This is a male patient 76 years old that was admitted presented with lethargy and generalised body weakness with fever. History from this patient is vague as there was no relatives around and patient could not talk. Besides that, he has been staying alone also. He was found lying in the house by his friends that comes over for visit and notice that he's having fever and was then brought to the hospital. Throughout the stay and further investigation, community acquired pneumonia was diagnosed for this patient. Besides that, it was found out that patient is actually a known case of lung carcinoma on chemo and radiotherapy. However, we do not know wether patient has completed his treatment or not. Throughout the stay in hospital, there were no visitors and contact tracing was unsuccessful. He was only being managed as community acquired pneumonia and optimized his nutrition state. Patient eventually passed away suddenly in the morning.
If you were the doctor, besides treating the pneumonia and his nutrition state, would you have done different?
If contact tracing is still unsuccessful what else can we do after we treated his pneumonia?
I would treat his pneumonia and try to investigate regarding his lung carcinoma to make sure has he completed his treatment or not or what was the plan of management for his lung carcinoma. After that what will you do?Discharge him and let him goes back to his house alone without people taking care?Palliative Care?
This elderly man with a lung cancer came to your attention because of a respiratory infection (diagnosed as community acquired pneumonia). He apparently has no one to care for him. Your questions are not easy to answer. My own feeling is that the responsibility for treating any disease is a shared responsibility between patient and doctor. The doctor alone cannot be held responsible for treating diseases in patients. By shared responsibility I mean that the patient has to follow the instructions of the doctor. This is a situation where the patient, like a child, may not be able to participate responsibly in his own treatment. But unlike a child, he has no one to care for him. I think I would keep him in hospital and treat his pneumonia and consider the next step after a referral to the social welfare department. He will need a place to stay where someone can care for him - so a hospice can be considered. I will not treat his cancer until his basic needs are met.
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