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Care outcomes cannot be guaranteed

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Early in my training, it never really occurred to me that so many medical outcomes involve a balance of risks, some created by the patient’s own personal decisions.

For instance, Mrs M, an obese patient with diabetes, recklessly stopped taking her insulin to reduce weight. She ended up losing her sight.

Similarly, Mr D, discharged after lung surgery, secretly resumed his smoking habits – his way of dealing with stress. He nearly died as a consequence; it was no fault of his carers.

In those two cases, there was a secretive, self-defeating dimension to the patients’ behaviour that could not be predicted but which must, on occasion, reduce nurses and doctors to despair.

In other cases, decisions are undeniably difficult. Mr H was coming to the end of a five-month course of chemotherapy, for which the normal adjunct would be intensive radiotherapy for a further four weeks. There was a complication, however, in that he had a double heart condition that increased the risk involved in taking it.

The consultants put the facts squarely to him, without pressuring him one way or another. He declined the radiotherapy, preferring the risk of abstention to the possibility of cardiac damage that radiotherapy might incur.

Happily, the chemotherapy alone seemed to do the job, for he is now nearly three years into remission – but his decision to refuse radiotherapy could have had disastrous consequences.

In my naivety, this kind of situation came as a surprise. Hypnotised by the wonders of medical achievement, it took time and experience for me to realise that nothing is 100% guaranteed and many care outcomes still turn on chance, risk, probability and the vagaries of human nature. Live and learn!

Lesley McHarg is a third-year nursing student in Scotland

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