Remember that Old Adage...

Remember that old adage "you can't please all of the people all of the time..."? Who is ultimately responsible for decisions made regarding the care of a patient? That is the question of the evening.

Is it the patient?
The patient's nurse?
The attending physician?
The surgeon?
The registered dietician?
The speech pathologist?
The physical or occupational therapists?
The medical student? or the physician's assistant?

Or, is it the team? And who is on that team? Is there a leader of that team? And who is that leader?

The patient?
The doctor?

Ultimately someone has to make the final decisions. How does that person make the right decision given a variety of recommendations? Do a JPEG. Don't do a JPEG. Downsize a trach. Don't downsize a trach. How does that person know that the entire team will agree or disagree? Does that person have the time needed to find out? Why? or why not?

Does it do any good to entrust to someone else communication of your recommendations and your rationale for them? And, are your recommendations always to be followed? Or, are they just recommendations?

And, is your recommendation the same as an "order?" Would suggestion be a more appropriate term? Why? Why not? If so, always or only sometimes?

And, why would someone ever say that a nurse does not "have the whole picture" of her/his patient? Why would someone ever imply that an attending physician did not have "time to know patients" entrusted to him or her?

These are my probing questions this evening. Aspects of being a therapist to consider and reflect upon.