Looking for Alternative Terminology for The Phrase 'the Patient Refused …'

GnarlyKnuckles on 30/05/2019 - 00:02
Last edited 30/05/2019 - 09:50 by 1 other user

I am a medico and I am frequently tasked with reviewing prospective journal article drafts generated by colleagues. I have always been a bit irked by the standard terminology used in journal articles/reports to state that a given patient (in a case study for example) decided not to opt for a certain course of treatment. The current convention is to state that that patient ‘refused’ that course of treatment. I think that conventional wording is outdated, and misrepresents the contemporary situation.

At least in countries with reasonable healthcare systems, patients of sound mind and under no duress do not ‘refuse’ anything. Instead, their treatment options are presented to them and they make their own choices as to what to decline, and what to opt for. In a sense, this is quite the opposite of ‘refusing’ anything.

Getting back to my initial point, I am not intending to open up a hornet’s nest of feverish debate about ‘right to choose’ or the state of healthcare in Australia. I am actually just asking what your opinion is about the standard terminology currently used in medical publications to state that a patient decided not to opt for a certain treatment option. Currently, what is usually published is that the patient ‘refused’ the treatment. I think ‘declined’ (or some similar word/wording) would be much more appropriate.

The last thing I will add is that ‘quibbling’ over what terminology is the most ‘PC’ is not something I would usually do. For example, I personally have no time for this whacky (yet unfortunately rapidly pervading) ‘movement’ that holds that it is not appropriate to use the words ‘cancer patient’, or ‘influenza patient’, etc … I am absolutely genuinely interested in anyone’s opinion on the ongoing use of ‘… the patient refused …’ in the medical literature though. To me it seems extremely outdated/misrepresentative.

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Comments

                      • Lysander on 30/05/2019 - 16:53

                        @nfr: Look, I am not sure what you are trying to get at but I always offer the clients to obtain and see my notes. Often they cannot be bothered and that is fine because they have been given the choice.
                        Often the clients are surprised at the transparency but so far I have only had very positive feedback and commendations for the transparency. But as I said - I have nothing to hide.
                        I understand the reluctance to be transparent if you have something to hide but then I suggest the solution is to work in a proper way so nothing must be hidden.

                        • nfr on 30/05/2019 - 18:54
                          +3

                          @Lysander: Doctors notes are routinely read by other team members, so I'm not sure why you keep referring to "hiding", which implies doctors nurses physios occupational therapists speech pathologists and social workers collude on something sinister, something that harms patients. Your wording is very misleading and very wrong. It puts people in drawers they do not belong in and imply moral issues that do not exists as a matter of fact.

                          See what I did? Write enough and you are bound to get misinterpreted.

                          The target readers of medical notes are health professionals, so they are written accordingly. If patients decide to read them, personally I don't care, but they should not get upset if the writing style does not cater for their psychological needs.

                          Anyway what profession routinely shares all personal notes with clients? Lawyers do it? Which law firm?

                          • Lysander on 30/05/2019 - 22:24

                            @nfr: If I work they are not personal notes but professional ones.

                            Example: I have often dealt with one particular very rich client.
                            My professional notes would deal with his contract issues while personal notes (if I took any which I don't) might deal with his behaviour and manners.
                            If you keep notes professionally there is no issue in giving them to clients. You have no odea what clients want to see and gave justified (rightly so) when their monthly legal bill is 100k (payable to the girm, not me).

                            Medical notes are primarily for other medical professionals but they should be written unambiguously and without connotations as more and more those end up in court or before a tribunal. You do not want to lose a case because you wrote "denied" or "refused" when you could have been more neutral writing "the patient said or reported". And yes, cases and the extent of duty of care can hinge on a single word.

                            When I worked mainly in medical negligence it was quite standard that people actually did hide something if only incompetence or failure to do something or on time.
                            If people know their notes can easily be reviewed and it is easy to hold them accountable, they ususlly work more diligently and cautiously in my experience.

                            • nfr on 31/05/2019 - 00:54
                              +3

                              @Lysander: I think if someone lost a case, it's because he did something demonstrably wrong, not just because he wrote one word wrong. Or I hope that's how the legal system works.

                              How strong can an argument be, if all you got is some subjective connotations of one word? I use the words refuse and deny the way they mean in dictionaries, they are descriptive terms that carry no value judgements. Other people may use them pejoratively, but I'm no mind reader, how can I prove what they were thinking unless they did something else that can be objectively verified? IMO the negligent should lose his case anyway, even if he used all the right words.

                              • Lysander on 01/06/2019 - 01:47

                                @nfr: If you want to find out the power one word or rather a few words can have, research the difference in extent of duty when the following words are used:

                                • with endeavour
                                • with best endeavour
                                • with highest endeavour

                                Just one word difference, big difference in extent of duty or effort required to satisfy one's duty.

                                I had to spent two hours with an expert to learn those differences when I was a trainee - in fact every trainee got solo training on things like that and it was compulsory.

                              • GnarlyKnuckles on 04/06/2019 - 04:18

                                @nfr: Re:

                                'I think if someone lost a case, it's because he did something demonstrably wrong, not just because he wrote one word wrong. Or I hope that's how the legal system works.'

                                I can assure you that is absolute 'lala-land stuff'/a 'Utopian myth'/a child-like perspective pretty clearly held by someone who is at least somewhat 'insulated' in a social sense. I have been trying hard resist chiming in on this exchange between you two, but I have some relevant experience in this area and Lysmo is absolutely correct here, and your simplistic summation about what you 'hope' is the case is utterly ill-grounded. Judges/magistrates often 'latch onto' a single word in some piece of evidence or other that they (alone) decide is pivotal, and things proceed from there.

                            • Ti-au on 31/05/2019 - 22:21

                              @Lysander: Doctor notes are Not just notes made with a client.

                              They are communication with the next doctor, specialist, etc.

                              Do you share internal emails of you Law Practice with clients? emails with external solicitors/barristers? emails with experts or other third parties?
                              IF you are/did - Why?
                              My guess is that you would tend not to agree to a client who demanded this level of access.
                              Even if they used the line "what have you got to hide?".

                              Do you share 'rough' interview notes or provide typed up notes which are then sent to the client?
                              (IF you are sharing your notes during an interview, it would be more professional to share with a follow up letter and not provide the actual notes).

                              Medical notes are primarily for other medical professionals but they should be written unambiguously and without connotations as more and more those end up in court or before a tribunal. You do not want to lose a case because you wrote "denied" or "refused" when you could have been more neutral writing "the patient said or reported". And yes, cases and the extent of duty of care can hinge on a single word.

                              In terms of language - the Courts will first look up legislation and see if the term is defined, then they will look to what how the word is used in the profession and finally they will look up how the word is used every day.
                              IF it is standard practice to use the word 'Refused' then I would highly encourage medical professionals to keep using that word, rather than start to invent their own terminology, which a Barrister could immediately question the professional on that.

                              If you could provide the case where the court overturned the use of 'refused' it would be interesting to see, as I would think that is more unequivocal (and so accurate) than 'declined'.

                              • Lysander on 01/06/2019 - 01:44
                                +1

                                @Ti-au: "Do you share internal emails of you Law Practice with clients? emails with external solicitors/barristers? emails with experts or other third parties?
                                IF you are/did - Why?
                                My guess is that you would tend not to agree to a client who demanded this level of access."

                                I do give them the notes - all of my notes if they choose to see them. Everything in my notes is essentially the same as in the later drafted advice with the difference that that is obviously well formulated and thought out.
                                So, yes. I do give clients total access to my notes. I do not need to know why they want to see it - they are paying which means they can see it.
                                I share rough interview notes, typed up notes - all notes if so requested.

                                It is not standard practice in the legal sense - different terminology is used and many medical professionals do NOT agree with words such as "refused", "denied" etc. precisely because of what they imply.
                                A barrister would question anything and as long as some professionals use a word it is very difficult to discredit it (one older famous case is the Bolam case which deals with accepted medical practice).

                                By the way, I would not use either "refused" or "declined". As I said, I would try to quote the client as closely as possible which in fact is very much accepted practice being the "subjective" part of doctor's notes.
                                In relation to family history though the information given by the client is the only factual info the doctor can rely on - hence they should not use words which could make those facts ambiguous.
                                Again, if there is no history of cancer in my family a doctor should write precisely that instead of "patient denied history of cancer in the family" - what should be written is "patient says/states there is no history of cancer in the family" - this gives any subsequent doctor all the info they need without any negative connotation.

                                It really is not that hard. The funny thing is that in my experience the people who like to use the terminology in question do not like it at all when they are on the receiving end of it, for example in cross-examination.

          • trapper on 31/05/2019 - 16:39

            @[Deactivated]: Yeah but if they said it then they said it, or 'stated' it.

            If they shook their head mutely, or used sign language, then you would have to write something else lol

  • Seraphin7 on 30/05/2019 - 10:37
    +7

    I am actually just asking what your opinion is about the standard terminology currently used in medical publications to state that a patient decided not to opt for a certain treatment option.

    I do not read medical publications as I am not a doctor/medical researcher … I dare say like most users of this site. Therefore, I have no opinion. I would suggest that if the word "refused" is well understood in the context it is being used (and by people using it) it would be far more risky to change terminology and introduce ambiguity than to simply stick with a word you don't like because of connotations outside of the context in which it is being used.

  • MrBear on 30/05/2019 - 10:43
    +3

    Here is the relevant definitions from dictionary.com. You think the word implies things it does not.

    verb (used with object), re·fused, re·fus·ing.
    * to decline to accept (something offered): to refuse an award.
    * to decline to give; deny (a request, demand, etc.): to refuse permission.
    * to express a determination not to (do something): to refuse to discuss the question.

  • ozbarhui on 30/05/2019 - 10:43
    +1

    Decline. The patient declined.

    • [Deactivated] on 31/05/2019 - 11:36
      +2

      Oh no. Are they okay? :(

    • Ti-au on 31/05/2019 - 20:42
      -1

      Imagine if medical notes had been damaged and thats all you can see!

      Better not give them this treatment because they declined last time They had it!

      • ozbarhui on 03/06/2019 - 08:49

        The word 'deterioriated' is more likely to have been used in that situation, I would have thought.

  • websterp on 30/05/2019 - 10:52
    +2

    I thought this was Ozbargain Forums? Or is it time for me to go to Specsavers because all I'm seeing is Ozretarded these days.

  • OzBargainGirl on 30/05/2019 - 11:03
    +3

    From another h.professional to another:

    If the patient was provided with informed consent, then the patient CHOSE to….

    Yes, the patient exercised their choice.

    That is all there is.

    Not the authoritarian - you must do this - and the patient - refusing;
    or them 'declining'…

    It is the same with any other treatment.

    You can never make the patient 'do' anything. They are not a toy, but a live person.

    Hence, if there is informed consent, there is - choice.

    • Lysander on 30/05/2019 - 12:43

      Beautifully put.

    • tempco on 02/06/2019 - 21:20

      Agreed. Choice/Chose/Choose would be what we use in education to record behaviour by students. "Student A was asked to … , and then chose to … ." Frames the event from the point of view of the person of interest - educators can't force anyone to do anything really.

  • jonnochen on 30/05/2019 - 11:07

    I try to use declined but I think it depends on how you feel about the patient at the time and certain situations. Some things we think are essential (refused) and some are more 'optional' (declined). No rhyme or reason tbh. And like others have said, it's a long road to change medical terminology and most people don't care.

    • Lysander on 30/05/2019 - 12:46

      The crucial part is "we think….." - therefore, in effect the medical professional is putting his thought before the patient's and takes away the patient's choice.
      Plus, in medicine as in law so often there is not the one definitive only or perfect choice as the professionals cannot even agree on that.

    • Save Medicare on 31/05/2019 - 00:38
      +1

      Perhaps if we had an additional 30 minutes of writing and reflection time between patients on ward rounds we would find the most appealing combination of words to use for our notes in every scenario.

      I try to make a habit to write decline but in reality when the junior is juggling three med charts, this morning's bloods, chasing micro and imaging reports what gets written down is whatever accurately reflects what has happened.

      Documenting that the patient is declining or refusing further analgesia isn't going to result in a substantial difference in their care or outcome.

  • sharkyoz on 30/05/2019 - 11:11

    refused = opted for a different process

  • [Deactivated] on 30/05/2019 - 11:59
    -1

    I can see why declined is not used, as it might get confused with their declining condition.

    • [Deactivated] on 30/05/2019 - 12:39

      But we don't write in our notes that the patient's condition is declining. That would be wasted words.

  • rompastompa on 30/05/2019 - 12:42

    The patient opted for alternative treatment.

  • Strahany on 30/05/2019 - 12:46
    +5

    The term “refused” is used to protect the practitioner, and rightly so.

    By using “refused” then it implies that the practitioner said “you need to undergo treatment X”

    If we use a different term, such as “patient chose not to do x” then it can openly imply that the practitioner said “you can do x or you can do y” whereby y is not a legitimate course of treatment.

    In the event that things go sour, and the patient may seek recourse, having “refused” protects the practitioner as it demonstrates they pushed for proper treatment, and the only reason said treatment did not go ahead is because of the patient. Conversely, it could be argued that, in the event of using the latter terminology, the practitioner did not properly explain the clinical reasoning for their proposed treatment, and they presented the options as equivalent pathways when they’re not. This could easily open the practitioner up to lawsuits and/or professional conduct reviews.

    • Tech5 on 30/05/2019 - 22:45
      -1

      I agree in principle, but I feel like a medical board should not have to infer things from what you wrote

      Technically the notes should contain

      • What options discussed (including option of no treatment, which is a valid option in regards to patient declining treatment)
      • Pros/cons of each
      • What patient chose and why

      That should be what protects you

      • Strahany on 31/05/2019 - 08:14
        +2

        Writing notes like how you describe them would be impossible in hospitals (where almost all cases of refused treatment takes place). It would more or less halve the number of patients which could be seen in a day and our already overloaded public health system would come screeching to a halt.

        If someone refuses, it’s noted as such (including what was refused and why; briefly). If there is a secondary option backed by clinical reasoning, that will be offered and noted. Even those are an already lengthy note, and doesn’t come close to what you’re suggesting. It’s just not feasible.

        • Pricebeat on 02/06/2019 - 18:06

          Clearly doesn't know when you are trying to finish notes at the end of shift, a patient is wanting to shit, other is vomiting and third one is about to fall out of bed. at that time you don't think of whether it's refused or declined.

    • trapper on 31/05/2019 - 13:05

      By using “refused” then it implies that the practitioner said “you need to undergo treatment X”

      Exactly. Although I would say 'it makes it clear that the practitioner said …'

  • The Wololo Wombat on 30/05/2019 - 13:03

    I get it. I have seen this on my file and it angered me. It's arrogant.

  • Typical16-bitEnjoyer on 30/05/2019 - 13:16

    I'm refusing the read this thread.

    • Meho2026 on 30/05/2019 - 13:31

      If you dont read it you will die

  • rave75 on 30/05/2019 - 15:11
    +2

    The patient opted for another treatment?

    • Dr C on 31/05/2019 - 23:51

      Exactly. What's wrong with saying they opted not to receive the treatment?

  • payless69 on 30/05/2019 - 15:19

    How politically correct do you wanna be? Since ssm it is cool to be a queer. Uncool to be hetro, even un-cooler to be married.
    Many govt forms still ask you if you are white or one of them dark skinned Aboriginal or Torres Straight Islanders?
    In India they do not have disabled worthless creatures. They have facilities for specially abled persons!

  • chronophysicist on 30/05/2019 - 16:21

    I think in the end unless u think "refused" could be used in such a way that could be misunderstood for something else I don't really think it matter?
    maybe, if not broke don't fix?

  • zuuutoootuuu on 30/05/2019 - 16:39

    As you and others have suggested, opt out is a reasonable replacement IMO.

  • Silicon Wizardry on 30/05/2019 - 16:59

    The standard wording is not just perfectly acceptable, but it is accurate linguistically and legally.

    Was the treatment offered to the patient? If it was, then it is perfectly correct to describe the patient choosing not to accept the treatment as "refusing" it. Linguistically, offers are refused or accepted. Declined is probably synonymous, but why change a perfectly good and accurate word? And, unpacking "declined", one simply declines an offer to have something done…

    In the medicolegal context, "refused" simply makes clear that the patient, having been offered a choice of doing / taking something, chose not to do it. It fits with informed consent: they either consent to something being done (if they if they accept the option offered), or they refuse consent to that thing being done. Here, refused is the better word, as it is precisely what is being done: the patient is refusing consent to have the thing done. (And this is key, as you surely know; if a patient does not provide consent, then doing that thing anyway would be an assault, subject to the usual edge cases in emergencies etc). So once you frame the inquiry around consent, "refusing" treatment / "refusing" consent is the best and most accurate description you can use.

    I think you are reading some pejorative overtone into the word that does not exist, and you are basing your view that it is "outdated" on that. Don't waste time on this! Focus on the quality of the article instead.

  • Gorgeousmorgeous on 30/05/2019 - 17:30
    +1

    "Patient declined"

    • Ti-au on 01/06/2019 - 15:23
      -1

      And then died….

      o_0

  • mousie on 30/05/2019 - 17:44

    You need to get out more and get some vitamin D

  • pformag on 30/05/2019 - 18:08
    +3

    Here you go. Pick one.

    decline
    ignore
    protest
    rebuff
    reject
    turn down
    withdraw
    withhold
    demur
    desist
    disaccord
    disallow
    disapprove
    dissent
    dodge
    evade
    nix
    regret
    repel
    reprobate
    repudiate
    shun
    spurn
    beg off
    brush off
    dispense with
    give thumbs down to
    hold back
    hold off
    hold out
    make excuses
    not budge
    not budget
    not buy
    not care to
    pass up
    refuse to receive
    send off
    send regrets
    set aside
    turn away
    turn deaf ear to
    turn from
    turn one's back on

    • Ti-au on 01/06/2019 - 15:25
      -1

      The patient turned one's back on the treatment offered to them.
      We don't know if they refused or just rolled over but we are not taking any chances, so we declined to give them the medication, then they declined.

  • BestofOZB on 30/05/2019 - 19:18

    I prefer declined.

    • Ti-au on 01/06/2019 - 15:26
      -1

      "The Patient declined"

      You want to get worse? :-0

  • Name on 30/05/2019 - 19:26
    +3

    Wow. I thought I was bored so I decided to read this thread. I decided I am going to put my phone down and go back to staring at a wall.

  • Vote for Pedro on 30/05/2019 - 19:29

    The patient chose not to proceed with the recommended treatment

  • MelCheapo on 30/05/2019 - 19:35

    It's not "the patient refused", its "the medico failed to convince".

    Really in any professional field, if someone consults with a professional, its the professional's job to use their experience and training to steer the consul-tee to the best path. If you can't, its not a case of a "patient refusing", its a failure of the professional to communicate. It's a dangerous arrogance to assume its the other way about.

    • Justtip on 31/05/2019 - 00:01
      +2

      Quite a lot of the time there is no "best path" to convince them. I'd suggest assisting them to come to a decision that is in their best interests and in line with their own beliefs and values is really the goal. Sometimes best interests and their values etc are at odds but that's far less common.
      For the record, I used declined.. or chose.. or decided not to.. I really save refuse only for when it's more adversarial: like "the pt refused to drop the scissors so physical restraint was required to prevent harm to them or others.."

    • pao2x on 31/05/2019 - 08:10
      +2

      Start convincing anti vaxxers to vaccinate, have a go. See how much “failure to communicate” plays a part

    • trapper on 31/05/2019 - 13:15
      -1

      Yeah I'd say the doctor gave up too easy if the patient just 'declined'.

      There is a professional obligation to get to an actual refusal before allowing the patient to be sub-optimally treated.

      • BestofOZB on 01/06/2019 - 18:21

        A doctor's job is to exlpain options to their patient and let them make an informed decision. I had a patient who declined having recommended radiotherapy to her brain when we told her long term side effects could be some memory loss and cognetive impairment, she wanted to continue looking after her husband with dementia at home for as long as she can. I had nothing but respect for her and her decision.It's all about doctors offering available treatment, and patients can accept, or…..decline.

  • MessyG on 30/05/2019 - 20:12
    +1

    RACP. We are trained to use "declined". Disrespectful language = fail the clinical exam. Edited to add - that 'movement' you're talking about to phrase things differently that you don't agree with? That's come from years of patients feedback. People are not their disease, hence referring to them as 'cancer patient' IS disrespectful. You choosing not to follow that really means choosing a line of disrespect. There's no moral agenda here, this is what patients have asked for so they don't feel demeaned when they're at their most vulnerable. I don't think it's too mentally taxing to respect that.

    • Ti-au on 01/06/2019 - 15:33

      You can't say "cancer patients"? Srs….

      So as an example when you put a sign up that says: "Lung Cancer & Emphysema Patients Only" - you have to change that to "Patients who are suffering Emphysema and Cancer of the Lung"?…. Ok….

      I wish we spent more time on reducing medical errors tbh.

      • MessyG on 02/06/2019 - 09:57

        We can say cancer patient, it's not banned or anything (the disrespectful language I was referring to as an instant fail is much worse), but feedback from the patients themselves is that they want to be talked about in a different way. They're sick, they're vulnerable, they're often facing their own death - it's really not a stretch to do it.

        We spend huge amounts of time medical error reduction, it eats into a lot of my time with patients.

    • AntonioSantino on 01/06/2019 - 23:39

      "people are not their disease" … referring to a "cancer patient" is NOT saying people are their disease. You are calling the person 'a patient", so not saying the person is their disease. With adjective "cancer". Hence I can't agree with your logic. Better grammatically, perhaps they ought be referred to as a "cancerous patient", but that doesn't have the same cache as "cancer patient".
      Personally, if I were such a patient, it'd be "call me what you bloody well like, just do your best for me medically"

      • MessyG on 02/06/2019 - 10:00
        +1

        Well your first mistake is in assuming that humans are logical when they're not. And it's not my 'logic', as I mentioned, this is the overwhelming feedback from patients. And if someone would prefer that I referred to them by name rather than 'the cancer patient in bed 23', it's no skin off my nose. Getting outraged over a request for a change in semantics is a bit over the top.

  • ozbjunkie on 30/05/2019 - 20:59
    +1

    Elected to
    Elected not to

    Obviously this is just "chose" dressed up to sound academic, as many papers are actually not saying anything clever, so they have to dress up mutton as lamb and "sound clever".

    But that's another thread.

    • allegiance86 on 01/06/2019 - 12:40

      Definitely the best one here ozbjunkie

      File reads - Patient had elected to not undergo XX

      Seems the most neutral to me

      • Ti-au on 01/06/2019 - 15:37
        +1

        IMHO way too easy to make a mistake in an emergency.

        The patient elected not to have a blood transfusion, could easily be read as the patient elected to have a blood transfusion.

        Patient refused blood transfusion would result in zero mis-reads.

        • ozbjunkie on 01/06/2019 - 15:39
          +2

          Agreed. Academic double speak is great for papers, not for patient case notes.

  • LikeMike on 30/05/2019 - 21:17
    +1

    This thread reminds me of last year when a doctor said on the tv news about someone's "condition not being compatible with life". Lot's of people were outraged but it's a common phrase in the medical industry. First world problems

  • factor on 30/05/2019 - 21:38
    +1

    Perhaps medicos typically use 'refused' when they disagree with the choice of the patient. They use 'choose' when they agree or it was entirely the patient's choice. There is indeed a level of arrogance attached, sometimes partially warranted but does misunderstand what it is to be human, to think differently, to exercise agency.

    I've read about 1000 pages of medical notes (public hospital) relating to my daughter. I don't see refused anywhere - perhaps because there was time for very clear discussion on problems and options (or lack thereof). All sides understood an informed choice was made at every step. As such no need for a bitchy, overworked 'refused' notation.

    • Ti-au on 01/06/2019 - 15:39

      there was time for very clear discussion on problems and options

      What happens if there is no time and the patient is bleeding out?

  • ahly92 on 30/05/2019 - 22:32

    I agree refuse has a underlying connotation that the treatment is being forced by the doctor.

    Forced => refuse
    Offered => decline

    Perhaps the issue here is it's missing context. Why not something like, "when given the options a,b,c the patient declined a,b in prefernce to c"

    • trapper on 31/05/2019 - 13:11

      Not 'forced' but it can and should have an underlying connotation that the treatment was desired by the doctor.

  • Tech5 on 30/05/2019 - 22:42

    Opted not to? Declined? That is what I usually write

  • RefusdClassification on 31/05/2019 - 07:37

    I prefer the word 'declined'. 'Refused' indicates hostility towards the physicians, perhaps a patient with oppositionl-defiant disporder or passive-aggressivity. Or perhaps a patient who had had a bad experience with that treatment before, or from another member of the same family of drugs.

    "At least in countries with reasonable healthcare systems, patients of sound mind and under no duress do not ‘refuse’ anything. Instead, their treatment options are presented to them and they make their own choices as to what to decline, and what to opt for." I like this idea, but the truth is that I have never been presented with a menu of treatment options. It has always been simply "Take this". Is the treatment doesn't work, it's "Take That".

    We need a patient-centric medicial system. As Harry Stack-Sullivan said, "The patient is always right". The patient has to live with the consequence of a doctor's decision, which often include iatrogenic side effects, and occasionally even death (from botched surgeries). People know whether a treatment is useful (reducing symtoms), malign (worsening existing symptoms or having prounounced sideFX), or just plain useless (no better than placebo). Humans are dumb, but they are not as dumb as the people in power think. They observe, form hypothesis, make conclusions, formulate alternate strategies.

    • trapper on 31/05/2019 - 13:18
      +1

      The patient is always right?? Why go to the doctor then lol

  • gimme on 31/05/2019 - 07:43

    I didn't think I was interested in the question until I started reading the thread. Sone really insightful comments very unOzbargainlike.
    Also what the hell are surgeons doing on Ozb?

    • [Deactivated] on 05/06/2019 - 06:38

      A Bargain Cavalcade catches all eyes, gimme.
      Enjoy - https://youtu.be/rD85HZQwwWw
      American, so managed to avoid a finding in The Royal Commission into the Banking and Financial Services Industry.
      :)

  • cimrak on 31/05/2019 - 09:52

    "After reviewing the options presented, patient has made an informed decision to decline treatment at this time but has expressed willingness to review further options that may become available at a later date".

    • Ti-au on 01/06/2019 - 15:41
      -1

      Why write 4 words when you can write 33?

  • MementoMori on 31/05/2019 - 10:43

    The patience 'chose not to'

    • Ti-au on 01/06/2019 - 15:41

      Patient says 'No'.. <cough>

  • cnrmlj on 31/05/2019 - 12:06

    The patient chose not to

  • trapper on 31/05/2019 - 13:07
    +1

    Refused makes it clear the patient is acting against professional advice.

    You decline water when offered in a work meeting.
    You refuse water when the nurse wants you to drink it in hospital.

  • blah88 on 31/05/2019 - 14:14

    Why not this one?
    You used it yourself.
    "…decided not to opt for…"

  • DarthAntz on 31/05/2019 - 14:17

    The patient dissuades medical advice

  • ozoner on 31/05/2019 - 14:37

    Personally I use "declined". It's a less judgmental, more empowering word in my opinion.

    The bigger question here is why the hell you would ask ozbargain such a question instead of asking colleagues, supervisor, senior staff or whatever. This place never fails to surprise/puzzle/confuse me.

  • this is us on 31/05/2019 - 14:52

    I am a medical doctor (a.k.a medico - that was the first time I saw someone writing in English and using the "medico" terminology, but we should NOT open a new topic for this discussion) and I think you should use the terminology that you feel more comfortable with, depending on the context:

    Patient refused…
    Patient denied…
    Patient declined…
    Patient rejected…
    Patient decided that…
    Patient didn't want to…
    Patient opted for not having…
    Patient preferred not to…
    Patient didn't accept…
    Patient disagreed…
    …
    Patient ran away because the doctor asked him/her what was the best terminology for what was happening in that room…

    Sorry but I do find very annoying that you have to come here (OzBargain, not a medical forum or a clinical meeting with your peers) to ask people's opinion about medical terminology for patients refusing treatment.

    EDIT: I've finished writing a research project about shared decision-making (SDM), and I do think that this is something we doctors should use (I've been trying to find evidence showing that SDM leads to better outcomes for the patients). We should give enough information to the patients so they can make an informed decision about the treatment. We can even recommend one option or another, and the patient has the right to refuse or reject or choose something else. The terminology is not the problem here.

    • Save Medicare on 31/05/2019 - 17:02
      +1

      Patient absconded during heated discussion regarding accurate terminology

    • Ti-au on 01/06/2019 - 16:18

      I keep seeing this: "better patient outcomes."

      But that does not mean the patient is cured or treated, which is why the go and seek medical advice in the first place, rather they are just made to feel better by nicer language, I think if its just the latter then its really a waste of time.

      • this is us on 04/06/2019 - 00:28

        Well… that depends on what "better outcomes" means. If that means increased adherence to treatment and that translates to less depressive symptom, I think that's pretty good.

  • microwaveporridge on 31/05/2019 - 15:15

    '…did not choose to (x/y/z)'

  • Save Medicare on 31/05/2019 - 17:07

    One interesting thing I've come across reading medical notes from the US (med mal reviewer blog) is "patient endorsed"… As in "patient endorsed left sided chest pain"

    Have never seen it used this way in Australia

    • nfr on 31/05/2019 - 19:47
      +1

      Lol that's just nonsense

  • ifailbot on 31/05/2019 - 18:09

    The patient did not provide informed consent to X

  • negger on 31/05/2019 - 18:12
    +1

    If options given and patient/carer selected one of them then does it really matter what term is used to describe others? I would give emphasis on the opted one rather than the refused/declined/whatever. I'm not a medico and I'm not sure about the intricacies in your life of course but I am worried about you guys trying to improve on the literature you produce rather than the pt outcome.

    • Ti-au on 01/06/2019 - 16:22

      bingo.

      "better patient outcomes" & yet patient died :/

      Perhaps a large part of it is trying to be nice so the patient does not sue…

  • Heaps for Cheaps on 31/05/2019 - 18:37

    You could say 'The patient patient patiently refused treatment, passionately', but it could be shortened to 'PPPRTP'.

    Many good ideas on the thread, but I agree with the poster who said that theres a few options that you can use depending on how comfortable you are.

  • ihbh on 31/05/2019 - 19:10

    I heard in childcare the phrases are similar - the kid refused to eat, etc.

  • greatlamp on 31/05/2019 - 19:28
    +1

    The wording is clear and unambiguous
    No patient is identified

    I think it is fine, the intended audience knows what it means.
    You could fill a dictionary with terms used in medicine that the general public misinterpret.

    For example "theory" or "hypothesis" both are taken to mean "we have no idea, this is a guess"

  • peterw1 on 31/05/2019 - 20:25

    why don't you use, patient exercised their autonomy and did……Sometimes they exercise their stupidity but it is informed stupidity/autonomy. Oddly enough this autonomy does not extend to driving without a seatbelt. So if they survive an accident without wearing a seatbelt and are then brought into hospital conscious their right to decline treatment is to be respected ie exercising their autonomy.
    I always find it odd that if someone dies hang gliding, mountaineering etc, a comment made is they died doing what they loved. If they died from a smoking related illness or obesity complication they never use this same term ie they died doing what they loved, smoking or eating.

  • [Deactivated] on 01/06/2019 - 08:46

    patient absconded. or abjured.

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