ER Experience 3: Safety and Ethics
May 23, 2006*interesting stories I’ve quoted from the net*
Danger in the least expected place.
As a group, ER personnel tend to underestimate the extent of danger to which we are exposed. We recognize the overt physical threats to ourselves and steer clear of patients who are trouble makers. We protect ourselves from patients with obvious symptoms and signs we know are contagious. Nonetheless, the patients with potentially dangerous diseases that do not show any recognizable indicators are those who present the most threat to the health of ER staff. Allow me to illustrate this with an example that happened before the Government recently strengthen the the law on patient’s confidentiality.
On a busy Saturday night shift, Mr. M was waiting patiently for me in the suture room. He had been assaulted, robbed of his wallet, and sustained a laceration to his head. The bleeding had been controlled by heavy pressure dressing applied by the triage nurse. He was a healthy looking pleasant gentleman, and we started to make small talk as I prepared to sew up his wound. As I fitted on my gloves and picked up the scrub brush to clean the wound, he asked me to stop a minute and shut the door because he needed to tell me something in private.
I did as instructed and waited for him to give me the message. “Doctor, I didn’t want anybody else to know about it, but I have the AIDS virus”. “Since you are going to be working with blood and sharp instruments, I thought I should let you know.” The reason he did not mention it to anyone else was to avoid the shame and stigma associated with the disease. I thanked him for his concern and for being forthright with me. I then proceeded, a little bit more careful than I normally would have been during a busy period, to close the wound.
As I worked, I wondered how many more patients I had sutured who had the AIDS virus or other contagious disease like hepatitis that never bothered to warn me. From that moment on, I decided to assume that any patient I came across potentially has something detrimental to my well-being and, that I must take extra caution to protect myself.
I had a dilemma though. Should I maintain the patient confidentiality or let the nurses in on his secret since they also would be taking care of him? Given the time constraint, I came up with a simple solution. I decided to eliminate any body fluid contact the patient might have with anyone else in the ER. I sutured him up, dressed his wound, cleaned the room and disposed of the instruments myself. The nurses were left with the only chore of reinforcing the wound instructions and signing out the patient. I was thereby able to protect the patient’s confidentiality and avoid needless exposure of the nurses to a lurking danger.
The recent outbreak of SARS in some South East Asian countries and Canada is a reminder of a similar danger. Many health care workers and scientists lost their lives when they were unknowingly exposed to the SARS virus while taking care of patients.
Contributed by JKL: Cincinnati Ohio
Source: http://www.er-experience.com
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I love life - its mystery and its complexity. There is much to discover and to understand. I love people with passion. It's always interesting to meet a person overflowing with emotion. I love to play the piano and listen to intersting music. I like working with my hands that proabably explains my affinity with playing, doing crafts, typing (blogging) and even eating when doing nothing but I can't seem to make my whole body coordinated that you can't make me dance or do sports. I also like walking beside the bay, watching people, singing or humming, smiling or greeting strangers, thinking and not thinking of anything at all. || I prefer intimacy. I don't like going into bars or partying where you go on group dates. I like it when I can give 100% attention to whom I'm with because when I'm with a lot of people, I feel I have to accomodate them and I'm not able to share quality time with any of them. Drinking coffee and dining out is always on the top of the list.|| I feel I'm sitll living in my comfort zone. I'm yet to understand what's on the the other side of the wall. I'm yet to understand what others say 'the cruelty of reality' (if there is such). I like to do so may things but remain generally a passive person. I'm still on the path of discovering and adapting to the ideals (irony) of reality .
