Mr. Aguilera injured himself with a saw and five days later went to his doctor with presenting symptoms of jaw discomfort. It is more than years since his last tetanus booster and the patient has no significant medical history. There were also no significant findings from a physical examination of head and neck and his lungs were clear.
The diagnosis was "tetanus with secondary wound infection" so the wound was cleaned and hydrogen peroxide applied. The patient's doctor referred him for an overnight stay in hospital for observation.
After the treatment was explained to him, the patient signed a form which gave his informed consent and he was given anti-tetanus immunoglobulin. He responded well and there were no side effects or complications. The patient said that because he was a vegetarian, he had special dietary requirements and should not eat hospital food. Also, he lived with his mother who is severely disabled, with hearing difficulties, and needs round-the-clock care. Mr Aguilera asked to be discharged and Dr Hashim gave his authorization.
To:Dr. J.K. Nayar
I'm referring to you for assessment. He is suffering from attacks of palpitations and breathlessness.
The patient is a student. He has suffered from anxiety since he was 13. He came to me 6 months ago. He expressed fears about having heart disease, because his brothers and his father have heart conditions.
When things are going badly, he eats too much. Consequently he is overweight with a BMI of 32, which partly explains his breathlessness. Urine analyses indicate the onset of type 2 diabetes. He said that he had gained weight as a result of the shock of losing his part-time job. It brought on severe palpitations, hyperventilation, and panic attacks.
In the past the patient has been treated with the antidepressant Lofepramine, even though there are no clear symptoms of depression. It is possible that weight gain and tiredness are side effects of the antidepressants.
Other physical symptoms include joint pains, chest pains, muscle pains and dizziness.
He is receiving Diazepam 2 mg t.d.s for anxiety. Because he has a history of asthma, I have not tried beta blockers.
Yours sincerely
Dr.R.T.O'Brien
b. There can sometimes be bleeding with a biopsy, Mr de long. This is because an incision has to be made. We have to cut it open and get a sample of the tissue. There can be bleeding, but that’s rare — about one in every two thousand. There’s also a small danger of infection, but we do our best to prevent this.
c. There is now no doubt that it’s cancer and a hysterectomy — the surgical removal of your uterus — is the best chance for survival. We can’t cure it so it’s best to cut it out. We feel it’s the best treatment option at this stage; better than radiation or chemotherapy.
d. I have to give you a local anesthetic. Do you know what that is? No. Hussein, could you help me here? I want you to explain to your mother that I want to give her something to make her eye numb so that I can get this thing out of her eye. Explain this to her, make sure she understands, and ask her if it’s OK. Tell her that I’m not going to use a needle, but she must keep very still.
| Nurse : | [simple_tooltip content="I’m sorry, I can't remember"]I've forgotten[/simple_tooltip] your name. |
| Mrs Stein : | It's Mrs Stein. |
| Nurse : | Of course, Mrs Stein. [simple_tooltip content="Can you let me have"]Give me[/simple_tooltip] your letter of referral. |
| Mrs Stein : | Here it is. |
| Nurse : | Thanks. So, Mrs Stein, you've come in for removal of varicose veins? |
| Mrs Stein : | Yes. The operation is this afternoon. |
| Nurse : | [simple_tooltip content="I’d like to check"]Confirm[/simple_tooltip] one or two things. First, [simple_tooltip content="could you tell me if you take"]are you on[/simple_tooltip] any medications? |
| Mrs Stein : | Yes, I take Venlafaxine. |
| Nurse : | [simple_tooltip content="May I ask why"]What's for?[/simple_tooltip] |
| Mrs Stein : | I take it for depression. |
| Nurse : | OK. Now, [simple_tooltip content="I have to ask"]tell me[/simple_tooltip] about your lifestyle. [simple_tooltip content="It's important to know about"]Report[/simple_tooltip] any alcohol or drug problems you have. |
| Mrs Stein : | None, I don't drink and I don't take drugs. |
| Nurse : | Also, [simple_tooltip content="I need to know if you have"]tell me if you have[/simple_tooltip] had any contact with HIV in the past six months. |
| Mrs Stein : | I haven't had any contact with HIV, no. |
| Nurse : | Fine, and [simple_tooltip content="can you tell me how you are"]who's[/simple_tooltip] paying for treatment? |
| Mrs Stein : | I'm covered by medical insurance. |
| Nurse : | Great, and lastly, [simple_tooltip content="would you mind if I asked you to"]you must[/simple_tooltip] take off your make-up and your rings. |
Hippocrate, the "father of medicine", would not have agreed with the idea of "consenting to treatment". He thought that giving information to patients was harmful, and advised doctors to ‘conceal most things from patients, turn their attention away from what is being done to them, and reveal nothing of their future or present condition’.Do you think there are ever times when it is necessary to lie to patients or not tell them certain things?
Dr Michael Foxton Confessions of a Junior Doctor