Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Patient autonomy in times of shortage

Deepak Gupta, MD
Policy
September 27, 2018
Share
Tweet
Share

Being self-aware sometimes to the point of turning self-critical — I, as a constituent of an anesthesiologist’s society, am writing this freestanding letter to bring forth our ethical questions and concerns regarding a shortage of not only medications but also skills, funds and time.

Scenario 1: Patient requests for spinal anesthesia for cesarean section, but a shortage of hyperbaric spinal anesthetics warrants epidural anesthesia as its replacement. What must be done? Is it sufficient to inform the patient, consent the patient for epidural anesthesia and move on?

Scenario 2: Patient requests for ultrasound-guided transversus abdominis plane block but a shortage of traditional team’s skill in regards to the “new kid on the block” discourages its use in the patient. What must be done? Is it sufficient to acknowledge team’s deficiency, give the option to choose an alternative method or an alternative team, and move on?

Scenario 3: Patient requests for labor epidural analgesia but a shortage of Medicaid funds warrants the hesitant team to explain alternative options for labor analgesia. What must be done? Is it sufficient to inform the patient about procedural costs, consent the patient for bearing costs and move on?

Scenario 4: Patient requests for preoperative placement of an epidural catheter for postoperative analgesia, but the shortage of time is discouraging it due to the patient arriving very close to scheduled surgical time despite being the first case of the day. What must be done? Is it sufficient to inform the patient, choose first-case-start-delay versus intraoperative/postoperative placement of the epidural catheter and move on?

All the aforementioned scenarios (case vignettes) boil down to the question: What constitutes patient autonomy? Is it an ethical responsibility or a legal obligation? For understanding, the providers will have to put themselves in their patients’ shoes and realize that the patients may want to know why their providers choose what they choose to present to them as their options. Will the patients’ consent change when they are able to comprehensively explore the available options and why they are available? Or will they be overwhelmed with the exhaustive information about what, why and how? Will they realize that their autonomy may never be absolute, but only relative to its inter-dependence on so many factors which may include, though not limited to, the availability of medications, skills, funds and time?

Being an anesthesiologist, the potential scenarios (case vignettes) presented here are only limited to the practice of anesthesiology. However, the responsibility lies with the providers of all clinical specialties, medical or surgical, procedural or non-procedural to acknowledge it to their consenting patients if their specialties are facing the challenging shortage of medications, skills, funds and time.

It may be interesting to let the patients know about why the specialties are facing the challenging shortage of medications, skills, funds and time. However, providers’ personal interpretations about ongoing shortages may only confuse independently interpreting patients instead of helping them to choose alternative options, including alternative teams.

Alternatively, if proactive patients want to enforce their relative-to-almost-absolute “right” to choose, it may become interesting when they collaborate with their providers in ongoing activism against societal and political challenges which may be leading to a shortage of medications, skills, funds and time. Essentially, it is all about being aware and making aware of challenges while balancing too many possible choices with too little available choices.

Deepak Gupta is an anesthesiologist.

Image credit: Shutterstock.com

Prev

Celebrate women (and men) who change their last names

September 27, 2018 Kevin 2
…
Next

Why do we think obesity is caused by lack of exercise and not junk food?

September 27, 2018 Kevin 3
…

Tagged as: Public Health & Policy, Surgery

Post navigation

< Previous Post
Celebrate women (and men) who change their last names
Next Post >
Why do we think obesity is caused by lack of exercise and not junk food?

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Deepak Gupta, MD

  • Why practicing medicine is both like and unlike practicing law

    Deepak Gupta, MD
  • How pre-procedure optimization could save your life—and the economy

    Deepak Gupta, MD
  • Privacy protection after death: an ongoing dilemma

    Deepak Gupta, MD

Related Posts

  • COVID, paternalism, and the death of patient autonomy

    Garrett Jensen
  • Why the baby formula shortage happened

    Divya Srinivasan and Tejas Sekhar
  • Redefining quality through a patient-centered approach

    Anne Zink, MD
  • How to start reversing the clinician shortage today

    Timothy Lee, MPH
  • The patient-physician relationship is in critical condition

    Ryan Enke, MD
  • A universal patient medical record

    Michael R. McGuire

More in Policy

  • The lab behind the lens: Equity begins with diagnosis

    Michael Misialek, MD
  • Conflicts of interest are eroding trust in U.S. health agencies

    Martha Rosenberg
  • When America sneezes, the world catches a cold: Trump’s freeze on HIV/AIDS funding

    Koketso Masenya
  • A surgeon’s late-night crisis reveals the cost confusion in health care

    Christine Ward, MD
  • The school cafeteria could save American medicine

    Scarlett Saitta
  • Native communities deserve better: the truth about Pine Ridge health care

    Kaitlin E. Kelly
  • Most Popular

  • Past Week

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • The dreaded question: Do you have boys or girls?

      Pamela Adelstein, MD | Physician
    • A world without antidepressants: What could possibly go wrong?

      Tomi Mitchell, MD | Meds
    • Rethinking patient payments: Why billing is the new frontline of patient care [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • The silent crisis hurting pain patients and their doctors

      Kayvan Haddadan, MD | Physician
    • Internal Medicine 2025: inspiration at the annual meeting

      American College of Physicians | Physician
    • What happened to real care in health care?

      Christopher H. Foster, PhD, MPA | Policy
    • Are quotas a solution to physician shortages?

      Jacob Murphy | Education
    • The hidden bias in how we treat chronic pain

      Richard A. Lawhern, PhD | Meds
  • Recent Posts

    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
    • Why great patient outcomes don’t protect female doctors from burnout [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why ADHD in women is finally getting the attention it deserves

      Arti Lal, MD | Conditions
    • How a $75 million jet brought down America’s boldest doctor

      Arthur Lazarus, MD, MBA | Physician
    • Why ruling out sepsis in emergency departments can be lifesaving

      Claude M. D'Antonio, Jr., MD | Conditions
    • The hidden cost of delaying back surgery

      Gbolahan Okubadejo, MD | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 3 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • The dreaded question: Do you have boys or girls?

      Pamela Adelstein, MD | Physician
    • A world without antidepressants: What could possibly go wrong?

      Tomi Mitchell, MD | Meds
    • Rethinking patient payments: Why billing is the new frontline of patient care [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • The silent crisis hurting pain patients and their doctors

      Kayvan Haddadan, MD | Physician
    • Internal Medicine 2025: inspiration at the annual meeting

      American College of Physicians | Physician
    • What happened to real care in health care?

      Christopher H. Foster, PhD, MPA | Policy
    • Are quotas a solution to physician shortages?

      Jacob Murphy | Education
    • The hidden bias in how we treat chronic pain

      Richard A. Lawhern, PhD | Meds
  • Recent Posts

    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
    • Why great patient outcomes don’t protect female doctors from burnout [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why ADHD in women is finally getting the attention it deserves

      Arti Lal, MD | Conditions
    • How a $75 million jet brought down America’s boldest doctor

      Arthur Lazarus, MD, MBA | Physician
    • Why ruling out sepsis in emergency departments can be lifesaving

      Claude M. D'Antonio, Jr., MD | Conditions
    • The hidden cost of delaying back surgery

      Gbolahan Okubadejo, MD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Patient autonomy in times of shortage
3 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...