Waking patients up?

[Carsinian Thau]

If you need to take blood from a patient (for example, I'm also a little curious about other procedures) and they happen to be asleep, would you need to wake them before you do so?

From an untrained perspective, I would think yes, because of the need to obtain consent before hand.

Also, (and I speak from personal experience here), it's not particularly nice to wake up with a needle in your arm with two people standing over you. Although fair play to those nurses, I didn't actually feel the needle at all. But I was still very very surprised.

[bluedolphin]

From my own experience being in hospital, I have always woken up when nurses take my BP/SATs, nevermind shoving a needle in me for bloods! But yes, I think it'd be necessary from a consent point of view. And common courtesy!

[Carsinian Thau]

Originally Posted by bluedolphin

From my own experience being in hospital, I have always woken up when nurses take my BP/SATs, nevermind shoving a needle in me for bloods! But yes, I think it'd be necessary from a consent point of view. And common courtesy!

That would be my instinct too.

Even though, the thought of having to wake someone up to take their blood would be a little daunting. But it is better than waking them up because you are taking their blood.

[PhysiologyRocks]

Thought about this too. I suppose for a lot of them you physically can't, but you obviously know that, so I'm being of no use.

I wonder is the general agreement different if the patient takes sleeping pills and would need them to fall asleep again.

[tallaght01]

They're nearly always going to wake up when you do it an pull their arm away, so you'll have to do it again.

But you need consent, too. It would be horrible to e woken up like that. Think about why the blood needs to be taken in the middle of the night. is it going to change your management? Can it wait until the morning?

BUt definitely wake them up first, unless you have an incredibly incredibly good reason not to.

[Piste]

Were you watching Junior Doctors? Cos one of the interns is taking blood while an old man is asleep and I also wondered why she didn't wake him up before hand. He woke up while she was poking around his arm and she said "oh did I give you a fright?" I'd be terrified if I woke up and somebody was poking at my arm with a needle!

[Carsinian Thau]

Originally Posted by Piste

Were you watching Junior Doctors? Cos one of the interns is taking blood while an old man is asleep and I also wondered why she didn't wake him up before hand. He woke up while she was poking around his arm and she said "oh did I give you a fright?" I'd be terrified if I woke up and somebody was poking at my arm with a needle!

I was actually.

It has happened to me. It was very shocking really. I just opened my eyes and I had two nurses right next to me and then I realised that one of them was holding my arm with a needle in it. I didn't move or anything but I was quite tempted to ask them to wake me next time. I didn't as it happens but I didn't really like it.

[MrCreosote]

You have to wake them up!!!

Like you say you have to obtain consent- even if that is somebody moving their arm towards you for the test.

[drkpower]

This has to be one of the funniest/unsettling threads on B&M I've read in a while...! To consider how silly, consider this question....

If you need to do a PV/PR on a patient and they happen to be asleep, would you need to wake them before you do so?

Is there any debate on this?

Of course not.

I dont mean to have a go at the OP (who, in fairness, answered his own question correctly) but it never ceased and ceases to amaze me the fairly relaxed attitude to consent and the persistence of overt paternalism in medicine.

The idea that there is any room for a question (or a thread!!) on whether any invasive procedure can be performed without consent on a sleeping patient is evidence that, despite great strides at diluting this paternalism, it still exists to a degree.

[tallaght01]

Originally Posted by drkpower

This has to be one of the funniest/unsettling threads on B&M I've read in a while...! To consider how silly, consider this question....

If you need to do a PV/PR on a patient and they happen to be asleep, would you need to wake them before you do so?

Is there any debate on this?

Of course not.

I dont mean to have a go at the OP (who, in fairness, answered his own question correctly) but it never ceased and ceases to amaze me the fairly relaxed attitude to consent and the persistence of overt paternalism in medicine.

The idea that there is any room for a question (or a thread!!) on whether any invasive procedure can be performed without consent on a sleeping patient is evidence that, despite great strides at diluting this paternalism, it still exists to a degree.

that's a little bit harsh. He just asked a question. I'd be worried if people had given him answers that suggested consent wasn't needed.

I suspect the question was influenced by him watching "junior doctors" where the intern may have started without waking the patient up. It was hard to tell. But it would cause a student to ask the question.
Plus it's happened to him! And it wasn't a doctor.
On the flip side, when I take blood from a central line in infants, I don't wake them up.

[Carsinian Thau]

Originally Posted by tallaght01

I suspect the question was influenced by him watching "junior doctors" where the intern may have started without waking the patient up. It was hard to tell. But it would cause a student to ask the question.

It was actually. And as a student, I got a bit curious and decided to ask.

Originally Posted by tallaght01

Plus it's happened to him! And it wasn't a doctor.

Probably worth pointing out that this was over ten years ago and I was a child at the time. It's possible that they just didn't want to wake me. Even though (at the time and definitely now) I'd rather they would.

[drkpower]

Originally Posted by tallaght01

that's a little bit harsh. He just asked a question. I'd be worried if people had given him answers that suggested consent wasn't needed.

I suspect the question was influenced by him watching "junior doctors" where the intern may have started without waking the patient up. It was hard to tell. But it would cause a student to ask the question.
Plus it's happened to him! And it wasn't a doctor.
On the flip side, when I take blood from a central line in infants, I don't wake them up.

In fairness, I was making a wider point about the profession's attitude to consent and specificaly said that I wasnt intending to have a go at the OP. His point was merely my springboard for a more general observation/criticism.

[Carsinian Thau]

Originally Posted by drkpower

It never ceased and ceases to amaze me the fairly relaxed attitude to consent and the persistence of overt paternalism in medicine.

The idea that there is any room for a question (or a thread!!) on whether any invasive procedure can be performed without consent on a sleeping patient is evidence that, despite great strides at diluting this paternalism, it still exists to a degree.

But would you agree that this is, at least, changing?

I have completed very little of my medical education, but from the aspects dealing with medical professionalism that we've covered thus far, consent and obtaining it have been very important issues for us.

[drkpower]

Originally Posted by Carsinian Thau

But would you agree that this is, at least, changing?

Absolutely.
It is changing and changing quite fast, thankfully.
But the approach to consent, in practice, leaves an awful lot to be desired. As does the level of explanation that is given to patients, in many cases. Both are time-consuming issues and are often seen as inconveniences. Although that can be quite understandable given the pressures that are on docs (and medical staff generally).

[tallaght01]

Yea when I was at med school we had the importance of consent battered into us.

The relaxed attitude is driven by the senior members of the profession. For eg, the intern on my last paeds team had just come from doing a max-fax job where she had to consent all the patients despite having no idea what she was doing.

But when I worked in the UK in surgery, our registrar would consent all the patients.