# I'm Pitting the Asswipes at Kaiser Permanente **URL:** \ **Category:** The BBQ Pit\ **Created:** [January 25, 2009, 4:34am UTC](https://boards.straightdope.com/t/im-pitting-the-asswipes-at-kaiser-permanente/482888 "2009-01-25T04:34:48Z")\ **Posts on this page:** 12\ **Page:** 5
**Author:** ![XJETGIRLX](https://avatars.discourse-cdn.com/v4/letter/x/9fc29f/32.png) [@XJETGIRLX](https://boards.straightdope.com/u/XJETGIRLX)\ **Post date:** [January 26, 2009, 12:52pm UTC](https://boards.straightdope.com/t/im-pitting-the-asswipes-at-kaiser-permanente/482888/81 "2009-01-26T12:52:20Z")
> [@Monster104](#): > > You cite also says: > > “All information need not be communicated to the patient immediately or all at once; physicians should assess the amount of information a patient is capable of receiving at a given time, delaying the remainder to a later, more suitable time, and should tailor disclosure to meet patients’ needs and expectations in light of their preferences.” > > A history of psychological problems and panic attacks in response to bad news certainly seems like a valid reason to delay full disclosure to a later, more suitable time, your vitriolic insistence to the contrary notwithstanding. You notice the section you quoted says “physicians should assess the amount of information a patient is capable of receiving at a given time, delaying the remainder, more suitable time … to meet patients’ needs and expectations in light of **their** preferences.” That’s the PATIENTS’ preferences, not the preferences of the family. The point is and always has been that the PATIENT is the one that gets to decide if they don’t want to hear what’s going on. Not the family. ---
**Author:** ![XJETGIRLX](https://avatars.discourse-cdn.com/v4/letter/x/9fc29f/32.png) [@XJETGIRLX](https://boards.straightdope.com/u/XJETGIRLX)\ **Post date:** [January 26, 2009, 12:57pm UTC](https://boards.straightdope.com/t/im-pitting-the-asswipes-at-kaiser-permanente/482888/82 "2009-01-26T12:57:39Z")
> [@Washoe](#): > > Where on earth did you get the idea that we were making that decision for her? The nurse asked my wife what my mother’s prior directives were concerning a situation like this, and my wife told her. If the nurse had asked my wife what my mother’s favorite color was, and my wife responded “purple”, would you be accusing my wife of making that decision on her behalf? Yes, I would. If the nurse asked your wife then your wife was the one making decisions for her. If the nurse asked anyone other than YOUR MOTHER first then the nurse fucked up. ---
**Author:** ![Jayn\_Newell](https://avatars.discourse-cdn.com/v4/letter/j/f9ae1b/32.png) [@Jayn\_Newell](https://boards.straightdope.com/u/Jayn_Newell)\ **Post date:** [January 26, 2009, 1:34pm UTC](https://boards.straightdope.com/t/im-pitting-the-asswipes-at-kaiser-permanente/482888/83 "2009-01-26T13:34:09Z")
> [@XJETGIRLX](#): > > Yes, I would. > > If the nurse asked your wife then your wife was the one making decisions for her. If the nurse asked anyone other than YOUR MOTHER first then the nurse fucked up. First off, if you have an unconscious patient, you can’t really ask them to make decisions. Someone has to make those choices for them. Close family is a logical choice. Secondly, it’s perfectly normal for people OTHER THAN THE ONE IN QUESTION to know that person’s preferences and be able to relay that information to others. If Mommy Dearest has preciously indicated she doesn’t want to be resuscitated should the situation arise, and the daughter-in-law tells the nurse this information, she is most certainly NOT making decisions for MD. She is passing along information that she happens to be privy to. ---
**Author:** ![XJETGIRLX](https://avatars.discourse-cdn.com/v4/letter/x/9fc29f/32.png) [@XJETGIRLX](https://boards.straightdope.com/u/XJETGIRLX)\ **Post date:** [January 26, 2009, 2:13pm UTC](https://boards.straightdope.com/t/im-pitting-the-asswipes-at-kaiser-permanente/482888/84 "2009-01-26T14:13:43Z")
> [@Jayn\_Newell](#): > > First off, if you have an unconscious patient, you can’t really ask them to make decisions. Someone has to make those choices for them. Close family is a logical choice. > > Secondly, it’s perfectly normal for people OTHER THAN THE ONE IN QUESTION to know that person’s preferences and be able to relay that information to others. If Mommy Dearest has preciously indicated she doesn’t want to be resuscitated should the situation arise, and the daughter-in-law tells the nurse this information, she is most certainly NOT making decisions for MD. She is passing along information that she happens to be privy to. According to **Washoe** she was sedated. It’s not that difficult to ask questions before you administer a sedative, or wait until it wears off. Knowing someone’s preferences is fine. Nobody has a problem with the family knowing and providing that information - but only after the patient themselves has said it’s ok for them to do so. If **Washoe** ’s mother was coherent enough for him to think she would be frightened to hear about what happened then she is also coherent enough to decide on her own if she wants to know what happened. I’ve never said that families should not be involved - just that they should not unilaterally make decisions on the patient’s behalf UNLESS THE PATIENT THEMSELVES SPECIFICALLY INDICATES THEY WANT THAT. Christ on a fucking cracker, how dense do you have to be to not get that? ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [January 26, 2009, 2:18pm UTC](https://boards.straightdope.com/t/im-pitting-the-asswipes-at-kaiser-permanente/482888/85 "2009-01-26T14:18:07Z")
Why don’t we try this: **Washoe,** does your mother have written directives? **Washoe,** has your mother discussed her wishes in regards to medical treatment with you in the past? Because that’s the information that missing here. **Jetgirl’s** biggest concern is that **Washoe’s Mom** has been cut out of the decision loop involuntarily. However, if there are prior directives and input (such as the case with my mom) then that changes the whole situation quite a bit. Even when not written down, if a person has expressed a preference or viewpoint to the rest of the family that can carry considerable weight. ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [January 26, 2009, 2:28pm UTC](https://boards.straightdope.com/t/im-pitting-the-asswipes-at-kaiser-permanente/482888/86 "2009-01-26T14:28:32Z")
> [@XJETGIRLX](#): > > According to **Washoe** she was sedated. It’s not that difficult to ask questions before you administer a sedative, or wait until it wears off. When someone is pulled into an ER the priority is on saving their life and stabilizing them, not on grilling them for information. Sedatives can have wildly varying effects and ill/injured people may be conscious but incoherent. Asking if an elderly and very ill person has a DNR order is _not_ inappropriate, no more so than asking if they have any advanced directives, religious prohibitions to blood transfusions, or any of a number of other questions. Some people do have DNR’s, some of those people are surprisingly healthy in appearance (my mom carried hers in her purse for _years_, walking around the grocery store and the mall with it, just in case she had a sudden collapse). If my mother is unconscious, delirious, or unable to communicate (my mother _does_ have a form of aphasia) it is _entirely_ appropriate for medical personnel to ask a family member that question because, aside from the patient, family is most likely to know. The key here, to _my_ mind (maybe not **Jetgirl,** I can’t speak for her) is whether or not any of the pertinent issues had ever been discussed with the mom _before_ this hospitalization. Is this a woman who, for years, whenever someone she knew had a stroke said “Oh - I just couldn’t handle knowing! If it happens don’t tell me until I start getting better!”? Or is this truly a unilateral decision on the part of the family? ---
**Author:** ![Jayn\_Newell](https://avatars.discourse-cdn.com/v4/letter/j/f9ae1b/32.png) [@Jayn\_Newell](https://boards.straightdope.com/u/Jayn_Newell)\ **Post date:** [January 26, 2009, 2:40pm UTC](https://boards.straightdope.com/t/im-pitting-the-asswipes-at-kaiser-permanente/482888/87 "2009-01-26T14:40:39Z")
> [@XJETGIRLX](#): > > Knowing someone’s preferences is fine. Nobody has a problem with the family knowing and providing that information - but only after the patient themselves has said it’s ok for them to do so. So it’s okay to know a person’s wishes, but not okay for you to tell others so that they can respect those wishes? :dubious: For the most part, I can see where you’re coming from, but someone has to make those decisions and relay that information at least until the point that the patient is stabilized enough that they can be asked directly. Or in more detail, what **Broomstick** said. A DNR order is on the list of things that may be needed to be known before that point comes. ---
**Author:** ![XJETGIRLX](https://avatars.discourse-cdn.com/v4/letter/x/9fc29f/32.png) [@XJETGIRLX](https://boards.straightdope.com/u/XJETGIRLX)\ **Post date:** [January 26, 2009, 2:42pm UTC](https://boards.straightdope.com/t/im-pitting-the-asswipes-at-kaiser-permanente/482888/88 "2009-01-26T14:42:37Z")
> [@Broomstick](#): > > When someone is pulled into an ER the priority is on saving their life and stabilizing them, not on grilling them for information. Sedatives can have wildly varying effects and ill/injured people may be conscious but incoherent. They may be incoherent but the doctors still have an ethical duty to inform the patient of what is happening to them. > [@Broomstick](#): > > Asking if an elderly and very ill person has a DNR order is _not_ inappropriate, no more so than asking if they have any advanced directives, religious prohibitions to blood transfusions, or any of a number of other questions. And nobody has said even come close to insinuating that asking is inappropriate. What’s inappropriate is asking the family before asking the patient themselves, not going straight to the source first. ---
**Author:** ![XJETGIRLX](https://avatars.discourse-cdn.com/v4/letter/x/9fc29f/32.png) [@XJETGIRLX](https://boards.straightdope.com/u/XJETGIRLX)\ **Post date:** [January 26, 2009, 2:44pm UTC](https://boards.straightdope.com/t/im-pitting-the-asswipes-at-kaiser-permanente/482888/89 "2009-01-26T14:44:53Z")
> [@Jayn\_Newell](#): > > So it’s okay to know a person’s wishes, but not okay for you to tell others so that they can respect those wishes? :dubious: > > For the most part, I can see where you’re coming from, but someone has to make those decisions and relay that information at least until the point that the patient is stabilized enough that they can be asked directly. Or in more detail, what **Broomstick** said. A DNR order is on the list of things that may be needed to be known before that point comes. **Washoe** has never said that his mother was not stable enough to communicate her wishes. If she were, would he really be that concerned about scaring her with the facts? In a case where the patient cannot communicate their wishes, yes, it’s perfectly appropriate to go to the family. This is not that case. His mother is not in a coma, and she was out due to a sedative. They could have asked her directly but did not. The failure is in bypassing a patient that has the ability to communicate their own desires firsthand. ---
**Author:** ![catsix](https://avatars.discourse-cdn.com/v4/letter/c/e19b73/32.png) [@catsix](https://boards.straightdope.com/u/catsix)\ **Post date:** [January 26, 2009, 3:32pm UTC](https://boards.straightdope.com/t/im-pitting-the-asswipes-at-kaiser-permanente/482888/90 "2009-01-26T15:32:37Z")
> [@](#): > > **Broomstick** said: > This is comparable to instances where family members are in an accident of some sort and not everyone survives. Relaying news of a death of a loved one may be delayed until the patient is deemed “ready to handle it”. I wouldn’t want anyone who would do that to be in any way involved with my medical care because I would not be able to trust them on any level. > [@](#): > > Keeping information from adults of sound mind isn’t right, but when you’re dealing with severe injury and illness minds are not always sound. There are times you must account for that. These sorts of decisions are not at all easy. If my family ever did that, they could count on such a thing ending any relationship I have to them. > [@](#): > > **Polycarp** said: > Legally? Remember all those discussions about age of consent laws? Dude, you’re in the hospital with serious medical problems – there’s a pretty good chance you have impaired mental capacity, even if you\* don’t think so. Which some overzealous dipshit could infer out of your desire to make a decision they disagree with, or to know something they want to withhold. I get that vibe from your phrasing here, that you would assume anyone who had a serious injury or illness is suddenly mentally incompetent and you can do what you want. > [@](#): > > **eleanorigby** said: > Should he has talked with the family ahead of time? Maybe. Should anyone’s doctor be talking to their family members unless the patient themselves have given explicit permission to do so? > [@](#): > > **mhendo** said: > But if the doctors believe that temporarily withholding information from the patient is in the patient’s best interest, then it should be the doctors who make the decision, in consultation with the family. Unless the patient has explicitly stated that they want the family to be consulted, why are their wishes even being considered? > [@](#): > > **XJETGIRLX** said: > That’s a situation that would require a legal power of attorney or guardian to help manage decisions about health care. This is why my family does not have power of attorney for me. Because I don’t want someone making decisions that they think are in my best interest. I want someone who is detached and objective who will carry out the decisions I have already made. > [@](#): > > **Washoe** said: > The nurse asked my wife what my mother’s prior directives were concerning a situation like this, and my wife told her. So that means if my mother lies to my doctor and says I want her making all the decisions, that’s what happens? Good thing I have that power of attorney, eh? > [@](#): > > **Jayn\_Newell** said: > First off, if you have an unconscious patient, you can’t really ask them to make decisions. Someone has to make those choices for them. Close family is a logical choice. And it may be the completely wrong choice. The thing that scares me is not being in a situation where I’m severely injured. It’s not having a way to indicate that they need to ask the person who has power of attorney for me, not my mother, what to do. My parents know that I don’t want them making those decisions. I told them, and I told them why, but I don’t know if they could stick to that should something happen. I don’t know that they would say ‘Here’s the phone number of her power of attorney.’ rather than start telling the doctors what they think should be done to/for me. > [@](#): > > **XJETGIRLX** said: > In a case where the patient cannot communicate their wishes, yes, it’s perfectly appropriate to go to the family. Unless, of course, that patient has set up a power of attorney that names someone else to make those decisions. ---
**Author:** ![bobkitty](https://avatars.discourse-cdn.com/v4/letter/b/c67d28/32.png) [@bobkitty](https://boards.straightdope.com/u/bobkitty)\ **Post date:** [January 26, 2009, 3:44pm UTC](https://boards.straightdope.com/t/im-pitting-the-asswipes-at-kaiser-permanente/482888/91 "2009-01-26T15:44:37Z")
> [@Broomstick](#): > > Asking if an elderly and very ill person has a DNR order is _not_ inappropriate, no more so than asking if they have any advanced directives, religious prohibitions to blood transfusions, or any of a number of other questions. _clap clap_ Mr. Kitty went into the hospital twice last year, and ended up in the ICU both times. The first time, his O2 level was 48, CO2 was 120, I was sitting right there and they still asked _him_ all those questions. They even handed him a copy of the advanced directives booklet to fill out (he had an AD, but wanted to make sure he hadn’t changed his mind about some things since his diagnosis). When he was intubated, he was sedated for much of the time because he kept trying to pull out the tubes; however, every doctor that came in talked to him before talking to me, and the only reason most of them talked to me was because he hadn’t gotten the writing thing down yet. I can get behind medical folks asking questions of the family when the patient is sedated. But clearly by the time the pulmonologist came in to “mess everything up” she had been awake and alert for some time (enough that Washoe’s wife looked to her and saw a look of panic on her face when the diagnosis was revealed). Boy, I hope the mom likes the wife, because I can think of dozens of situations where the daughter-in-law being that involved in medical decisions could go horribly wrong. Washoe, I’m sorry, but I think you have a really, really warped idea of how hospitals “should” work. “Nobody is supposed to discuss diagnosis with a patient without authorization.”?? You claim it’s because the PCP is supposed to hold all those conversations, but what if you’re in a hospital that your PCP doesn’t have privs at? What happens if something goes wrong and your PCP is on vacation, or not on call? I can see “No one else can _diagnose_ the patient” (although that’s an issue in and of itself), but your mom had already been diagnosed _long_ before this incident. Everyone around her (but her) knew she had a stroke. So based on _basic medical ethics_ the pulmologist acted reasonably. We’ve come a long way from the days when people weren’t allowed to make their own decisions or be included in discussions about their condition and care. Honestly, it terrifies me that anyone could choose to LIE and keep me in the dark about the nature or severity of my condition, especially if I’m awake. Had I been in your mom’s shoes, the pulmonologist- the ONLY person who has been honest this whole time- would’ve skyrocketed to the top of my Christmas card list. In addition to Broomstick’s questions, I also want to know: how was it documented that the diagnosis should be kept secret? Who was aware of this decision? Also, not my business or needing to be answered, but how are you going to address this with your mom and rebuild her trust in you? ---
**Author:** ![XJETGIRLX](https://avatars.discourse-cdn.com/v4/letter/x/9fc29f/32.png) [@XJETGIRLX](https://boards.straightdope.com/u/XJETGIRLX)\ **Post date:** [January 26, 2009, 3:49pm UTC](https://boards.straightdope.com/t/im-pitting-the-asswipes-at-kaiser-permanente/482888/92 "2009-01-26T15:49:40Z")
> [@catsix](#): > > Unless, of course, that patient has set up a power of attorney that names someone else to make those decisions. Exactly. The concept in all of this is that the patient should be the first and foremost point of contact and source for decisions about their own healthcare and absolutely every possible effort should be made to ensure that the patient is aware of their condition and that their requests are being carried out. Advanced directives and power of attorney are the means to carry out the _patient’s_ wishes in the case they themselves cannot make their wishes known. No one should ever just assume that anyone else has the authority to speak on behalf of the patient. [Previous page](https://boards.straightdope.com/t/im-pitting-the-asswipes-at-kaiser-permanente/482888.md?page=4)