do doctors talk to a bf/gf/friend about a patient if the patient is unconscious and no next of kin?

Which country?

About ten years back a friend in the UK was very ill and the hospital would not accept her long term live in partner as her next of kin. Her parents were available.

It is possible to write documents - living wills, powers of attorney, which might tip the balance. The last time I looked into that it was a bit up to the UK hospital whether or not they gave weight to the living will.

jaybird83 said:

I am writing a story that the main character is in a car accident with her ex boyfriend. She just found out that she is pregnant. Her injuries will be a contusion in her brain resulting in a coma for a couple of days. Also some broken bones, etc. Her only next of kin lives 1000+ miles away. So my question is will the doctor give her ex any information concerning her injuries and condition? Also some of the tests that I figure that they would do (ie: x-rays) can't be done necessarily on a pregnant woman. Would they test for pregnancy or ask if she might be? Thanks in advance and sorry for such lengthy questions.

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Anyone with a head injury from a high speed car accident, especially with any alteration in level of consciousness, is getting an urgent head CT, pregnant or no. And she might need an abdominal CT to look for internal injuries. Don't forget that the trauma itself can cause catastrophic injuries to the fetus, and they will weigh the potential risks to the fetus against the safety of the mother. Read this, especially the quoted:

Trauma is the leading cause of nonobstetric maternal mortality and affects up to 7% of pregnancies.[29,30] Maternal death almost always results in fetal death, and the best chance for fetal survival is maternal survival. All efforts are made to save the mother. Fetal loss occurs with both major and minor trauma. When the mother survives the most common cause of fetal death is placental abruption.[22,31] In high-energy trauma, such as motor vehicle crashes seen at a level I trauma center, the mother is imaged the same as the nonpregnant trauma patient with x-rays, CT, and angiography as necessary.
[...]
In the seriously injured patient, the mother may require several studies with ionizing radiation through the gravid uterus, and the fetal dose may exceed 50 mGy.[8] In trauma patients, the total fetal dose should be calculated by the hospital physicist and recommendations made accordingly. Even in major trauma, it is the rare situation when the fetal dose exceeds the actionable level of 150 mGy when one may need to discuss therapeutic abortion with the mother (Table 3).

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jaybird83 said:

I am writing a story that the main character is in a car accident with her ex boyfriend. She just found out that she is pregnant. Her injuries will be a contusion in her brain resulting in a coma for a couple of days. Also some broken bones, etc. Her only next of kin lives 1000+ miles away. So my question is will the doctor give her ex any information concerning her injuries and condition? Also some of the tests that I figure that they would do (ie: x-rays) can't be done necessarily on a pregnant woman. Would they test for pregnancy or ask if she might be? Thanks in advance and sorry for such lengthy questions.

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Okay, so you have a couple of issues. Would the MD's discuss the situation with an ex-boyfriend? Probably not. In situations where there's no family present, and they're on the same insurance policy, probably. If they're living together, but not married, and have the same address on the they're driver's license they'd probably involve him. But if they're not living together and not in a relationship probably not. He can't consent for her, but they next of kin could consent electronically.

Coma? I work with people who are coming out of a coma, it doesn't happen quickly, or at all like it's portrayed in most fiction. Even a short coma is typically followed by a significant recovery time. It's like waking up from a deep sleep over the course of four-to-six weeks.

The American Congress of Obstetrics and Gynecology don't suggest ruling out an X-Ray or any test entirely. I would think an MRI would be the tool of choice though.

Was the ex injured as well? Either way, no, they won't give the information to her ex boyfriend unless they have some evidence of them living together or if he's listed as an emergency contact on an ID card. They will ask him if she has any next of kin and will try and get in touch with that person first. Is he the father of her unborn baby? That may also play a role in their decision, particularly if the life of the fetus is at stake.

Maryn said:

I'm not a medical professional, but I'd be amazed if they'd give information to a boyfriend if there are living, but distant, parents. They would not give information to our adult children until we added them to the disclosure forms.

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It depends on the facility. At the ones I've worked at we want to be supportive of GLBT couples who may not live in a state where they can be married, so we have loosed up a bit. If someone says they're related hospitals don't typically doubt that. That said, if you say you're the "Ex-boyfriend," you get nothing.

MDSchafer said:

I would think an MRI would be the tool of choice though.

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The gold standard for head injuries is a CT scan. MRIs don't show the most common complications of head trauma very well. They're also too time-consuming and impractical to use with an unstable (unresponsive) patient.

Unless the hospital has a pressing medical reason the ex-boyfriend won't get any information. And yes, they should do a pregnancy test.

asroc said:

The gold standard for head injuries is a CT scan. MRIs don't show the most common complications of head trauma very well. They're also too time-consuming and impractical to use with an unstable (unresponsive) patient.

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Head injuries yes CT Scans are the tool of choice but MRIs image the spine better.

They wont talk to the ex unless he lies and says he is the husband. 1000 miles is nothing to a telephone. They will contact next of kin.

MDSchafer said:

Head injuries yes CT Scans are the tool of choice but MRIs image the spine better.

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Later on, sure. But MRIs aren't used in the emergency department.

It's worth remembering that "no x-rays in pregnancy" is a statistical, theoretical risk, not something which is going to cause instant damage to the baby.

In the late 1960s, x-rays were used as standard to determine the position of the baby - my mum had one a week for the last few weeks when pregnant with me.

I am not a medical professional, however, I have some amount of experience with a similar situation. My ex-husband of over 15 years was in an accident while his current wife was out of town.

The ER personnel were more than happy to take information from me. I didn't have a lot to tell them, since I wasn't current on his medical information, but I was able to give him some known allergies and his parents' number.

They were less forthcoming in sharing information with me, but with a little wheedling, I got some of it "off the record," and a bit more that I was able to put together from clues, like the kinds of questions they asked me. I'm pretty sure they're not supposed to say anything, but if you're persuasive, people talk, even if the rules say they shouldn't.

jaybird83 said:

Could the next of kin give the hospital permission to discuss the information with the ex?

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If I remember my days at the Doctors Office correctly, then generally speaking, not exactly. Just because the next of kin has access to private medical info doesn't mean the ex can if the NoK consents to it. It doesn't work that way.

Here are some considerations:

• The next of kin could just tell the ex what the doctor told her/him.
• If the next of kin needs to sign something, it must be his/her signature. The ex cannot step in as a proxy unless it's been legally substantiated.
• Because the ex is the paternal father, then what occurs with the fetus (not the mother) is information he MIGHT have access to. However this, too, must be substatianted through a paternity test.

Not all hospitals, doctors, etc work alike. When it comes to crime and medicine (among other things) it can become jurisdictional. As the previous poster mentioned, talk travels fast, and in certain cases med professionals can and share info... they will get fired for it if caught, though.

I would look at where your story is taking place and conduct research on hospital protocol. You can always write in a loose-mouthed nurse or admin who shares some info with the ex also if that's what you're going for.

jaybird83 said:

Could the next of kin give the hospital permission to discuss the information with the ex?

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Let' try this from the other end.

What do you want the hospital to share with the ex? What does your story need the ex to know and when and under what circumstances?

jaybird83 said:

He doesn't know that she is pregnant so I was going for him finding out from the doctor.

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I don't think the doctor would tell him simply because at that point they may not know he was the father. The ex may have to find out from NoK; then, have a talk with the doctor who may run a paternity test, particularly if there's a chance that the mother may die but there's a chance to save the baby.

I agree. That is certainly information they won't share with an ex boyfriend (or anyone other than possibly the next of kin, and maybe not even them). HIPAA limits disclosure to what is necessary, and telling next of kin that their single female relative is pregnant isn't necessary to her care.

They might ask exbf if there's any possibility she might be pregnant, but they might not even ask that and just do a routine test. (Later. First comes the really important tests they need to treat her right now.)

They wouldn't know he's the father. It would take some time for a paternity test which they probably wouldn't do anyway.

HOWEVER if you really need him to know this, there's always overhearing stuff in the emergency room. Depending on the size of the hospital they end up in, and how severe his injuries are, he just might be in the emergency room at the same time the staff finds out she's pregnant. This is doubtful as she's really badly injured so she'll be whisked off to CT Scans and spinal xrays and all the other stuff they need to do immediately to determine the extent of her injuries, while he'd be treated for whatever his injuries are and then released into the tender arms of a police person to find out what happened. (Not arrested, just questioned.)

They wouldn't allow him back into the emergency room area after he's been treated unless he needs some observation.

I will note, however, that I know quite a bit about a baby left in the care of a grandmother who left it in the care of an uncle and then s/he ended up in the emergency room with lots of bruises and lots of police standing right outside my wife's cubicle talking all about it while I sat behind the curtain. If I'd bothered to read the board with all the patient stats on it hanging on the wall between wife's cube and the toilet, I probably could have put a name to the battered baby. So overhearing IS possible if you can get your injuries and timing right.

Doubtful, since they'd probably get her into surgery or ICU after the tests, which is where they'd find out she was pregnant. By then no one would be discussing her care in the emergency room within earshot of him.

jaybird83 said:

He doesn't know that she is pregnant so I was going for him finding out from the doctor.

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Unless the doctor makes a mistake, this isn't going to happen.

They'll talk about the patient with the person who brings them in, but it will be a one way process. They'll just want to find out if they know anything useful, they won't tell them anything they don't know. Round here, what they ask is whether the person's taken any drugs, whether they're on any medication / have any medical conditions, and whether they're pregnant.

asroc said:

Later on, sure. But MRIs aren't used in the emergency department.

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In my large tertiary care teaching hospital and trauma center, they run MRIs out of the emergency room all the time. No, the equipment isn't located in the ER, but the patient is transported a short distance for the exam. If an MRI is indicated, that's what the patient receives, ER or no.

Yeah, my wife was taken off for an MRI and CT scan from the emergency room and then brought back.