Reference no: EM133657848

"Joe" a well respected APRN with many years of experience, works in a primary care clinic. One afternoon a patient presented for care with the complaint of "the worst headache ever". The physical exam showed no neurological deficits. Although Joe wanted the patient to have a stat CT of the brain or be evaluated in the emergency department urgently due to the severity of the headache, the patient declined. The patient was agreeable to having a routine CT scan scheduled the following week which was scheduled.

On the morning of the scheduled CT the patient collapsed, was transported to the hospital by ambulance and died shortly afterward. The ER director called Joe to let him know that the patient "died of a big brain bleed". The ER director berated Joe for not ordering a stat CT. "You should have made them go. Nag them until they go!"

The clinic's medical director also berated Joe for not forcing the patient to go to the emergency room for evaluation. He yelled at Joe in the middle of a very busy clinic in front of patients and staff. "You call the ambulance and you make them go!" He filed a complaint against Joe with the clinic manager.

1. What do you think of the response of the ER director to the situation? What do you think of the medical director's response?

2. How would you advocate for the patient's right to refuse medical treatment? How do you document the refusal?

3. How do you think Joe should respond to the complaint?