Baimbridge Savannah, Neil Julie, Aisenberg Gabriel M
Internal Medicine, University of Texas Health Science Center at Houston - McGovern Medical School, Houston, USA.
Cureus. 2024 Jul 26;16(7):e65464. doi: 10.7759/cureus.65464. eCollection 2024 Jul.
Sensory deficits, including hypoacusis, can cause a barrier to communication between healthcare providers and patients, which in turn can lead to misdiagnosis and loss of patient autonomy. Such deficits are frequently overlooked in clinical encounters. We present a 92-year-old Spanish-speaking female who presented twice to the Emergency Department for complications of a diabetic foot infection. Limited evaluation, documentation, and accommodations regarding the patient's hypoacusis led to a misinterpretation of her mental status and a transfer of decision-making to surrogates. A two-toe amputation, mechanical intubation, and intensive care unit stay were followed. It was only after these events that the caregivers realized the patient's hypoacusis and learned about her different wishes focused on pain control and hospice care rather than surgical intervention. Available geriatric tools, a consultation with a geriatrician, a thorough evaluation of sensory deficits, and a multidimensional and comprehensive approach could have prevented the loss of autonomy and unexpected care.
包括听力减退在内的感觉缺陷会给医疗服务提供者与患者之间的沟通造成障碍，进而可能导致误诊以及患者自主权的丧失。在临床诊疗过程中，此类缺陷常常被忽视。我们介绍一位92岁讲西班牙语的女性，她因糖尿病足感染并发症两次前往急诊科就诊。对该患者听力减退的评估、记录及应对措施有限，导致对其精神状态的误解，并将决策权转交给了代理人。随后进行了双趾截肢、机械通气插管以及入住重症监护病房。直到这些事情发生后，护理人员才意识到患者存在听力减退，并了解到她更倾向于控制疼痛和临终关怀而非手术干预的不同愿望。现有的老年医学工具、咨询老年病专家、对感觉缺陷进行全面评估以及采取多维度和综合性方法本可以避免自主权的丧失和意外的治疗。
