Luppo Kuillman

The predictive values of a Deliberative and a Paternalistic Attitude 127 5 The stinky patient! (vignette 2) As a physician assistant, you are the first medical point of contact for all matters that arise daily in the lung medicine nursing department. Last night, a 54-year-old homeless man with schizophrenia in poor condition was admitted after a major exacerbation. A day after the ad- mission, a medical assistant reports that the patient spreads an intol- erable, pungent, stench. As a homeless person, he has been wearing the same clothes for eight months, 24 hours a day. The patient reacts violently to the offer to wash the clothes, because he says: without this “magical robe” I am defenseless against evil. The situation in the room is unsustainable, he doesn’t want to shower and no other clothes, and his roommates want him to sleep separately. The tension mounts when it appears that the only single room is occupied by a terminal lung cancer patient. To make matters worse, all surrounding hospitals do not have single rooms available. Your hospital’s psychiatry depart- ment is prepared to have the patient continue treatment there until he is well again. The patient absolutely does not want this and knows that he cannot be forced to be admitted there. The tensions that are evoked in this conflicting situation make the patient speak louder and louder in his head. This increases the fear of his roommates even more. You are considering sending him out with enough antibiotics. For the patient this means back in his homeless life. There is a great risk that the antibiotics will no longer be taken and the course of treatment will not be completed.