How to deal with refusals

You enter the room and the patient adamantly refuses.  You say "Okay, just let me know if you change your mind."  Or perhaps you're busy and don't want to do back, and you simply say, "Okay."  Either way, you did your job.

Is that right?  Perhaps not according to some physicians.  I know one doctor who hates it when an RT doesn't do a treatment.  She says, "If I order a treatment I want you to do it.  If the patient doesn't want it it's your job to talk them into it."

In the ideal world this doctor is right.  Yet in the real world we RTs are often inundated with an amalgamate of therapies we have to do on a daily basis, and many of them aren't needed for any other purpose than for the patient to meet reimbursement criteria.  So when a patient refuses we often feel relief and walk away.

Whether wrong or right, most RTs I know go on the three strikes and your out policy.  If you refuse three treatments in a row we just walk by your room after than.  If it looks like you're breathing okay then we just keep on walking.  In the ideal world it wouldn't be this way, but in the real world that's all we have the time or energy for.

And this is how it is whether the patient is has a PRN order or a specific frequency ordered.  If the patient doesn't want the treatment he probably doesn't need it anyway.  The only exception I make to this policy is when the patient is a fun discussion.

Discuss.