Last night I had an ER rotation which, for the most part, was pretty uneventful (and by uneventful I mean there were no major traumas or anything).
There was a patient who came in with a broken left humerus and I was able to see the ortho resident set it which was actually very interesting. The way he gently moved the bone around seemed almost magical. He explained to me that the humerus tends to heal “beautifully” unlike the other bones in the body and we are not sure why. That was interesting to watch.
One case, in particular, was quite interesting. It was an elderly patient who lives alone at home. She had fallen and had multiple open wounds and a laceration to one of her legs. I watched the attending suture her wound which was quite amazing seeing how her skin was very fragile and it seemed as if there would be nothing to pull together. The most interesting part, however, was that this sharp and extremely alert woman refused anymore help than the nurse that sees her a few times a week. This got me thinking about how one could deal with such a patient.
The attending was able to keep her overnight but previous episodes resulted in her either not staying or not going to the hospital at all. With the population in the United States getting much older, physicians, and health care providers in general, are sure to come across more of such individuals who refuse any help, unable to realize the possible detriment to their health if they will not receive it. The most we can do is refer them and/or their family members to social workers who may be able to help but it seems there is not much the health care provider can do.
What will happen to these patients once they get home and have no one to care for them? How can the health care provider help without stepping upon patient autonomy? Does the physician have a responsibility to help the patient, even once outside of their office? What will happen as doctors see more and more patients such as this one?