["Refusal of interventional cardiology care : what to do ? "]

In emergency, physicians are confronted with obligations that may appear in opposition: assistance to a person in danger and consent to care. Knowing the seriousness of acute coronary syndromes, the cardiologist in front of an ignorant patient should not too quickly resolve himself to accept a refusal. In 2 clinical cases, the different means to obtaining consent are recalled: the evocation of the risks in the absence of care (death, physical incapacity, professional aptitude, heavy treatments) taking into account the psychology of the patient, without him make them lose face, by reassuring them about the steps of the procedure, while explaining the lower effectiveness of other therapies (loss of chance). The participation of all medical and paramedical actors makes it possible to match a psychology adapted to the patient's profile, to prevent an incompatibility of mood leading to death by refusal of care. More than ever, the cardiologist has an "obligation" to implement "all means". If the refusal persists, it will be necessary to find the most effective alternative and to get the patient to return to the optimal strategy by a rapid contact, by involving his family and his attending physicians, who will be informed without delay, with remission of prescriptions. To protect themselves from possible prosecution, the healthcare team will record in detail the course of the events, as well as a detailed document of the refusal of care, signed by the patient who acknowledges having been informed of the risks involved.