Filed under: MSW, counter-transference, medical ethics, social work, social work ethics | Tags: choice, death
I think all social workers have to learn to come to terms with their clients making bad decisions. I work hard and remembering we all have the freedom to make bad decisions. And of course I think for anyone, realizing a bad decision making only comes from hindsight. In the medical field, I see poor decisions being made all of the time. People who drink too much and end up with liver disease, diabetics who fail to seek treatment and end up with a myriad of consequences from that. Heck, in my short time at my current job, I’ve had at least once very, very ill client who left the hospital against medical advice. And I struggle with these things…knowing how much to challenge a client without making them feel alienated.
The other problem I struggle with is that sometimes clients make bad decisions because they don’t get enough information from the medical provider. Sometimes I think the occurs because they are too intimidated by said medical provider or have been taught that they should trust doctors. Then, they fail to ask questions or let the medical provider know that they just don’t understand a word the doctor has just said and, as a result, don’t even know which questions to ask. But, sometimes, I think that maybe the medical provider just doesn’t truly convey the client’s medical situation.
I think this is the case with one of the clients I saw this past week and have seen several times over the past few weeks. Looking over their records I just can’t believe that the doctor would have recommended the aggressive treatment that this client is undergoing. Granted, I’m not a doctor or even a nurse, but given the extent of this patient’s disease process I just don’t understand why they weren’t offered hospice as an option. And, maybe it was. I wasn’t there when the patient was told of their diagnosis and prognosis. Maybe this was fully the patient’s decision to pursue such aggressive treatment.
Maybe I’m just experiencing some good, old-fashioned counter-transference. It is painful for me to see this patient deteriorate. They have been unable to go home. They have been able to be around their family because of the treatment they are receiving.
The other problem I have in this situation is that the MD handling the case is well known for providing many patients with a rosier-than-real prognosis. And this MD is known for being highly resistant to making hospice referrals. Often, the hospice referrals made by this MD are done at the point where the patient has days to live.
So…I just don’t know where to go with situations like this…where is it the patient making what I feel is a bad decision based on personal choice and where is the patient making a bad decision based on a lack of information?
