I’m not implying every nurse or doctor does this, but couldn’t come up with a better title.
A cognizant patient is above all a free person. A free person is free to accept and to deny care, whatever may come. It’s his life, let him live his life as he sees fit. Explain, educate, inform and then ask: do you understand that if we don’t do this you may die / lose a limb / lose your liver / fall down and have a stroke and end up bed bound if we’re lucky enough to save your life?
I don’t understand the logic playing mental gymnastics to make a patient stay at a unit because the nurse or doctor in charge are convinced it’s in the patient’s best interest to do so, even when after education he wants to leave. I’m the odd one at my unit, as most of my coworkers do vehemently disagree with me, as they expect me to provide care AND to care. They feel they lost if a patient leaves against medical advice.
To me it looks like they don’t understand individual freedom and forget that a patient is still a free person. I wouldn’t want to be my coworkers’ patient.
You cannot stop grown ups from making stupid choices. The cognizant patient gets to decide his answer. Not a nurse or doctor convinced they get to decide for the patient.
Another problem I see: say you force a cognizant patient to stay at your unit because you are convinced you are doing the right thing. Why do you think he’s going to be a pleasant patient to work with? People lash out when they feel trapped and they insult and punch personnel. What’s the point?
Punched coworkers will call in sick and start looking for jobs elsewhere, some insulted ones too.
Wouldn’t it be better to inform, document, let him leave, move on?
I’m not in healthcare, so I’m not sure how valuable my opinion is
If I had to guess, I’d say that there’s a cost associated with a patient refusing care, particularly if the condition is going to be aggravated.
This cost might be financial. It might also mean that the patient returns to the healthcare system and requires more intense care. It probably also means that the patient will suffer more while outside the system.
I don’t know what your healthcare system looks like, but mine is stretched to the breaking point. If someone discharged themselves against the advice of doctors and then later worsened and returned to the hospital, they might die waiting for triage. It’s an extremely bad look for the hospital and erodes the public’s opinion of healthcare. And while the hospital is being raked over the coals for allowing someone to die in the waiting room, the media will conveniently ignore that the patient previously discharged themselves against the advice of their doctor.
Another scenario to think about: just because a patient is cognizant doesn’t mean they’re behaving rationally. While the patient is in care they could be heavily medicated and not realize how bad their situation would be without care: until the meds wear off and their suffering returns. If they got a particularly bad prognosis, then the panicky ape brain could take over and they just want to get out of their, damn the consequences.
Does all that add up to being more important than the patient’s autonomy? Opinions will probably be divided. I don’t personally think so, if I was restrained against my will I’d be pretty angry about it. But I understand the rationale behind the people who want to keep their patient in the system.
Does that mean YOU have to care? Probably not. People should be free to make their own decisions, and you can’t and shouldn’t take responsibility for the decisions that they make.