Patients, Doctors, and Patience

[ownedsubgal]

It was serious, it was just silly too (mostly because of the hat). There are plenty of times to question medical treatment, whether or not you want anesthesia during your c/s is really not one of those times.

Here's the way I feel about requiring a partner for consent. Probably going to offend, but oh well. I don't care what your relationship is with your significant other, but for medical procedures the patient's consent and the patient's consent only is what I care about. No one else is having your c/s, no one else is shoving a baby through your vagina, I don't give a damn about anyone's opinion but the patient's. If you need to discuss it with them that's fine, but if I feel like your person is being coercive in any sense, I will kick their ass out of the room. I'm responsible for and liable for the patient, not the patient's friends, family, etc.

Granted, my passion for the subject comes from the fact that most significant others are morons. I spend too much time on a daily basis saying, "No your epidural won't kill the baby, no it doesn't cost any different to you, not like you're paying for this anyway, yes you can still breast feed, if you think your contractions hurt now you really won't like them later, not to mention that if you think not giving us consent for anesthesia means we're not going to have you on the table and open a heartbeat if it's an emergency you've got another thing coming..."

Course, I'm also one of the people who doesn't mind at all when momma wants to get her tubes tied without telling anyone.

well considering the typical patient population with whom you are primarily working, your stance is completely logical. but as someone whose life is entirely under the authority of someone else, i do understand being in the position of a medical authority wanting or demanding a decision from you, and knowing that it's really not my call. it's an issue i deal with nearly every time i visit a new doctor/health care worker. it has to be made clear to them that i don't/can't make the decisions about my health care. that is my Master's role, and one he takes very seriously. it has never happened, but if for some reason a medical worker physically kept my Master away from me and demanded i make my own decision, i'd just leave.

 

[Soumis]

well considering the typical patient population with whom you are primarily working, your stance is completely logical. but as someone whose life is entirely under the authority of someone else, i do understand being in the position of a medical authority wanting or demanding a decision from you, and knowing that it's really not my call. it's an issue i deal with nearly every time i visit a new doctor/health care worker. it has to be made clear to them that i don't/can't make the decisions about my health care. that is my Master's role, and one he takes very seriously. it has never happened, but if for some reason a medical worker physically kept my Master away from me and demanded i make my own decision, i'd just leave.

I need to think about this a bit, because here's my kneejerk reaction. You don't "want" to make a decision, that's your call, but to say you "can't" make a decision is false. Legally, your will is all that matters, nothing else.

 

[ownedsubgal]

I need to think about this a bit, because here's my kneejerk reaction. You don't "want" to make a decision, that's your call, but to say you "can't" make a decision is false. Legally, your will is all that matters, nothing else.

actually, it is your assessment which is false. in situations like you are describing, dealing with my body and the care of it, i cannot make a decision. at varying times, i may want to, i may not want to, or i may not care one way or the other....but regardless of my personal desire at a particular moment, the bottom line is that i just cannot independently make the decision. as for my "will," at the core my will is to please and obey the one who owns me, even when my personal desire may conflict with that.

 

[un4gettable]

when I was pregnant with my kids I went to the same OB. He is sooo good looking. He used to work in construction before his wife helped him through med school. He is an amazing doctor but has these huge hands. I remember when I was in labor and he checked to see if I was dialated I screamed "I HATE YOUR FINGERS!!!" All the nurses laughed cause they knew exactly what I was talking about!

 

[Keroin]

When I was 16, I had to have all four of my wisdom teeth surgically removed before they came through - not enough room in my big mouth for them, go figure.

This was the first time I'd ever gone under general anesthetic. Also, I didn't realize it but apparently, when this surgery is performed, your mouth gets cranked open pretty hard. Anyway, I woke up from the surgery, waaaaaay out of it but in tons and tons of pain. Bleary eyed, I spotted a nurse and thought, 'As soon as she looks at me, I am going to to tell her how much pain I'm in and ask her for a pain killer'. I rehearsed my line over and over, 'I need a pain killer. I need a pain killer. I need a pain killer...'

When she finally looked my way, I was so excited. I opened my mouth to speak but I was still too groggy and all that came out was a very slurred, "Hi". I promptly passed out again.

 

[Cattypuss]

My flatmate at university had to go and have wisdom teeth out under general anaesthetic and she was very worried about it as she'd never had an anaesthetic before.

When she came to she thought she'd died and gone to heaven. She could even hear the angels singing.

(Actually it was carol singers at the other end of the ward - she had the op done just before Xmas)

 

[Soumis]

God bless anesthesia for wisdom teeth. I'm pretty sure I laughed at the oral surgeon when he asked if I wanted it.

"If I wanted some yahoo sticking me a half dozen times in the gums with local, I'd have let my dentist do the procedure. I came to you for the good stuff!"

 

[Keroin]

Here's something interesting. My friend has managed a dentist office for almost 25 years now. She says that less and less people have wisdom teeth anymore. Turns out evolution has decided that they are no longer necessary for us.

Hm. I may have to start a poll.

 

[Cattypuss]

Here's something interesting. My friend has managed a dentist office for almost 25 years now. She says that less and less people have wisdom teeth anymore. Turns out evolution has decided that they are no longer necessary for us.

Hm. I may have to start a poll.

OK. Time for me to admit I often get bamboozled by facts/assertions like this.

I thought evolution worked by changes/mutations being advantageous, to the extent that individuals possessing the changed genetic material would survive and breed more successfully than individuals who didn't.

How/since when/why are people with the "no wisdom teeth" gene breeding and surviving more successfully?

 

[Keroin]

OK. Time for me to admit I often get bamboozled by facts/assertions like this.

I thought evolution worked by changes/mutations being advantageous, to the extent that individuals possessing the changed genetic material would survive and breed more successfully than individuals who didn't.

How/since when/why are people with the "no wisdom teeth" gene breeding and surviving more successfully?

Beats me. She just said she's noticed a big shift. Older people people used to grow wisdom teeth and keep them. Then, with subsequent generations, more and more people had to have the wisdom teeth removed because there was no room in their mouths . Now she says she's seeing lot of young people who simply aren't developing wisdom teeth at all.

Anyway, I started an informal survey.

ETA: See new thread for wiki

 

[ownedsubgal]

unfortunately i had all 4 of my wisdom teeth pulled during the 2 yr period where i had no health insurance...so we went with a local anaesthetic. the pain was immense but not nearly what i had imagined it to be...the hardest part was not freaking out over the sounds being made, and forcing myself to not look at what the surgeon was doing. it helped that the doctor was friendly and chatty...it succeeded in distracting me slightly. but when he complimented me on my scent and asked what perfume i wear (don't wear any btw), i started getting a little nervous, lol.

 

[Cattypuss]

I had all four of mine out under local too. Had it done in my lunch hour and went back to the office afterwards. An hour later, when I fainted and slid off my chair, they sent me home lol.

 

[sb2009]

OSG - I'm curious, I'm not trying to flame you or anything. I understand your owner makes all decisions for you. However, in the case of the OP when a healthcare worker has to hear from you the decision, do you do the talking? And just let the health care worker think it's you making the chioce? I mean, legally, in the hospital setting, to them, your O/p status means nothign to them, even though it means everything to you.

Wouldn't it just be easier to discuss ahead of time what he wants you to say and then say it, rather than go through the "he owns me, he makes the choices regarding my healthcare" or is that a battle you feel if important for you both to fight?

 

[Soumis]

Okay, home from work, thought about this a bit.

Even being in the lifestyle, I could allow very little flexibility when it comes to consent. If a patient needs to discuss their decision with a significant other that's fine, but legally what matters is the patient. I am obligated legally and ethically to place my patient's well being first. If my patient is legally capable of giving consent than it is their consent I require, not a surrogate's. A bdsm relationship does not trump the fact that the patient is legally the responsible party.

The reason I say that a person in a bdsm relationship won't give consent, rather than can't is because submission is a choice, one that the patient was presumably mentally competent to give, so they should be mentally competent to give medical consent.

The reason I can't be flexible with this is as I said legal and ethical. I'm sure as hell not going to explain in court that I accepted a significant other's decision concerning medical care over the patient's.

Even ignoring the legal implications, I have no way of knowing if the patient truly agrees with the person to whom they are deferring the decision making. Few things piss me off more than when my patients look at their significant others before answering questions, particularly as they relate to their care and pain medication. I always make it a point to have the patient's family wait in the waiting room while we're admitting them and getting consent. This way I can run though their desires concerning their pregnancy and ask if they're safe at home without visitors. More often than I could have imagined, the answer is no, and I have to police access to the patient.

I couldn't in good conscious act otherwise. To do so would make me a poor advocate for my patient.

Keep in mind I work in a very specific medical field. I see a lot more patients that are being abused than patients considered unable to give consent.

Someone working in end of life care obviously has to contend with family wishes a lot more.

Side note: I hate to use the word ethics, but the medical field does have a better handle on the word as it relates to our practice than most.

 

[Primalex]

Few things piss me off more than when my patients look at their significant others before answering questions, particularly as they relate to their care and pain medication.

What happens if they request a second opinion from a different staff member? Do you get the shotgun then?

I would worry if someone makes decisions about care and medication immediately without getting different opinions first.

EDIT:
I know that my wife would act this way, too, most likely. But this would have nothing to do at all with our BDSM relationship or that I wouldn't grant her her own opinion and decision. She asks for advice or opinions in dozen areas, then why should she completely disregard it in the medical field, where it actually is really important?

 

[Netzach]

So I'm talking about meds with my cute, uptight GI, who I like, and M is there.

"So how long do I get from remicade, you think?"
"Well I'd like to think we can get you into your forties, and then there are other TNF blockers, like Humira, Cimzia"
"So the duration, is kind of a crap shoot with these things."
"Yeah"

M: "Like Crohn's. Heheh. Crap. Chute. Get it?"

Yes, it cracked up my MD.

 

[Netzach]

What happens if they request a second opinion from a different staff member? Do you get the shotgun then?

I would worry if someone makes decisions about care and medication immediately without getting different opinions first.

EDIT:
I know that my wife would act this way, too, most likely. But this would have nothing to do at all with our BDSM relationship or that I wouldn't grant her her own opinion and decision. She asks for advice or opinions in dozen areas, then why should she completely disregard it in the medical field, where it actually is really important?

I do that and I'm the pants in the rel. I like to know if I'm walking into what M thinks is a bad idea because he's another reasonably smart person and I picked him for a reason. He's there at most appointments with me and goes in with me. Maybe they think we're some kind of ultraconservatives or something but I really couldn't care less.

 

[Netzach]

actually, it is your assessment which is false. in situations like you are describing, dealing with my body and the care of it, i cannot make a decision. at varying times, i may want to, i may not want to, or i may not care one way or the other....but regardless of my personal desire at a particular moment, the bottom line is that i just cannot independently make the decision. as for my "will," at the core my will is to please and obey the one who owns me, even when my personal desire may conflict with that.

From an MD doesn't want to get sued standpoint, which is how they need to operate - they generally need to see a POA or believe that your decision is yours with the consent of your partner or your partner is articulating what you'd want.

Seems to me that the latter is the best way to get what you want without creating a little battle that just screws things up for you. Lose the battle win the war kind of thing.

 

[sb2009]

I'm seeing it differetnly than a lot of you might be...when the OP is asking about pain leve, for example, I wouldn't look at someone else for the answer. If the dr was asking about any meds I took, I can see checking with him "Hey, did I take the iron supplement last night, I can't remember?" and he might say "no, your stomache was hurting too much, remember?" ect.

Sometimes the PYL/pyl needs to be there.. when my husband had a kidney stone he was incapable of speech, and they had to ask me about when he last ate, etc. But his pain level was pretty obvious from the "FUCK FUCK FUCK THIS FUCKING HURTS GIVE ME SOMETHING" shouts.

 

[ownedsubgal]

OSG - I'm curious, I'm not trying to flame you or anything. I understand your owner makes all decisions for you. However, in the case of the OP when a healthcare worker has to hear from you the decision, do you do the talking? And just let the health care worker think it's you making the chioce? I mean, legally, in the hospital setting, to them, your O/p status means nothign to them, even though it means everything to you.

Wouldn't it just be easier to discuss ahead of time what he wants you to say and then say it, rather than go through the "he owns me, he makes the choices regarding my healthcare" or is that a battle you feel if important for you both to fight?

first, although i may have a general idea on what my Master would and would not want for me, having to make very specific decisions, unexpectedly and on the spot is something very different. if my Master is not already right there by my side (many doctors will not allow anyone else in the examination room itself), then i refrain from making any decisions and usually say "i have to think about it." this takes the pressure off and gives me the time to consult my Master so he can then make the decision he feel is best.

secondly, we have never and would never broadcast our M/s relationship in a medical situation...we are not the flag-flying sort by any means. if it's a really hairy situation, like a medical emergency and decisions are expected to be made on the fly, my Master reveals his legal guardian status. but thus far that has only happened once, that's not something we really want to shout from the rooftops either.

 

[Netzach]

first, although i may have a general idea on what my Master would and would not want for me, having to make very specific decisions, unexpectedly and on the spot is something very different. if my Master is not already right there by my side (many doctors will not allow anyone else in the examination room itself), then i refrain from making any decisions and usually say "i have to think about it." this takes the pressure off and gives me the time to consult my Master so he can then make the decision he feel is best.

secondly, we have never and would never broadcast our M/s relationship in a medical situation...we are not the flag-flying sort by any means. if it's a really hairy situation, like a medical emergency and decisions are expected to be made on the fly, my Master reveals his legal guardian status. but thus far that has only happened once, that's not something we really want to shout from the rooftops either.

Is it state by state? I'm just asking - I have *never* had anyone refuse to let the person I want in with me in and I can't imagine the level of hissy I'd have if that happened.

I mean the pt IS the consumer in this situation.

 

[ownedsubgal]

Even being in the lifestyle, I could allow very little flexibility when it comes to consent. If a patient needs to discuss their decision with a significant other that's fine, but legally what matters is the patient. I am obligated legally and ethically to place my patient's well being first. If my patient is legally capable of giving consent than it is their consent I require, not a surrogate's. A bdsm relationship does not trump the fact that the patient is legally the responsible party.

your legal and ethical obligations are totally understood.

(btw, i am not in a "bdsm relationship")

The reason I say that a person in a bdsm relationship won't give consent, rather than can't is because submission is a choice, one that the patient was presumably mentally competent to give, so they should be mentally competent to give medical consent.

i personally chose to give myself to my Master, not to submit to him. the submitting part comes naturally and is rather outside my direct control. so speaking only for myself, it is a "can't," not a "won't."

The reason I can't be flexible with this is as I said legal and ethical. I'm sure as hell not going to explain in court that I accepted a significant other's decision concerning medical care over the patient's.

and you shouldn't have to. if everyone conducts themselves properly, it never has to be known that someone else is truly making the decisions. i agree with Netz in that it should appear to any questioning outsiders that the Dominant party is only going along with the personal desire of the submissive party.

Even ignoring the legal implications, I have no way of knowing if the patient truly agrees with the person to whom they are deferring the decision making. Few things piss me off more than when my patients look at their significant others before answering questions, particularly as they relate to their care and pain medication.

then you would absolutely hate me as a patient. and if a medical professional were to force me to answer such questions all alone, again i would just refrain from making any decisions. i think all of my regular doctors/nurses read me as intelligent, well-informed, inquisitive (because i ask many questions so my Master can make the best choices), thoughtful and somewhat reserved. definitely not abused or frightened, so they are not made to feel uncomfortable or ethically obliged to intervene.

 

[ownedsubgal]

Is it state by state? I'm just asking - I have *never* had anyone refuse to let the person I want in with me in and I can't imagine the level of hissy I'd have if that happened.

I mean the pt IS the consumer in this situation.

at first i thought perhaps it was some sort of law, but i was never able to find any information backing that up. now i feel it is just the "ethical" desire of the individual physician or nurse practitioner. they may allow Daddy to accompany me into the pre-examination room, where you are questioned and have blood pressure checked, etc...with a raised eyebrow but no fuss...but then when he starts to follow me into the actual private examination room, many will say, "you can wait for her outside," or "patients only." and i can understand in certain environments...say an abortion clinic. but getting a general physical or a teeth cleaning??

if i were the type to stand firm or throw hissies, i'm sure it would be different. unfortunately Daddy can't throw the hissy for me, that makes him look like psycho-womanbeater.

 

[sb2009]

I had no idea that he was actually your legal guardian. So there is a legal leg to stand on.

 

[graceanne]

So I'm talking about meds with my cute, uptight GI, who I like, and M is there.

"So how long do I get from remicade, you think?"
"Well I'd like to think we can get you into your forties, and then there are other TNF blockers, like Humira, Cimzia"
"So the duration, is kind of a crap shoot with these things."
"Yeah"

M: "Like Crohn's. Heheh. Crap. Chute. Get it?"

Yes, it cracked up my MD.

LOL..