Friday, August 8, 2014

The Patient

Are Patients a Burden?
By Ilene Corina
August 2014

The patient was at least 450 lbs. He was very uncomfortable in his bed and due to his medical condition he kept soiling himself. I had to clean him up and change his bedding a number of times. This was the start of a conversation I had with a hospital worker (I will call Pat) about Pat’s day at work.
Pat described how co-workers would pass by this patient without attending to his needs, obviously considering him someone who would take extra time and need extra work, and could even pose the risk of a back injury. Disappointed at the lack of concern from co-workers, Pat treated this patient alone, with the dignity he deserved. “Doing it alone,” Pat explained, “there is more of a chance for me to be injured.” 
Because Pat was working alone, overtime was approved. “I knew there was a good possibility I could be injured,” Pat said. “But that didn’t seem to be a concern for anyone in charge.”
Morale is down in that hospital department and this lack of concern may be part of the reason. It was apparent that the traditional desire of medical staff to care for the weakest and most vulnerable was no longer present.
Pat wondered, “If I were the patient, would I be a too much of a bother for this staff?”
Medical injuries such as falls, infections and medication errors happen at the bedside. This is where patient safety training needs to happen. Medical injury does not happen in the C-Suite although that’s ultimately where staff morale is determined.
Because this patient was not in a private room, this lack of care was not only experienced by Pat, and the patient, but by the neighboring patients and their families. Other staff knew what was happening as did leadership (remember, they told Pat to stay and handle the patient alone). How can this be handled? Should Pat “complain?” Although that is a harsh word, that’s how it will be seen: as complaining. Should Pat report a “near miss?”  “I almost got hurt, or could have,” Pat could write in a report. Who should Pat tell about this experience? The same people who told Pat to stay?  Can’t you just hear middle level management saying, “What do you want me to do about it?”
So here we have it: a patient is sick or injured and vulnerable.  Add to that the other possibilities — disabled, unable to read, homeless, unkempt, drug-dependent, transgender, mentally ill, teen, unwed mother or any other category of “different” — and the sensitivity training is just not there.
It reminds me of the time I visited a woman who was disabled and in the hospital. I was called in by a local agency to check on her safety. They feared for her safety and at each visit the patient told me the staff struggled to lift her, wouldn’t listen to the patient when the patient tried to explain the best way to lift her, and a few times almost dropped her. But the patient feared retaliation if I were to go to management and try to work out a best plan for everyone involved.  Not long after my last visit I received a call from the agency. While hospitalized this patient was dropped, hit her head, and never woke up.