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

When we torture our patients

Shoa L. Clarke, MD, PhD
Physician
May 18, 2014
269 Shares
Share
Tweet
Share

Today, a patient attacked me. A nurse got kicked. Another punched. I was gouged to the point that blood was drawn. The patient was neither intoxicated nor psychotic. Rather, she was a meek 92-year-old grandmother, and she was terrified. It took five of us to hold her down, as she summoned the strength of a woman fighting for her life.

Linda is an elderly woman with moderate dementia. She is blind and nearly deaf, and she speaks no English. Normally, she is quite pleasant. She lives in a nursing home where she has several friends and gets along well with the staff. Although she is forgetful about day-to-day events, she frequently tells stories of her past. She loves having visitors.

In the days leading up to her hospitalization, Linda had begun acting strangely. She accused staff of conspiring against her. She even cursed at a friend. Then, she had a seizure. By the time EMS arrived, the seizure was over, and she was confused. She refused to go with them. What were they to do?

She arrived to the emergency department on a stretcher with her hands bound. A small old woman, she appeared harmless. We tried speaking to her in English; she replied in her native tongue. We called for an interpreter and attempted to contact her family. Using the interpreter, we explained that she was in the hospital and that we were here to help her. She spit vulgarities at us. When we unbound her hands, she suddenly sprung into action, punching and kicking. She screamed at the top of her lungs — a scream saturated with fear.

We were forced to hold her down against her will, jab a needle into her arm, and inject her with a medication to calm her. She did not respond to the medication right away, and we tied her to the bed with four-point restraints. She continued to thrash and shout.

Of course, there are many reasons why an elderly patient might have a seizure. We needed to act quickly to look for the cause and treat her appropriately. As soon as she appeared sedated, we attempted to obtain a blood sample. Again, she went wild. We gave her more meds. Finally, we were able to do the work that we needed to do — checking labs, scanning her head, etc.

The situation I encountered with Linda is more extreme than typical, but it represents a common scenario. Few will disagree that in special circumstances physicians need to treat patients against their will. In particular, we may do so when a patient is deemed to lack the cognitive capacity to make decisions for him or herself. Linda was delirious, and she lacked capacity. For that reason, we did what was necessary to treat her. But what was necessary was torture.

Admittedly, using the word “torture” is hyperbolic. We had no malicious intents. We were working in Linda’s best interests. But let’s put semantics aside and try to understand the situation from her perspective.

Linda has dementia. She is blind and nearly deaf. She was forcibly taken from her home by people she did not recognize who spoke a language that she could not understand. She was tied down to a bed and stuck with needles. In her frail mind, the only way to understand this situation is as an attack on her life. To her, it was torture.

The mere thought of torturing a patient makes me queasy. My rational mind immediately objects to the use of that word. I had no desire to hurt Linda. Quite the contrary, I desperately wanted to help her. But in order to help her, I allowed her to experience a terrible situation.

I did not torture her, but she surely felt tortured.

Is this alternate phrasing clever doublethink? Am I simply protecting my conscience? I suspect that I am. I have to. If I do not, how will I be able to go on treating patients like Linda?

When I tell Linda’s story to friends outside of medicine, their response is, “That’s horrible!” When I tell the story to young physicians, their response is, “That’s too bad.” Older physicians simply respond, “That’s life.”

Inevitably, physicians become desensitized to these experiences. It is not because they have lost their humanity or their compassion. Rather, these unfortunate situations are simply part of the job.

Linda is better now, but it’s only a matter of time before she gets rushed back to the hospital for some other reason, likely to go through the whole ordeal again.

That’s life.

Shoa L. Clarke is an internal medicine-pediatric resident.  He blogs at Multichotomy and can be reached on Twitter @ShoaClarke.

Prev

The white coat can be an inadvertent barrier to care

May 18, 2014 Kevin 2
…
Next

The ethical dilemma of being a runner, doctor and journalist

May 18, 2014 Kevin 10
…

Tagged as: Emergency Medicine, Geriatrics

Post navigation

< Previous Post
The white coat can be an inadvertent barrier to care
Next Post >
The ethical dilemma of being a runner, doctor and journalist

More by Shoa L. Clarke, MD, PhD

  • a desk with keyboard and ipad with the kevinmd logo

    Approach patients as one human caring for another

    Shoa L. Clarke, MD, PhD

More in Physician

  • Heartwarming stories of cancer patients teaching us about life and the human spirit

    Johnathan Yao, MD, MPH
  • We need a new Hippocratic Oath that puts patient autonomy first

    Jeffrey A. Singer, MD
  • The meaning of death in medicine: the role of compassionate care in end-of-life patient care

    Ton La, Jr., MD, JD
  • How can there be joy in medicine if there is no joy in Mudville?

    Arthur Lazarus, MD, MBA
  • Physician entrepreneurs offer hope for burned out doctors

    Cindy Rubin, MD
  • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

    Elizabeth Cerceo, MD
  • Most Popular

  • Past Week

    • A patient’s perspective on the diminishing relationship between doctors and patients

      Michele Luckenbaugh | Conditions
    • How chronic illness and disability are portrayed in media and the importance of daily choices for improved quality of life

      Juliet Morgan and Meghan Jobson | Physician
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Why affirmative action is crucial for health equity and social justice in medicine

      Katrina Gipson, MD, MPH | Policy
    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • Unlocking the secrets of cancer conferences: an end-of-life counselor’s journey among pharmaceutical giants

      Althea Halchuck, EJD | Conditions
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
  • Recent Posts

    • The pros and cons of taking a gap year during medical school

      Med School Insiders | Education, Sponsored
    • A family physician’s journey on the OIG list and the struggle to return to practice [PODCAST]

      The Podcast by KevinMD | Podcast
    • Heartwarming stories of cancer patients teaching us about life and the human spirit

      Johnathan Yao, MD, MPH | Physician
    • We need a new Hippocratic Oath that puts patient autonomy first

      Jeffrey A. Singer, MD | Physician
    • The meaning of death in medicine: the role of compassionate care in end-of-life patient care

      Ton La, Jr., MD, JD | Physician
    • From skydiving to saving lives: a surgeon’s journey on adversity, passion, and perseverance [PODCAST]

      The Podcast by KevinMD | Podcast

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 11 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

CME Spotlights

From MedPage Today

Latest News

  • Catching the Optimal Amount of Z's May Be Protective Against Long COVID
  • Treating Early Hospitalization Blood Pressure Deemed a No-No for Patient Safety
  • Addressing Burnout in an Invisible Part of the Health Workforce
  • Family-Oriented Sedation Protocol Helps Kids With ASD Manage Routine Healthcare
  • Bariatric Surgery in Kids With Obesity Becoming More Common

Meeting Coverage

  • New Model Aims to Study Intestinal Fibrosis in Crohn's Disease
  • Hypertension Tied to Worse Survival After Surgery for Upper Tract Urothelial Cancers
  • The Role of Amyloid PET in the Management of Alzheimer's Disease
  • New Inflammation Inhibitor Proves Effective and Safe for Dry Eye Disease
  • No Access to Routine Healthcare Biggest Barrier to HPV Vaccination
  • Most Popular

  • Past Week

    • A patient’s perspective on the diminishing relationship between doctors and patients

      Michele Luckenbaugh | Conditions
    • How chronic illness and disability are portrayed in media and the importance of daily choices for improved quality of life

      Juliet Morgan and Meghan Jobson | Physician
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Why affirmative action is crucial for health equity and social justice in medicine

      Katrina Gipson, MD, MPH | Policy
    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • Unlocking the secrets of cancer conferences: an end-of-life counselor’s journey among pharmaceutical giants

      Althea Halchuck, EJD | Conditions
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
  • Recent Posts

    • The pros and cons of taking a gap year during medical school

      Med School Insiders | Education, Sponsored
    • A family physician’s journey on the OIG list and the struggle to return to practice [PODCAST]

      The Podcast by KevinMD | Podcast
    • Heartwarming stories of cancer patients teaching us about life and the human spirit

      Johnathan Yao, MD, MPH | Physician
    • We need a new Hippocratic Oath that puts patient autonomy first

      Jeffrey A. Singer, MD | Physician
    • The meaning of death in medicine: the role of compassionate care in end-of-life patient care

      Ton La, Jr., MD, JD | Physician
    • From skydiving to saving lives: a surgeon’s journey on adversity, passion, and perseverance [PODCAST]

      The Podcast by KevinMD | Podcast

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

When we torture our patients
11 comments

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

Loading Comments...