Yesterday the physician informed your patient that he will have to have his left leg amputated. Whenever you attempt to discuss this with the patient, he says that the doctor told him his leg was fine and he was going home any day now. What would be the most helpful in facilitating the patient's plan of care?

 

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Correct

- Asking, "does needing this upcoming surgery make you feel anxious?"

- "We must get consent signed for surgery tomorrow"

- Calling his next of kin for consent ASAP

- Canceling the surgery and notifying the MD of the need for a psych consult

Rationale

This patient is utilizing the defense mechanism of denial. Defense mechanisms are utilized to decrease anxiety. Asking the patient about feelings of anxiety will help him explore them and you to understand them, hopefully working towards being on-board with his upcoming surgery. Getting consent when the patient is in denial about the surgery is inappropriate, as is calling his next of kin for consent at this time without further discussing it with the patient. Canceling the surgery and a psych consult is warrented until his feelings are explored.

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