Hypotheticals

Suppose you have a patient come in by EMS who shows all the signs of stroke: severe right-sided weakness, expressive aphasia, facial droop, with a known time of onset three hours ago. Suppose your patient is a youngish 54 year-old guy, with no medical history. Suppose your hospital’s Stroke Protocol calls for stat transfer — no CT, no blood work,  just pick up and go — to the Regional Stroke Centre 10 minutes down the road, and if the patient leaves immediately, he will just make it within the window of opportunity to get his thrombolytic, and hopefully make a full recovery.

Now suppose you inform the emergency physician of all of this, and he says, “I don’t believe in that shit!” and then proceeds to order the full stroke work-up, thus ensuring the patient will face permanent disability. The physician will not change her mind.

As charge nurse, do you:

• Do nothing, because the physician knows best?

• Do nothing, but write up the physician later, and discuss the matter with the manager?

• Advise the family to take the patient in their own vehicle to the the Regional Stroke Centre immediately?

Assume there is no practical way to get the physician to reverse her decision before time running out, and that each of the choices carries potentially dire consequences for yourself or the patient or both.

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