively fit and well, its nonsensical.

@mindfulman ... the DNAR form was completed and signed by the A&E Dr. who examined her whilst I was there. Mum went to MAU with it.
@AutumnRose1... they thought she had a UTI but the first two tests were unacceptable to be tested due to insufficient sample and the specimen being incorrectly labelled.

@AlexanderHalexander... thank you for your comments. Are you trying to misunderstand me? I shall say several things again. I trained and worked in the NHS for 29 yrs if you include training. I have no particular view of private health care. I am not anti-NHS. I know if the hard work involved, working in the health service. Performing CPR (as they did on Ca. lung with mets dad) is not justified in many cases and it is a medical decision. I am entitled to my views regarding overseas aid, as are you. And to assume that people who don’t agree with you might have paranoia! My goodness, you are very pleased with your medical qualifications, aren’t you? The scenario you gave of the death’s door fragile old lady... I do hope that wasn’t supposed to be my mother? If so, you have NOT READ THE PATIENT HISTORY FULLY AND OUGHT NOT TO BE MAKING LIFE AND DEATH DECISIONS.

@EverdeRose... as I have already explained, the GP arranged admit and the ward were expecting her HOWEVER, when we got there we were told she HAD to go through A&E. you tell me why...I’ve no idea and neither did her GP when we spoke to him about it.
@Deathgrip... thank you so much. Some of the HCPs on here are either not reading the full post or jumping to the conclusion that my Mum and I were DEMANDING resuscitation. I objected to her being asked many times, her saying yes she’d prefer to be resuscitated and then the Dr. writing “doesn’t want resuscitate”.

And yes, I am grieving terribly but I don’t need to find someone to blame...my grievances are all there, written by the HCPs, in black and white. I do not believe my mum received the best of care and it started early on in A&E with the Dr. who asked her a scary question, insisted in trying to persuade her to just give in and die and then wrote the EXACT opposite of what the patients wishes were. WHY ASK the question in the first place?

The independent hospital wouldn’t be taking an acutely unwell patient with unknown diagnosis generally. Most have just one relatively junior RMO Doctor providing care. Most diagnostic facilities in the independent sector are quite limited - someone with respiratory symptoms would usually need pulmonary function testing, for example, which is rarely available in a private hospital because they specialise in elective surgery on well patients. If concerns were rather more about her heart, echocardiogram would usually be considered but again, this isn’t usually available in your average private hospital.
Very, very unusual for a patient to be admitted via an emergency department for transfer to a private hospital.

Very unusual for a patient to be admitted in a fairly well condition for tests - they would usually be done as an outpatient because of increased risks to elderly people from admissions and because of lack of beds.
I don’t think I’ve ever met a clinician who felt the elderly were worthless or where treatment was restricted purely on age grounds. Most people get good or better care most of the time. Inpatient surveys show an England average of approx 94 % of patients would recommend the hospital they were in. In the better trusts it’s about 97/98%.