A college student is a patient is on a medical unit for treatment of Guillain-Barré syndrome, a rare disorder that produces ascending paralysis and can be fatal if respiratory function is compromised

Question

She is very anxious and frequently calls for staff. Staff direct her to try to calm down and explain that her sensation of being short of breath is due to her anxiety causing her to hyperventilate. Her family becomes increasingly concerned as the patient moves from being anxious to panic-stricken, saying she cannot breathe. Her resident doctor is called and reinforces the need for the patient to slow and deepen her breathing to control anxiety. Away from the patient, staff talk about how histrionic and whiny she is. Soon afterwards, the patient goes into respiratory arrest. She is left in a permanent vegetative state from hypoxia. The primary cause of this tragic outcome is: a. the paralysis had impaired respiration.
b. her disorder was not adequately treated.
c. staff stigmatized the patient as a whiner.
d. her doctor was negligent in his response.

Answer 1

C
Although the cause of the respiratory arrest was the Guillain-Barré syndrome, an objective assessment would have correctly led to identifying the patient's symptoms as representing the onset of respiratory distress, and the hypoxia would have been averted via use of oxygen and mechanical ventilation. The reason staff did not perform an objective, accurate assessment is that they had labeled—stigmatized—the patient as "histrionic and whiny" and as a result, they did not fully investigate her somatic complaints. The doctor may have been negligent, and there may have been better treatment available, but the primary problem was a failure to identify the impending respiratory arrest until it was too late, and the root cause of this was that the patient had been stigmatized.