This week my placement was in the minor injuries department at the Western General. During this week I was aiming to pass my clinical mobile assessment. The minor injuries department deal with the all of the mobile requests for the entire hospital. I was hopeful that I would be provided with enough requests to gain confidence in my work and therefore be competent in performing my assessment.
I encountered a number of difficult situations throughout the week, such as difficulty entering small rooms due to beds, equipment and tables which severely impede the manoeuvring area of the mobile machine. Another problem was the reluctance of some people to move away from an area when a mobile x-ray is being exposed.
The most difficult situation I encountered involved a female patient who required a chest x-ray. The x-ray was due to the fact that she was suffering with progressive shortness of breath (SOB). When we arrived on the ward we identified ourselves to the nursing staff and enquired where to find the patient. The nurse advised us the doctor was still with the patient but we could go in. I could hear the patient who seemed in obvious distress and very agitated. A nurse and doctor were in the room trying everything they could to try and elevate the patient’s condition and help calm her down. However she repeatedly shouted for help stating she just wanted an injection to end her suffering and she wanted her life to be over. The doctor advised her that if she tried to calm down this would help her breathing and she would feel better, she also advised the patient she had phoned for her daughter who she had been asking for, and that she would be arriving shortly. The patient was not responding to the doctor’s efforts to calm her and began to threaten that she was going to jump from her room window.
I found this situation quite distressing and advised the accompanying radiographer that I was unsure how to deal with this from a radiography standpoint. The radiographer was also unsure what to do in this situation and advised the doctor she didn’t feel comfortable performing the request with the patient in the condition she was in. The doctor advised that she needed the x-ray to exclude any underlying conditions and to also plan future treatment. The doctor reassured us that it was in the patients’ best interest to have the x-ray. We duly performed the procedure and, although the patient didn’t refuse the x-ray, she wasn’t very co-operative.
Afterwards, while reflecting on the incident with a radiographer, I wondered what the correct course of action was ethically. In a situation whereby a doctor requests an x-ray in the interests of the patient, however, the patient themselves is in obvious distress about receiving any help or treatments. This seemed like such a grey area. From the patients point of view I can understand if they are in pain and distress and they want to stop the interventions that are keeping them from passing. However, from most patients and relatives point of view, doctors are there to help to alleviate the pain and suffering and must be seen to be doing so. I really felt for this doctor as she was in an awkward situation, for us as radiographers not to perform the x-ray would have made her diagnosis impossible and therefore it would have hindered the patients’ treatment and prolonged her suffering. However, whilst obtaining the projection it felt like we were coercing the patient into something she obviously didn’t want with a complete disregard for her wishes.
Since this experience I have revisited and attached to this piece of writing, The Code of Conduct, as well as The End of Life Strategy document provided by the Society and College of Radiographers (SCoR). Section 3.1in the Code of Conduct states, “Frequently, you may work as part of a multi-professional team and you need to respect the skills, knowledge and contributions of colleagues from other professions and other team members.” While the End of Life Strategy advises, “the SCoR wishes to raise the profile of end of life care within its membership, and to encourage radiographers to consider skills around end of life care as part of continuing professional development”: this document also states, “Radiographers, and imaging and radiotherapy staff in general, need to have a good basic grounding in the principles and practice of end of life care, and many have unmet training needs. They need to have the necessary core competences to enable them to deal with these situations without adverse consequences for the patient, family members and themselves”.

I feel that, after this experience, it is necessary for all radiographers to have situations of this nature, and the appropriate steps to be taken, defined with clear policies and procedures.

This entry was posted on Saturday, October 3rd, 2009 at 5:11 pm and is filed under Reflectives. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.