Right Of Refusal

Dealing with Doctors - April 30, 2015

When I was in high school I was unexpectedly hospitalized for several days to treat an infected mosquito bite. Because the bite was so close to my knee the doctor worried the infection could cause long term damage to my joint. So I was admitted to the hospital to have it drained and treated and I was placed on very high doses of IV antibiotics for several days. This happened at a teaching hospital. After my doctor treated me there were several new residents and medical students who visited me and reexamined me for the benefit of their own educational development purposes. At the time I found it amusing and interesting to talk to so many new people about my knee. Recently a friend of mine was unexpectedly hospitalized for an injury and experienced a similar "over review" of their case. Unlike me the patient did not appreciate a parade of new doctors and care givers examining and reexamining the injury and asking the same questions about it. I immediately suggested that my friend refuse to allow anyone but the primary physician perform any exams or have any discussions with the patient about the case. The patient always has a right to refuse a test, exam or any sort of treatment or care unless they are mentally incapacitated.

Often when we are undergoing medical treatment we sometimes forget that the patient, not the doctor, is in charge of the patient's care. A patient does not have to submit to tests and exams, comply with treatments or participate in conversations that they don't want to. What the patient wants is what matters. Now of course there are some limits to this, the patient cannot demand anything they want and expect it to be provided. A doctor may refuse to order a treatment or procedure that the patient wants because s/he feels it will cause harm or is inappropriate for the patient's case. The doctor even has a right to terminate the doctor-patient relationship in some rare circumstances. But we must never forget that it is the patient's body and the patient's choice to decide what will or will not happen with their care.

I have written previously that sometimes when things aren't going well with your doctor patient relationship it is appropriate to fire your doctor and find a new one. While this is indeed sometimes the best course of action for everyone involved it is also a drastic step and most of the time is not necessary or appropriate. Instead it is important for the patient and doctor to communicate so that the best and most appropriate care for the patient can be achieved. Many times this might mean the patient must speak up and refuse a test or procedure or treatment if it is not what the patient wants or desires.

When my husband was first diagnosed with cancer at first we did not question the recommended treatment plan. We were in shock by the diagnosis and we did not think to question the doctors' professional recommendations. However a few days after the shock wore off my husband began to wonder if the plan for doing chemotherapy before surgery was best. He wanted to have surgery to remove the tumor first before starting chemotherapy. We made an appointment to talk with the surgeon and requested a change in plan. It was a difficult conversation because we were openly asking her to go against the recommendation she and the medical oncologist made for his case. However she responded professionally and explained in detail why they made their recommendations. At one point during the conversation my husband asked the surgeon if she would refuse to do the surgery when he wanted. She said she would not refuse but wanted to review the case with other surgeons to help her determine the best approach for doing the surgery immediately. By the end of the conversation my husband decided he wanted to follow the doctors' recommendations and start chemotherapy immediately. I believe that exercising his right to refuse the care plan being recommended and thoroughly discussing it with his doctor empowered him to take charge of his own body. That can be a critical step for any patient to take in directing their own care. He knew the doctors were the experts about how to treat cancer but he was the expert on how he wanted his body treated.

You may find that after questioning or refusing your doctor's recommendation that it leads to a candid conversation with your doctor where you ultimately feel comfortable following their recommendation. You may also have a conversation where you feel confident that choosing a different path than your doctor's first recommendation is what works best for you. What is critical is you remember that as the patient you get to decide what does or does not happen. We often defer to our doctors because they are the experts and this is wise but to quote an oncologist I recently met "Doctors are service workers. If the patient is happy it's ok."