The Doctor Will See You Now [Non-Fiction]

Chapter 10: Gastroenterology

Sometimes work can be frustrating. Sometimes people needing help or medical interventions don't want it or their priorities are different. I'm not specifically talking about psychiatric issues, although those can also apply. I'm also not blaming the patient. People with capacity have the right to refuse medical intervention and are also allowed to prioritise different things, no matter how 'crazy' it may seem to us. As a doctor who knows the true implications of refusing medical treatment and also who is being prevented from doing my job properly, respecting that personal right can be very frustrating, however.

Alistair is a guy in his 50s who needs an endoscopy to see if his gullet or stomach is bleeding. If there are bleeds, we give medications or band/burn away the bleeding bits so the patient does not in the near future get a major bleed and maybe die.

This scope can take place much quicker as an in-patient. Alistair is admitted anyway for something relatively unrelated. Alistair tells me he wishes to self-discharge. I told him why we advise otherwise and our proposed plans -- scope, treat, then home. He declines. Conversation goes thus:

Alistair (A): But I can just come back next week. I'm free then. I need to go home right now [for errands].

Me (M): It's not a matter of when you're free, sir. You have the choice of taking medical advice and staying or signing yourself out. Those are the rules. You stay in, you get it done quickly. You discharge yourself, you'll wait at the back of the outpatient queue like everyone else.

A: But I'm not signing myself out. I'll come back [to the ward to get the scope] on Monday.

M: That's not how the health service works.

A: Then you can refer me to the specialists and they can sort it.

M: We are the specialists.

A: Then my GP can refer to the specialists and I can do it then.

M: We are the specialists. Your GP's referral to us will just end up with you being right here, awaiting the scope.

A: *gives a myriad of reasons why they need to be out of hospital right now, including how they need to collect benefits, pay rent, and go to the job centre*

M: Sir, just sign the form if you want out.

Eventually they agree to sign the DAMA form.

A: You're just washing your hands of me, then, aren't you?

I'm internally thinking, "Isn't this the whole point of you doing a self-discharge?!"

M: I'm just following the rules, sir.

A: So you're just telling me to piss off, then.

M: Have a good day, sir.