Why Is There No True, Empathic Patient Engagement or Is There?"
Staff shortages may be blamed for burnout and less-than-caring interactions with patients, but should this be the case, or do we need a review?
A significant factor in all medical procedures relative to returning to health is the interaction and belief in staff's empathy and professionalism. But a recent encounter with a large medical facility blew holes in this belief for me, and I suspect for many other patients and their caregivers.
Healthcare professionals have entered a field where empathy, compassion, and an ability to relate well to patients are implicitly mandated. But are some of the staff falling through the cracks, is staff shortage playing a highly detrimental role, or is management falling short in their responsibility to care for patients? Maybe all of it must be factored in, but the bottom line is that patients are suffering from a lack of caring in too many instances.
Additionally, any patients who are older, physically or mentally compromised, may be trained, by brutal experiences, and being a "good patient" is the only way to go. Is that how this is coming to fruition in our fields?
Why should a loved one have to almost plead with a medical staffer to truly "take care?" It's not my speculation but related in an article in the professional literature.
"I know you have a lot of patients, but he's all I've got. Please take care of him like he's one of yours." The partner of my hospitalized patient pleaded.
I remember saying something similar to the chief of a specialized unit at a major NYC hospital. "I'll take care of her like she's a family member," he said, and I responded, "I hope you like your family."
Cheeky, yes, and he didn't follow through as I had expected, and an instrument was broken during his procedure — but they persisted. He's dead now, so no family members need to worry about his ineptness.
The Rocky Road of Care
Why would anyone need to plead in a situation where the highest level of care, concern and personal connection should be the norm? It's because it's not the norm, and some staff seems to take umbrage at being expected to be helpful and understanding. Mental status exams after anesthesia might be a case in point.
The patient, who had not been adequately sedated and, as a result, the surgery was canceled because of excruciating pain, tried to lighten the nurse's load at the bedside.
"Do you know your name," the nurse asked brusquely.
With an attempt at humor (despite the frightening experience), the patient responded, "Yes, I know my name. Do you?"
Screwing up her face, the nurse asked the question once again.
The patient responded, "Do you want to know my name? I'm trying for a little humor here, as you can see," the patient said. How the patient managed that, I can't imagine because she had just come from a harrowing, painful experience that now necessitated yet another, later visit to the OR.
No answer from the nurse but a cold stare. The nurse walked away without completing any further questioning, such as the place, the day, and the date. It was incomplete, but who cares? Who would check, and what would the chart show? A mental status had been administered when it was not completed, a deceitful error.
Before the procedure, a port for administering anesthesia had been inserted into the patient's arm. A nurse, attempting to pull a gown sleeve up for easier access, inadvertently dislodged the port, and another had to be inserted.
"Look what you've done," the young physician inserting the port (without wearing gloves) said to the patient. The patient had done nothing, but she was being blamed now. Wasn't she anxious enough without this type of treatment, or was that the usual physician-patient banter before surgery?
Waiting for the procedure to be completed and expected to take the patient home, there was a query. What was the reason the surgery was canceled? "The patient kept moving around," was the answer to that question. Again, untrue because it was pain caused by inadequate sedation that led to the patient asking the physician to stop because of the pain, and they both agreed.
I've always told patients in my office that they need an advocate for medical consultations or a procedure. I know how anxiety affects memory, and I wanted to ensure they got the information as intended. But in an operating room, you have no advocate, and everyone waits outside to be told whatever is convenient for the staff.
Am I being too harsh? I think not because I saw and heard the entire scenario I've described. Where do we go from here? How can we improve patient engagement if we have a resistant staff or management who wants procedures, not re-training in something that doesn't generate more income?
Patients don't have unions as medical staff are now seeking. The hospitals pay hospital advocates, so where does their feeling of responsibility lie? Inevitably, the patient will be blamed in some way, either overtly or covertly, and this is not acceptable.
To be continued at some time in the future.