But this did bring up another interesting question. Just what would be the protocol if someone had an iron event in center and a DNR was in place. For those of us on home hemo we were advised by our social worker and given a copy of our DNR (if we had one) to have on had in case emergency personnel wanted to do CPR etc.
Clinics should have policies and procedures for resuscitating patients. If a patient has talked with his/her doctor and they have agreed upon a “do not resuscitate order,” I would hope that the clinic staff would honor the patient’s wishes. In my mind, treating someone for anaphylaxis related to a drug reaction is different from doing a code on someone who has seriously damaged lungs and/or heart to the point that he/she does not have acceptable (to him/her) quality of life. I would hope that the dialysis staff and nephrologist would talk with all patients with DNRs about whether there is a distinction in their minds.
In my opinion, everyone should talk with their loved ones and write instructions that say what treatment you would/would not want if you can’t speak for yourself. Some people want everything. Others want nothing. And still others want something in between. Although hospitals, nursing homes, home health and hospice agencies are required to offer patients education about advance directives, but dialysis clinics are not mandated to do so. In spite of this, many social workers share information with patients. Some states require that people with DNRs in the dialysis clinic have a special form called “outside the hospital do not resuscitate” if they do not want to be resuscitated in their breathing or heart stops. Patients need to ask if your doctor and/or clinic will honor their wishes. I’ve heard that some clinics will not honor advance directives or DNRs.
Hi Folks
Hi Beth
It is my understanding that in most cases that even if you (the pt) or your family and you have everything on paper that the call as far dialysis centers and doctor the papers are worthless. The center and doctor still have the poweras till what they want to do, this is from a lawyer lips. I my advance directive etc. But in talking with my lawyer told not to count onit if it things happen in center. You can look it up but that is what I also found in my search that there is a debate in center on this and it has more to do with how other pts feel at seeing someone die next to them?It just what I’ve read and heard.
Marty : this a s**ck a-- way the medical world has come but it is what is real. And I don’t think it is just Davita, The dialysis world needs more com,panies ,but more companies won’t come in why $$$
bobeleanor :?:
Just for the record let me say no matter what field it is farming, machine repair, dialysis etc. there is always a big difference when working with corporations and private enterprises. Due to the size of corporations they adopt more of a one size fits all policies and tend to let the lawyers and accountants set the protocol whether or not it benefits the product or customer. Where as in a private enterprise there is more focus on product and customer and less on lawyers and accountants. I have always wanted to get into a center closer to home and now I can but just the fact that the decisons are made at the corporate level and not the nephrologist who is working with the patient I haven’t been able to convince myself the shorter distance is worth it. This is just my opinion on corporate ownership vs private ownership and it isn’t meant to imply Davita, Fresenius and other Corporate Centers are wrong they just have a different way of how they handle business.
Hi Folks
Now I talked with my doctor and silly me thinking that the doctor was after all was said and done had the end word. Silly for to think that, my nurse just talked with me and is not happy that a “doctor made a call without talking nurse first, but to the pt” to see if the two of us (doctor and pt) could try something new ,not for ever just for a two to three months. I guess doctors have no more say when it come to company rules ,not the law as what might be best for the pt.
bobeleanor :roll:
Bobeleanor wrote:
I guess doctors have no more say when it come to company rules ,not the law as what might be best for the pt
Yrs. ago at the Dialysisethics.org site,the person who owned the site, Arlene, stated that nephrologists had sold out their prescription pads to the corporations. We have had nephs like this, that no matter what we desired for our family member’s care, we were told the corporation wouldn’t go for it. It became an exercise in futility to discuss anything with these nephs. On one occassion, one of these nephs did go to bat for us, somewhat. The corp. had switched dialyzers on us without even saying anything to us, for a much less efficient model which took our family member’s clearance right down (we quickly picked up on dishnoest practices like this) and we asked the neph to do something about it. He was burning mad that they had done this, whcih made us think that maybe he did really care, and said he would write an order to restore the dialyzer that was providing a good clearance, but said he couldn’t promise they would honor it. Fortunately, about 2 txs later a compriable model for the orignal one was subsituted. We learned very quickly in dialysis that if one doesn’t speak up, he will be given bottom of the barrel care. And even if one does speak up, it doesn’t guarantee that one’s rights for care will be respected. Let’s face it- either one’s neph and unit owner is honest and above board or they are sneaky and deceptive. That’s the way it goes.
I think Marty’s points stand unrefuted.
I don’t really buy into this is a lawsuit waiting to happen either. First of all it has to happen and it hasn’t. Then one has to make the assumption if it did happen it would happen to that 1 dialysis patient who wanted to sue and try to make a quick buck. Then you have to assume that patient is going to be one that has enough money to go through a law suit. Then you have to assume they can find a lawyer to take the case. Then you have to assume if they do find a lawyer… he can win. Can it happen, yes, After all someone sued McDonalds because of hot coffee. Would I go so far as to make a statement that it is a lawsuit waiting to happen… bit of a stretch for me. Hopefully someone will take a look at these posts and really evaluate the “fear” they have of a lawsuit against the odds of it actually happening.