Don't Lie to Patients
Once again we have a disposition issue on the rehab unit. A gentleman who lived alone was admitted following a stroke. While on the unit his stroke has continued to evolve resulting in impaired judgment and making it impossible for him to live alone. To make matters worse he has a history of psych problems for which he hasn't been taking his medicines. The result is someone with frequent mood swings and poor insight.
From the moment of his admission he has been talking about going home. To him there is no other option. During weekly rounds it was decided a SNF would be a good alternative disposition. He would be in a safe environment while providing his son with more time to make more permanent arrangements. This seems very simple except for one thing. No one has told him there has been a change in plans.
As early as this morning our PA, who is responsible for addressing this was, and was present when the decision was made, told him he was going home. She encouraged him to participate in therapy by telling him he needed to get stronger so he could go home this week. Not only was that unnecessary it was so wrong in so many ways. He will be upset, angry and difficult to manage. He may become combative or verbally abusive. He has every right to be mad. He was lied to.
There is a special relationship between patient and caregiver. Patients trust us to have their best interests in mind. Patients and family members make decisions based on the information we give them. They assume the information is accurate and provided in good faith. There is unspoken trust that whatever we tell them is true. When our PA told this patient he was going home he had every reason to believe her. Caregivers can't go around misleading patients. She was wrong to tell him he was going home when that wasn't the case. Avoiding the situation has made it worse.
When I was working on my DPT we looked at the ethics of healthcare as well as the professional rules that guide us. Both clearly state that it is our obligation as PTs (healthcare providers) to provide true and accurate information to patients. I assume other disciplines have similar statements. There is a reason for that. It is to ensure patients really do receive accurate and truthful information upon which to make informed decisions. That statement can be found in the Patient Bill of Rights.
Now we have two problems. One involves the patient in question and his eventual disposition. The other involves the PA lying to the patient by reinforcing his belief he is going home when she knew that wasn't the case. This is an example of what I assume were good intentions going horribly wrong. I would hate to think there was some other reason to mislead the patient. To me this is a reminder of how carefully we must choose our words.