Maybe I didn’t title this post correctly. But, my thought is that it really does go hand in hand with my “Compassion Post” from yesterday. This article by a physician, Val Jones, M.D., is speaking about ‘patient morale.’ I will say that what is being said is that the author is shining a light on the lack of respect and dignity given to patients by healthcare providers. Please, remember that these are my words and my ideas, not the author’s. There is no question that physicians, physician assistants, nurses and other medical staff are overworked and underpaid. The instances that are written below appear that they are doing the most expedient ways to take care of a situation with a patient. The problem that I see is that they have not taken time to think about a kinder, more considerate method that would end with a better outcome for the patient. I can relate to this with an occasion in the Emergency Room with my son Alex. We had been in the waiting room for over an hour with mucus, saliva, and specks of blood flowing from his mouth while Alex held a soaked towel to his chin. He was ten years old, could not swallow, hardly breathe and was scared. We were finally escorted back to a room with a flimsy curtain. They called a gastroenterologist, and by the time he arrived, they realized that Alex was in distress. Unlike the times before, when he was taken to the operating room and given a sedative, this time the doctor requested an endoscopy set-up and a nurse to assist him there in the ER room number nine. The doctor disregarded his asthma and delivered the lidocaine spray into his mouth and throat. I saw my little boy begin to cough when a tube was shoved down his throat to retrieve whatever was keeping him from swallowing. Alex was turning blue when the tube was removed and a breathing treatment started followed by oxygen. My thinking is that their must have been a better way.
ITS TIME TO THINK ABOUT HOW WE’RE AFFECTING PATIENT MORALE
VAL JONES, MD | PHYSICIAN | MARCH 10, 2015
Many of the patients that I treat have brain injuries. Whether caused by a stroke, car accident, fall, or drug overdose, their rehab course has taught me one thing: nobody likes to be forced to do things against their will. Even the most devastated brains seem to remain dimly aware of their loss of independence and buck against it. Sadly, the hospital environment is designed for staff convenience, not patient autonomy.
In the course of one of my recent days, I witnessed a few patient-staff exchanges that sent me a clear message. First was a young man with a severe brain injury who was admitted from an outside hospital. EMS had placed him in a straight jacket to control his behavior on his trip and by the time I met him, he was in a total panic. Sweating, thrashing, at risk for self-harm. He didn’t have the ability to understand fully what was happening, but one thing he knew – he was being restrained against his will. The staff rushed to give him a large dose of intramuscular Ativan, but I had a feeling that he would calm down naturally if we got him into a quiet room with dim lights and a mattress with wall padding set up on the floor. As it turned out, the environmental intervention was much more successful than the medicine. Within minutes of being freed to move as he liked, he stopped moving much at all.
Later I was speaking with one of my patients in the shared dining room. An aide arrived with a terry cloth bib to tie around his neck so that he didn’t spill anything during lunch. I saw a flash of anger in my patient’s eyes as he pulled the bib away from his neck with his good arm and placed the towel on his lap instead. I could tell that he found the bib infantilizing, though none of us had thought twice about it before. Here again, a patient did not appreciate having everything determined for him, right down to napkin placement.
Towards the end of the day, I was bidding farewell to a patient whose care would be provided by another attending physician going forward. I was summarizing my view of his progress and expectations going forward, and stopped to ask if he had any questions. What he asked completely flummoxed me. Instead of probing for details about his medical condition and treatment options, he asked, “Will the new doctor be a good listener? Will she pay attention to what I’m saying and be easy to talk to?”
It is unfortunate that health care providers and patients are often on very different wavelengths. In Atul Gawande’s recent book, Being Mortal, he argues that nursing homes have often failed to provide healthy environments for patients because they have focused exclusively on safety and meeting basic needs (eating, dressing, bathing, etc.) on their terms. The removal of patient independence unwittingly results in devastating loneliness, helplessness, and depression. It seems to me that hospitals end up doing the same thing to patients — if only for a shorter period of time.
I was moved by Gawande’s book (and I consider it required reading for anyone facing a life-limiting illness or caring for someone who is). It renewed my conviction about the importance of rehabilitation — helping people to become as functionally independent as possible after a devastating injury or disease. Even as we age, we all become less able to do the things we hold dear. Preserving dignity by prolonging independence, and respecting patient autonomy, are often overlooked goals of good health care. It’s time to think about what our actions — even as small as placing a bib around someone’s neck — are doing to our patients’ morale. Maybe it starts with asking the right questions. Or better yet, just watching and listening.
Val Jones is founder and CEO, Better Health.
TAGGED AS: HOSPITAL, PRIMARY CARE