General Question

stemnyjones's avatar

If you go to the ER for chest pain can you refuse bloodwork and get only an EKG?

Asked by stemnyjones (3959 points ) July 15th, 2012

Imagine that someone has a serious case of trypanophobia. And by ‘serious’, I mean that it’s not a case of “needles freak me out so I’d rather not get a vaccination”. I mean real, diagnose-able trypanophobia.

Imagine that this person starts experiencing chest pain and goes to the ER.

I know that standard practice is blood work and an EKG. Imagine that this person wants to refuse blood work, but would like an EKG.

SO, THE QUESTION(s):

Is someone who is experiencing chest pains allowed to refuse specific types of treatment?

Is it against the law for the emergency room to deny alternative medical treatment/testing to someone, when an alternative exists and is feasible?

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44 Answers

stemnyjones's avatar

Note; i am not experiencing chest pain or trypanophobic, so please don’t suggest for me to go to the hospital.

cazzie's avatar

When I went to the ER with bad chest pains, they did both, right away. If you are still more afraid of needles than your immediate, critical pain, your chest doesn’t hurt that bad. When I was passing gall stones, I wouldn’t have noticed a needle in my arm if it had taken 10 minutes.

stemnyjones's avatar

@cazzie As I said, this situation does not apply to me.. i’ll take a needle even if it’s not guaranteed to help anything. everyone thinks needles suck, but that’s not trypanophobia. Someone who truly has trypanophobia is likely to fight to the grave to not get anywhere near a needle. just throwing that out there.

Linda_Owl's avatar

Why would any sane person refuse to allow the blood-work that would tell the doctors if the person has had a heart attack or is having a heart attack. If you are in enough pain that you go to the ER, then you need to allow the doctors to decide.

gondwanalon's avatar

It would e a huge mistake to not allow doctors to test the blood. Doctors need as much information as possible about patients as soon as possible so that they can treat them correctly. If you don’t allow doctors to utilize all of the tools that they need to treat you then you are asking them to treat you blindfolded. And that is a very bad idea.

srmorgan's avatar

There is no legal requirement for a blood test if you are having chest pain and the physician orders an EKG for you. Butt if the physician suggests that one be taken it is probably a good idea to let them do it. They are checking your blood counts and heart enzymes which can give additional information towards a diagnosis of whether you have had a heart attack.

But if you are going to have any kind of medical care beyond the EKG, you had better get over your fear of needles. In most procedures, they are going to insert an intravenous line in case they need to get some drug into you in a hurry.

SRM

stemnyjones's avatar

@everyone other than srmorgan, this is the general section, not the social section. if you’re not answering the two questions at the bottom directly, please don’t answer.

bkcunningham's avatar

Great question. It is the first time I have heard of the phobia. I found this: http://elizabethmcclung.blogspot.com/2007/01/trypanophobia-needle-phobia-fencing-and.html

which is very educational. It also suggests that a physician can give you something to knock you out so you can have your blood drawn. I would hope an ER doctor would work with the patient for their treatment. I can’t imagine it is illegal to only do one type of test as long as you are counseled on the pros and cons.

stemnyjones's avatar

@srmorgan, thank you for the information. I stated this question as hypothetical because it’s not happening to me, and i know that if it wasn’t hypothetical, everyone would suggest that i immediately go to the hospital, which is reasonable. this question actually applies to my fiance, who has refused bloodwork when going to the hospital in the past. But it wasn’t chest pain in the past, and i’m not sure if the laws differ for chest pain patients, seeing as it can turn fatal quickly.

I have fought and fought for her to get bloodwork in the past, and I know it’s a battle I am not going to win. But now she is experiencing chest pain, has been since last night, and since she’s not my child, I can’t force her to go to the hospital and get the blood work. Believe me, I would if i could.

So, if the physician suggests bloodwork, can you still refuse it and still get an EKG? Is the hospital required to do the EKG even though you refuse bloodwork? I’m asking because I called the hospital and explained the situation briefly, and the receptionist (or whoever it was that answered) simply responded with “if she comes in with chest pain, they are going to do bloodwork”. So I’m wondering if it would even be legal for them to refuse to do an EKG without doing bloodwork as well.

Adirondackwannabe's avatar

I’m with the “If it’s bad enough for you to go to the ER, it’s bad enough for you to let them do whatever they need club.” But needles don’t bother me. I’m also very easy to stick. That might slant my view.

stemnyjones's avatar

PLEASE DONT TELL ME TO JUST GO TO THE HOSPITAL. I AM NOT EXPERIENCING CHEST PAIN. IGNORE EVERYTHING ABOVE “SO, THE QUESTIONS”. I’D EDIT IT OUT IF I COULD.

gondwanalon's avatar

Sorry I’m not an lawyer. But I can tell you for sure that an ECG alone is not enough information for treating a suspected heart attack. By the way the first thing that they will do to a suspected heart attack patient is to start an I.V. and draw blood. A patient would be slowing down his/her treatment by attempting to change the standards. And when every minute is critical for a good outcome, that would not be a good idea.

Adirondackwannabe's avatar

@stemnyjones That was a generic you. I meant if I go, I let them test whatever.

Trillian's avatar

There is more than one cause of chest pain. Part of going through the tests is to rule out what those causes are in order to find out what that cause is. They are legally obligated to to the blood tests to rule out all possible causes. It is a question of liability.
You do not get to go to the ER then dictate what they do. You, or whoever, are completely within your rights to seek alternative medicine. Where alternative medicine is practiced. That would not be the ER of a hospital.

DigitalBlue's avatar

I don’t see why you couldn’t refuse. I agree that it is probably not wise, but, I can’t see them forcing you to give blood. If your chest pain is severe and at some point, for whatever reason, you lose consciousness, I don’t know if they would be able to take blood at that point if you had previously specified that you did not want that, but aside from that, I don’t know that they would be willing to administer treatment without being able to pinpoint a cause. As mentioned above, I would think that would fall into issues with liability.

Hard to say, since I’m really only guessing.

srmorgan's avatar

Under EMTALA, a law governing emergency departments, the hospital is required to evaluate you, they are not required to treat you. Most will treat you anyway.

If you walk in there with a complaint of chest pains, the triage nurse is going to get you in as quickly as possible and get an EKG. They will also get some blood work. If your fiancee absolutely refuses to have an injection, they can’t force her into it. This is an invasive procedure which, in the absence of a court order, is voluntary. But they are going to warn your fiancee of the risks involved in not having it done.

The big problem is if the EKG indicates she is in the process of having a heart attack they are going to want to get her into a cath lab (if there is one in they hospital) to see what’s what. This is a surgical procedure that involves making an incision in your groin and inserting a tube into your heart in order to view the possibility of any heart blockages.

It is inconceivable that in this day and age they can do anything for your fiancee without starting an IV, drawing blood and administering drugs. If she is truly frightened to death of this they can give her a calmative, like Valium or even Halcyon orally in order to get her calmed down.

This is not like going to the dentist and refusing an injection of novocaine and telling the dentist you are just going to “tough it out:”.

If she has been having chest pain since last night it is either indigestion or something really serious going on with her heart. Get her to an urgent care if she is terrified of the hospital. Do something.

stemnyjones's avatar

@srmorgan Again, thank you for the information. I have already told her that I will do everything in my power for her to avoid bloodwork, but that if she is having a heart attack or there is serious evidence that she will, I will stop fighting for her. She will have to get the bloodwork or walk out herself. I think the only reason she didn’t immediately refuse to go to the hospital at that point is because I reminded her that if she doesn’t go in, then has a heart attack, she is going to wake up with IVs, regardless of what she says. I just don’t want to push it unless it’s critical, because I know that she will walk out in a second. And not just walk out, but have a breakdown that will trigger a heart attack. The last time that she went to the hospital and they said they were going to stick her, she had a psychological breakdown and started crying hysterically and wouldn’t let any of the nurses near her. I don’t want them to misunderstand the severity of her phobia and trigger a heart attack. Then again, I know that trypanophobia is different than most phobias, in the sense that a trypanophobe’s heart rate and blood pressure actually drop dramatically in the presence of a needle, rather than speeding up and raising.

I just want to make sure I have my information straight before I walk into the ER and ask to speak to the head of nurses or whoever I need to speak to, so that I can have knowledge of the laws before I tell them that they can’t refuse an EKG. I don’t know what to google to get the information I’m looking for.

funkdaddy's avatar

please assume a “general you” for me here, not lecturing, trying to help

I believe if you refuse blood work and are complaining of chest pain their assumption would not be a fear of needles (even if that’s what’s being said), it would be drug use.

Chest pain is common after using cocaine, so it would color your treatment from that point forward that they’d at least need to entertain the probability that a) you’ve used something and b) you’re lying about it.

I think if you can stay calm and explain yourself, even multiple times, and handle the stress involved, that goes a long way towards credibility. This seems like something you might be able to prepare for and that’s why I mention it. Just keep your requests steady and consistent. Remember what you’re telling them and their experience is all they have to go on because many of their other tools would rely on invasive procedures.

One last thing, they can refuse to provide an EKG if they don’t deem it medically necessary or if you’re a threat to people there. So again, keep your cool.

Seaofclouds's avatar

Any patient has the right to refuse any care they want That being said, the staff in the ER probably will be very blunt about it and they will be limited in what further care they can provide if they are only able to have access to some diagnostic tools (meaning missing the lab work). The EKG alone only provides one piece of the puzzle. Also, as @funkdaddy says, the ER staff may believe there are other reasons behind the refusal of the blood work.

stemnyjones's avatar

I’m aware that they may make assumptions about the blood work refusal. None of that matters to me, or probably more importantly, her. As long as she can get the EKG.

Response moderated (Unhelpful)
Adirondackwannabe's avatar

@stemnyjones The EKG is only one part. The real key is in the blood enzymes so they can tell what is happening or has happened.
And please, everyone go easy. Getting upset with each other doesn’t really move us closer to any answers.

Response moderated
Response moderated
Seaofclouds's avatar

@stemnyjones I understand your concern about making sure you can get the EKG done, I just hope you understand that the EKG alone might not do you any good at all.

stemnyjones's avatar

@Seaofclouds Thank you for being respectful about it. I am aware of this; my mother has been an RN since before i was born, and is head of nurses or whatever at a heart hospital. I’d just go there and get luxury treatment, except that we live 2 hours away from her and the heart hospital.

My mother herself has heart disease, and has gone in multiple times at her own hospital, so I know a little about it. I know an EKG doesn’t give enough info for them to properly diagnose her. But for me, a small bit of info as to what is going on is better than none. Honestly, assuming that she is going to have a heart attack, I hope that it happens during the EKG, and that it scares her into letting the nurses do what they have to do. And even if she fights them as best she can, she will be there to get treatment, even if it means anesthesia… better than her having a heart attack at home.

Tropical_Willie's avatar

If the patient has an EKG and it shows that they are in Arterial Fibrillation, they are not going to just give them a aspirin and then release them.

There going to be meds and other procedures that will require a needle.

If the patient refuses in writing, the hospital will still have ethical requirements. The patient may be dead but their wishes have been respected.

JLeslie's avatar

I have not read the above answers.

I am very very upset about my last ER visit because they CT’s be from head to pelvis, and had I known they were going to do my abdomen and pelvis I would have refused it. When I spoke to someone about my complaint they said to me, “if you had refused we would have told you to leave.” I really doubt that is true, because the brunt of my injury was my chest, and I had absolutely no pain in my lower torsoe except for some cuts on my stomach. I really am disgusted he said that to me. I said I would have signed that I was advised to do it and refused, and he said I would not have that option. I still don’t believe it.

I went to the ER with severe back pain a week after my accident, had a bad setback, and they wanted to do a urinalysis which I refused. Standard would be to rule out a kidney infection with back pain, but I knew it was related to the accident.

Meanwhile, if there is a chance someone is having a heart attack, the blood test is extremely important, especially if the diagnosis is not easy to figure out initially. If heart enzymes are elevated, it is very important to monitor is they go back down or go up.

bewailknot's avatar

A patient who is alert can refuse any test or treatment. Being upfront and calm about it can help. Tell everybody that blood work is out of the question and why – the registration person, the triage nurse, anyone else who approaches (especially someone carrying a rack with test tubes). If you are worried about it being accepted you could always claim some type of religious conflict.

Plain EKGs do not always diagnose heart attack in women. A stress echo may work better for a female patient if the EKG doesn’t show anything. I know the small hospital I work at can do a stress echo with the local cardiologist pretty much any time, any day.

Cruiser's avatar

I would imagine the minute you walk through the doors and sign the consent forms for treatment, you are now committed to their algorithms of treatment protocols and the minute you vocalize a refusal to any test they feel is necessary, you will be asked more than one time to allow this test or remove yourself from their facility.

augustlan's avatar

I ‘refused’ blood work in an emergency room once. I was 15, and not thinking they would take me seriously, “I said, “No more blood work!”. The tech immediately left me and minutes later a doc and my mother came in to convince me that they needed to do it, basically pleading with me to change my mind. Since I hadn’t been serious in the first place, I obviously consented. At no time did anyone say they’d kick me out of the ER if I didn’t comply.

funkdaddy's avatar

@Cruiser – not true, an extreme example would be Jehovah’s Witnesses (link below, won’t link correctly) who won’t allow for blood transfusions of any kind.

http://en.wikipedia.org/wiki/Jehovah's_Witnesses_and_blood_transfusions

Another example would be anyone with a DNR (do not resuscitate order) will only be treated up until that point.

You can still call the shots for your treatment, you just have to be up front and make your wishes known before a treatment plan is devised. Also understand you’re taking tools off the table and taking the people treating you out of their comfort zone so they may not be as familiar with alternatives.

Cruiser's avatar

@funkdaddy That is simply reiterating my entire answer.

josie's avatar

A doctor who formulates a treatment plan and then modifies it to accommodate the capricious whims of a patient is arguably exposed to malpractice claims and certainly behaving unprofessionally. Take it our leave it. Plus I would suck it up and get over your trypanophobia. Let’s face it. Nobody enjoys getting stuck, but it is not the end of the world. It won’t kill you.

gorillapaws's avatar

If she were my fiancé, I would take her to court and declare her legally incompetent to make medical decisions due to a mental illness. With the power of attorney in-hand, I would have them gas her or to knock her out, or use something like valium and do whatever is medically necessary/recommended.

JLeslie's avatar

@funkdaddy Sometimes the religious are happy the doctor took it out of their hands. They get treated and still can claim the treatment was not with their approval so they are ok with their God. Depends on the situation of course. Sometimes it takes court orders, usually it has to do with a minor child, and not the adult himself. My girlfriend’s dad had prostate cancer, sought a highly recommended surgeon in NYC, spent an hour with him to discuss his case and set up the surgery, and at the end he mentioned to the doctor he would not take blood transfusions because he was Jehovah and the doctor refused to do the surgery. I don’t even think that surgery often needs tranfusions, but the doctor would not take the risk. He did find another doctor willing to do it.

Buttonstc's avatar

The plain fact is that they cannot legally physically force anyone without their consent. That’s it and the reason I know that is because a Dr. who treated me for a blood test phobia (fortunately I’m perfectly OK with needles. Just not ones destined for my veins :) advised me to never allow anyone to use a Vacutainer on me for a blood draw.

When I asked him how I could prevent that (I was considerably younger and more naive in those days) he told me straightforwardly : ” Its your body and no one can force you without your consent. That is the law”

So, I’ve had to deal with my share of very unhappy blood techs and nurses who did not like the idea of a patient insisting that they either use a syringe or it doesn’t get done at all. But there were others who understood and were fine with it. I was always very polite about it but quite firm. Some refused to deal with me at all and the pros just went to get a syringe and got the job done without undue fuss and angst.

So the corollary to refusing a procedure is that they CAN refuse to deal with you further and have you sign an AMA form (Against Medical Advice).

That’s what they CAN do but it’s pretty much a judgement call as to whether they WILL DO that. It really depends upon the personality of whom you’re dealing with, assuming that you and she remain calm and polite. (at least that’s what I’ve experienced)

And I would hope that they would do the EKG first and then the blood test, but that could go either way.

So, if it’s just a matter of getting her to go in the first place you can reassure her that they can’t legally force her into bloodwork or injections.

Once you get through this crisis, it’s imperative that she gets therapy for this phobia as it can (without doubt) cost her her life one day.

And for those of you who have never had a phobia about anything (not just a fear or strong dislike) kindly just shut up already. You have absolutely no idea what you’re talking about. At all.

A person can be perfectly sane and yet have a phobia. A phobia, by definition, is NOT RATIONAL. That’s why it’s called a phobia. If it responded to logic, it wouldn’t be a phobia for crying out loud.

So asking what sane person would refuse life saving treatment is extremely unhelpful. Sane people have and will continue to do just precisely that if they are in the grip of a PHOBIA. It’s not rational. That’s why it’s termed a phobia and not something else. It doesnt mean they are insane Get it? Sheesh.

But the good news is that phobias can be successfully treated with progressive desensitization and it works. It’s a very gradual process and no one is forced into anything.

If you want more info, shoot me a PM. I’ve been there.

jca's avatar

I would think that they would ask the patient to sign a form that they are refusing treatment, and if the patient refused to sign the form, then many witnesses (nurses and other staff) would be witnessing that the patient refused recommended treatment. That way, if the patient left the hospital and died of a heart attack, the hospital would not be to blame, as it would be the patient’s fault for refusing treatment. I know people who were deathly afraid of needles, but in life, people have to suck it up and deal with it, if their life depends on it.

JLeslie's avatar

@Buttonstc Are you saying the tech needs to collect the blood in one larger container or pouch, and then they separate it for testing? If they use a butterfly instead of a regular syringe I think you would have no trouble, and then they can use the vacutainers for the blood without any affect on you. The stick is the same or many times less traumatic than a needle, because the tibe is not in the way so the angle is better, and then the needle is nod disturbed when changed vauctainer tubes. Discomfort from drawing blood mainly has to do with the tech being steady, especially when they put in and pull out the tubes. With a butterfly all of that concern dissappears, the needle is undisturbed during tube changes.

Buttonstc's avatar

As the Dr. explained it to me (after he had done a thorough physical exam on my veins) the strong suction on a Vacutainer is far more likely to collapse veins like mine. (I really don’t have good veins and many people since him have told me the same thing)

My veins are not easy to find to begin with and they tend to shift and collapse easily. If the vein collapses, then it’s either gouge around looking for a better spot or taking it out and starting all over again.

He wanted to be certain that nobody undid the 3–4 months of hard work he put into the whole deal and throw me back to square one (which can happen).

Believe me, I’m well aware of how much more simple and automated the whole process is with Vacutainers. And if I had arms with big blue bulging veins like a football player or truck driver, they could use whatever they want.

Unfortunately genetics gave me the complete opposite. So I figured he knew what he was talking about. And for those medical people who were secure in their abilities and knowledge, it just wasn’t that big a deal for them to go get a syringe or a butterfly (without the Vacutainer)

But others took it personally and got their nose out of joint abput it and that was the end of our interaction. It was mutual. They didn’t want to be bothered and I didn’t want somebody with a negative attitude messing around with my crappy veins.

And their reaction had far less to do with me than it did with their personality.

Insecure people who are in authority resent having their methods altered, no matter how polite the request. (and believe me, I bent over backwards to be polite and non confrontational. But some people are going to react regardless)

I know it’s difficult for some medically knowledgeable people to accept the fact that I really did know what I was talking about.

That’s because an integral part of the entire gradual desensitization protocol is to inundate the person with more exposure to and knowledge about their phobia than they ever wanted to know in three lifetimes :) It gets to the point where it starts to become boring. And that’s a large part of the goal in the beginning You can’t really be bored and terrified simultaneously no matter the subject.

If my phobia had been snakes, I would have ended up knowing as much ( or more ) about snakes as any herpetologist.

So I actually do know how Vacutainers work and why techs prefer them. But my request for them to use something else is not that outlandish. It’s merely uncommon. (They routinely do it for kids) And the real pros just went to get the other equipment and got the job done instead of wasting time trying to arm-twist me or try to bully me into doing it their way.

JLeslie's avatar

@Buttonstc The container is at the end of a tube coming from the butterfly, the blood basically just drains in. I am not saying my way is for sure the best, but I do think it would work. Definitely worth a try if you find yourself in a situation with little choice, butterflies are usually readily available.

I agree some people get defensive and insulted all too easily, and it should not be a big deal as long as they have the supplies necessary to accomodate you.

I have a vein that tends to not be able to fill more than 2 tubes and then it stops. I steer the techs away from that vein usually.

Buttonstc's avatar

AFAIK any time that a butterfly has been used, the blood just flowed out, albeit quite slowly due to the extremely thin flexible tubing being used. But i guess it was finally attached to a syringe This is what my regular Doc in Philly preferred to use.

I’m not ridiculous enough to watch that closely. I just turn my head away and concentrate on breathing :)

The only Vacutainers I’ve seen have always been attached directly to the needle and they really do suck the blood out really fast. Of course medical people prefer to use them.

So, basically drawing blood from me may take all of 6 mins. instead of the 2 or 3 they’re used to. Big deal. Adjust. You’re the professional. That’s what you’re getting paid for.

When I was teaching I had all kinds of oddball kids with all kinds of oddball needs and special situations. So I dealt with them. That was my job. Same thing.

JLeslie's avatar

@Buttonstc I hadn’t realized it was a different tube with the butterfly? Could be. It does take a little longer. Absolutely you should be accomodated. It will take longer in the end if the draw doesn’t go smoothly using a method the tech prefers, or thinks is preferable.

Buttonstc's avatar

Yes it’s a really thin and lengthy flexible tubing that kind of curls around but I’ve never seen a Vacutainer at the end because I think the length and narrowness wouldn’t work with it.

But I don’t know of anyplace that doesn’t have plain old syringes. As long as someone has a steady hand, it’s fine.

And I let them know that they only get one chance at it per 24 hr. period :) that’s the point at which some decide to bail out and go fetch the person with the rep for being able to hit the vein every time :)

It’s as much an art as it is science. If I’m ever in a hospital, I male certain to let them know that I’m not the one that they want to send new people to practice on. Let them go learn blood draws on the guys with big bulging veins :)

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