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What happens when a patient gets angry or refuses to get their anesthesia?

I am a curious high school who is aiming to become an anesthesioogist and I want to know what the protocol would be when a patient gets angry, and if the answer is to call security then, what happens if the patient has tubes through their nose or their arms or something connected to them? #doctor #curious #hospital

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Julio’s Answer

Hey Camila! Great Question,

One thing you have to take into account is that 99% of patients who are having a procedure done that will require anesthesia will talk to doctors way beforehand to talk about the procedure, have a check-up to ensure they are eligible for said procedure, and talk about the anesthesia, whether they are allergic to anything, prefer a type of anesthesia, or have any concerns about the procedure. Once the day comes for the procedure, patients are usually ready and comply with everything doctors and nurses tell them to do.

Now, for the 1% that refuses or becomes angry within a short period before a procedure there are different things that could happen. If it is an elective procedure, then the doctors will simply not do the procedure if it is one that absolutely cannot be done without anesthesia such as surgery. If it is something life-threatening, they may make patients sign forms that allow the doctors or loved ones to override their requests, ensuring they stay within legal boundaries. Take for example, someone who has a serious case of necrosis, which is the death of cells in a limb such as a leg or arm, if this is a critical emergency, the doctors have no power to "force" the patient into accepting anesthesia or moving forward with any surgery without consent, whether it be verbal or written, but in situations like that where patients know they may die without care, it is usually a go.

If a patient is upset and begins to react physically, then yes, security will be called, not before calling nurses and possibly other medical assistants to try and calm down the patient. If they have some sort of tubing or device attached to them, it will usually cause some sort of discomfort to the patient, enough pain or discomfort for them to call down, if it is a device that is less invasive such as a pulse oximeter, then security will be called and they will be escorted out or calmed down.

Hoped this help Camila!

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Estelle’s Answer

Camila, what a good ethics question. I agree with Julio. Usually, lots of counseling has gone on between doctor and patient before the anesthesia. However, when patients refuse treatment or become angry, it is usually because they are afraid. It is very important to address this in a calm and comforting manner and explain what the diagnosis and treatment plan are. If one physician is not able to confidently work with a patient that needs a procedure or treatment, sometimes another provider (doctor or nurse) is helpful. Usually communication and patience are the keys. Calling security is a last resort unless the medical staff is in danger. Finally, patients always have the right to refuse treatment, even if the standard of care is to have a procedure done.