Fiduciary relationship with patients and families
fractures, COPD
CHRONIC OBSTRUCTIVE PULMONARY DISEASE, COPD, SAID, MULTIPLE SCLEROSIS
When it came to discussing their reasoning with patients and families, interviewees described a fiduciary commitment to communicate any concerns they had about a given anesthetic option. Reflecting on whether to offer recommendations about the anesthetic approach to patients with hip fractures or their surrogates, one anesthesiologist drew the following analogy:[I]f I go in to meet with my financial advisor, and he says, “Well, you know what? You have X amount of dollars here. Here are the five things you can do with the money, and I won’t give you my personal opinion at all on what is the best.” I might be sitting there and saying, “Well, why did I actually come to you? You’re the specialist. What am I talking to you for […]?” So that’s how I see it for patients, too. (interviewee 9)Interviewees felt that patients and families held similar expectations and recounted being asked to present their opinion on which anesthetic was preferable even after patients or proxies had agreed to enroll in REGAIN when approached by study staff.Patients will sometimes come down consented, but then they’ll very much want to know what my personal feeling is one way or the other. […] [I]f they ask me for my opinion, what would I do if I was treating my parent, I’ll usually present my opinion for that and then that will actually affect their decision. (interviewee 21)Whether done by their own initiative or in response to patient or family prompting, most interviewees saw conveying a recommendation as necessitated by their fiduciary duty even if it created problems for REGAIN enrollment. A few added that they felt being as transparent as possible about their concerns was a means of empowering the patient to make the most informed choice about whether to participate in the trial. For example, said one anesthesiologist of two patients he withdrew from the trial:[I]n the two patients I discussed, the ones with the COPD [chronic obstructive pulmonary disease] and the MS [multiple sclerosis], I think when they’re enrolled into the study, there’s not a lot of discussion given to them. […] They didn’t have any frank discussion [with research staff] about the MS or the COPD, and then the implications of that. So, I think we shouldn’t be obstructive, but I think it’s important that the patients are fully informed, so that they can make the choices. (interviewee 22)