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Doctor Instruction:
A 78-year-old woman, called Mrs Jane Smith, with a history of COPD and mild LVF, underwent mastectomy and axillary lymph node clearance for breast cancer. On postoperative day 2, she experienced axillary discomfort, swelling, and shortness of breath. Despite the planned discharge for the next day, her daughter, who has just arrived at the hospital, is adamant about taking her home this afternoon to a house 60 miles away. The patient, although eager to return to her own bungalow, should ideally remain in the hospital due to emerging complications.
Despite spending the last 20 minutes unsuccessfully trying to dissuade the daughter from an early discharge, it is evident that she is determined and not easily convinced. She firmly believes that taking her mother home today is the best course of action, despite the patient's preference to return to her own house when fully recovered. The daughter, a school teacher with a busy household, is focused on the convenience of avoiding hospital or bungalow visits. It is noteworthy that the patient has another daughter living nearby, but she struggles with paranoid schizophrenia.
You have been asked to phone the breast consultant to update him about his patient whom the daughter wants to discharge her against medical advice. Please summarise the case and discuss on further management.
Questions from the Breast Surgeon: