Monday, August 10, 2015

Too Many Stories

Stories from the Field
In less than 24 hours I heard 3 different stories.  One from a patient who used their local emergency room and told me about how rudely they were treated.  The nurse spoke down to the patient (giving me numerous examples) and then when an error was found on the patient’s record, the staff seemed annoyed instead of apologetic at their own error.

Another conversation was about a grandchild who died days after being born because the problems associated with this birth were not escalated the way they should have been.

One conversation was from a spouse in the hospital watching clinicians who didn’t wash their hands.  The patient’s “advocate” who shared the experience with me gave up in asking and just wanted their family member to get better and get out – defeated in trying to protect a loved one.
Patient centerdness is not a television
 show - it is real life

Why are these stories so frustrating and even more upsetting than usual?  These were from 3 different physicians heavily involved in the patient safety movement for much of their adult life.  Recent stories of inappropriate care are still happening and called a “system problem" so blame can be avoided.  Is the “culture” patient safety experts talk about?

Behavior that is anything less than safe, kind and sympathetic to a patient can easily lead to avoiding an intervention that can cause injury or death. Speak up has become just words in many institutions.  “Sure, speak up - but not to me” is probably what many people working in the system think.  Not wanting to ask a question about test results, medication or a treatment plan because a patient may bother their clinician, or the nurse is too busy, leads many patients taking their care into their own hands.  Called “noncompliant” by medical professionals.  Maybe they need to look at themselves to learn about noncompliance.

I was contacted by a California man whose mother is in a New York nursing home.  They “found her” he said in pain with a dislocated shoulder.  Then a broken hip.  His mom who has cared for him his whole life now suffering from dementia is alone, injured and in pain.  It took them days to contact him.  He has no idea how these injuries happened but the staff isn’t answering his questions.    

I  have had to let families know when staff are doing their best.  The patient may be being a bit unreasonable or there is a major tragedy on the floor that the staff are tending to - keeping other patients waiting.  But when patients are vulnerable – sick, frail or injured, they often remember how they are made to feel, even more than what is said.

How do these things happen?  How are we living in a society that the patient is still not in charge or made to feel respected?  Families and loved one’s must find their voices and expect no less than, at the very least, having respect in a system that is meant to save lives but designed for failure would be a start.  If this is the “culture” of our healthcare system than that means it comes from the leadership and the boardroom.  Errors don’t happen in the boardroom – they happen at the bedside.  This is where the training of family needs to be done.

Where does a patient or family go when someone isn’t “nice”?  How does being nice, respectful or kind to a patient change the outcome? 

It’s been 25 years since my son died because no one listened.  I was intimidated and scared but not angry enough to demand service.  His body filled with infection and bleeding to death from a tonsillectomy it’s too late to change that outcome.  Those stories at the beginning are from medical professionals who, when sitting on a gurney are no different than the scared mother I was 25 years ago. How far have we really come? 


Anonymous said...

Sadly I think its gotten worse.

Anonymous said...

The reason things have not moved forward is because there is still no real accountablity. What began as Patient Safety has somehow evolved in to some sort of perverse customer satisfaction thing. Advocates have been more than patient with the industry to change itself from within. The American system of for profit healthcare delivery paid for by a third party has taken customer choice away from the healthcare consumer, or patient, as the industry wishes them to be called. It cannot be both ways, we are either patients or consumers. With profits soaring, and leading our national economy as healthcare spending has grown to 17.4% of the GNP, we must relook at what the medical industrial complex really is. We cannot blame the clinician, instead try to understand all that they have to tolorate as providers, and how they are enslaved to this dysfuntional monster that we call healthcare. It is time for clinicians and patients to demand change as a single force, to work together as one unit to bring about positive changes, that can even still keep the industry lucrative without so much harm. This is possible if we bring back the basics, bring back common sense, joy and real healing. Most of all, we all need to rethink our expectations and the industry has to be more candid and honest about what it can or cannot do. The only way to make this a reality is for us to all give a little bit.