Note: The following is a fictitious rendition of a hospital scene(s). Any resemblance to any particular person(s) or place(s) is entirely coincidental.
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So I am still in shock.
Was invited to visit an Intensive Care Unit (ICU) patient and am currently just floored.
Hmmm. In the ER room, there was a defibrillator present. Hmmm. I wonder why. No one mentioned a little thing like Cardiac Arrest.
Hmmm. In the ICU, the patient "..needs a blood transfusion, so you can sign here." Ummm. Really? That is it? You decide and we sign? What happened to the concept of Informed Consent? Risks, benefits, explanation, brochure. Nothing.
So I provided the Informed Consent myself.
Maybe it was just a bad time. Maybe the nurse was just in a bad mood, or tired. We all have our moments.
Next morning: we arrive at 7:30 am, after Nursing Change of Shift. I introduce myself to the nurse and am met with, "I don't know the patient yet and I can't give you any medical information." Umm. Okay. Maybe you are busy. But that's okay because I already said a gentle hello to the patient as I then noted all the vitals, the drips, the machine settings, the urine output, and was satisfied that progress and hope are just around the corner.
So if that is okay with you, we are going to go to the Cafeteria and eat breakfast. "Whatever." Ummm. "Please let the doctor know that the family is here and would like to speak with him/her. If you don't mind." Sure. Walks away from me. But wait! "If you don't mind, what is your name?" Got it. Wow.
Maybe this nurse is in a bad mood too, or too busy, or overworked and underpaid. Or maybe another patient is more sick, and needs more attention. Okay. These things happen and I am a big girl.
So we eat spinach and mosey back up to the Waiting Room. Visiting hours start at 8:00 am but we patiently Wait so they can do their magic in the ICU without our being in the way.
30 minutes pass. No word from the doctor or the nurse.
60 minutes pass and it is now 9:00 am. No word from the doctor or the nurse.
So we ask to go in. After all, Visiting hours have been opened for 1 hour and we would like to see the patient.
"No." "We are doing a Procedure. You can't come in yet."
Ummm. Excuse me? "The family has been Waiting for an hour and a half and we were not advised of any Procedure." I peek through the window and see a tall male nurse with body language that tells me that he is upset.
So I say, "Some one needs to talk to the family." Charging out, a tall male nurse takes great big strides and is in front of us within 15 seconds. "You can't come in right now. We are busy doing a Procedure." Oh really? We have been here the whole time, remember?
"We were not asked for Informed Consent for any Procedure." Hmmm.
So the story changes. "Well, we are just following the doctor's orders from last night. It is not really a Procedure." Well then why didn't any one tell us about the Procedure that is Not a Procedure, since we are literally 20 feet away, waiting....Hmmm. Not nice. Doesn't make sense. So what else don't we know? What else are you not telling us?
"Well, we are going to do something else after that, so you won't be able to come into the room for 45 minutes." Really. Okay. So what are you going to do? Oh. It is another Procedure that is Not a Procedure. So you were going to do all of this without telling the family, knowing that we have been waiting here all morning? Really?
The male nurse is emphatic. "Listen, you don't have to be contentious."
Well. that is nice. It would have been nice to let us know you were doing two different things to the patient, especially since we both know that the family has been waiting. So the Procedure that is Not a Procedure is really going to be two Procedures that are Not Procedures and the family never would have known if we had not inquired. I just want to have great clarity here.
This man is 2 feet taller than me, and he turns his back to me and seemingly proceeds to pit one person against the other. "You are the next of kin. We listen to you." Hmmm. "Excuse me? We have a minor child in the Waiting Room. Do you mind stepping outside a little bit more?"
The conversation continues without me in it. Wow.
So then I recall other small bits of events. The Blood Transfusion Consent was given to us in Spanish. Ummm. Excuse me? Because we have brown hair?
We are native Californians with English as our Primary language. We are professionals with good brains. Hmmm. Maybe you think we are clueless about hospital protocols, doctor:patient relationships, rules and regulations, and/or common courtesy. Maybe we are female. Maybe we are shorter than you.
But that does not give you the authority to hide information from the family. It does not give you permission to neglect to give Informed Consent for every procedure. It does not absolve you from letting us speak to a M.D. or to allow you to neglect the Standard of Care.
I just have to wonder: is this how you treat all your patients? Doing procedures without telling the family? Or do you just do this if you think we don't speak English? Didn't you get an Inservice about providing Informed Consent, and aren't you supposed to offer the Blood Transfusion Brochure at the time of signing for a blood transfusion?
Is it just me?
It can not just be me. I think you must be doing this to many other patients. It is not right. So here it is for all to see.
It is okay to ask questions. It is your right to get Informed Consent before any Procedure. Hat's off to the families that Wait and Wait and Wait in the Waiting Room....hat's off to you.
Pre-Medical Students: Respect and Dignity for the Patient are also exhibited by extending courtesy to the family.
Medical Students: Sometimes, it is not all just about the Patient. You give dignity to the Patient by extending courtesy to the Family as well.
Interns: You may not realize how rewarding it is to spend 2 minutes with the Family and make a generation (or 2) of loved ones cherish every single word that comes out of your mouth. This is one of those times when you 'receive' a blessing.
Residents: Teach your Medical Students and Interns compassion and courtesy.
Chief Residents: Common courtesy, the Standard of Care, and the Patient's Bill of Rights. The Patient is represented by the Family, who now serves as an Advocate for a Patient (especially if the Patient is sedated, comatose, and/or intubated).
Fellows: Gather your Housestaff to speak to the Family. Teach your Housestaff by example.
Patient Dignity. When you give the Patient Dignity, you honor the medical profession....and the human race as well.
_________________________________________________________________________________
So I am still in shock.
Was invited to visit an Intensive Care Unit (ICU) patient and am currently just floored.
Hmmm. In the ER room, there was a defibrillator present. Hmmm. I wonder why. No one mentioned a little thing like Cardiac Arrest.
Hmmm. In the ICU, the patient "..needs a blood transfusion, so you can sign here." Ummm. Really? That is it? You decide and we sign? What happened to the concept of Informed Consent? Risks, benefits, explanation, brochure. Nothing.
So I provided the Informed Consent myself.
Maybe it was just a bad time. Maybe the nurse was just in a bad mood, or tired. We all have our moments.
Next morning: we arrive at 7:30 am, after Nursing Change of Shift. I introduce myself to the nurse and am met with, "I don't know the patient yet and I can't give you any medical information." Umm. Okay. Maybe you are busy. But that's okay because I already said a gentle hello to the patient as I then noted all the vitals, the drips, the machine settings, the urine output, and was satisfied that progress and hope are just around the corner.
So if that is okay with you, we are going to go to the Cafeteria and eat breakfast. "Whatever." Ummm. "Please let the doctor know that the family is here and would like to speak with him/her. If you don't mind." Sure. Walks away from me. But wait! "If you don't mind, what is your name?" Got it. Wow.
Maybe this nurse is in a bad mood too, or too busy, or overworked and underpaid. Or maybe another patient is more sick, and needs more attention. Okay. These things happen and I am a big girl.
So we eat spinach and mosey back up to the Waiting Room. Visiting hours start at 8:00 am but we patiently Wait so they can do their magic in the ICU without our being in the way.
30 minutes pass. No word from the doctor or the nurse.
60 minutes pass and it is now 9:00 am. No word from the doctor or the nurse.
So we ask to go in. After all, Visiting hours have been opened for 1 hour and we would like to see the patient.
"No." "We are doing a Procedure. You can't come in yet."
Ummm. Excuse me? "The family has been Waiting for an hour and a half and we were not advised of any Procedure." I peek through the window and see a tall male nurse with body language that tells me that he is upset.
So I say, "Some one needs to talk to the family." Charging out, a tall male nurse takes great big strides and is in front of us within 15 seconds. "You can't come in right now. We are busy doing a Procedure." Oh really? We have been here the whole time, remember?
"We were not asked for Informed Consent for any Procedure." Hmmm.
So the story changes. "Well, we are just following the doctor's orders from last night. It is not really a Procedure." Well then why didn't any one tell us about the Procedure that is Not a Procedure, since we are literally 20 feet away, waiting....Hmmm. Not nice. Doesn't make sense. So what else don't we know? What else are you not telling us?
"Well, we are going to do something else after that, so you won't be able to come into the room for 45 minutes." Really. Okay. So what are you going to do? Oh. It is another Procedure that is Not a Procedure. So you were going to do all of this without telling the family, knowing that we have been waiting here all morning? Really?
The male nurse is emphatic. "Listen, you don't have to be contentious."
Well. that is nice. It would have been nice to let us know you were doing two different things to the patient, especially since we both know that the family has been waiting. So the Procedure that is Not a Procedure is really going to be two Procedures that are Not Procedures and the family never would have known if we had not inquired. I just want to have great clarity here.
This man is 2 feet taller than me, and he turns his back to me and seemingly proceeds to pit one person against the other. "You are the next of kin. We listen to you." Hmmm. "Excuse me? We have a minor child in the Waiting Room. Do you mind stepping outside a little bit more?"
The conversation continues without me in it. Wow.
So then I recall other small bits of events. The Blood Transfusion Consent was given to us in Spanish. Ummm. Excuse me? Because we have brown hair?
We are native Californians with English as our Primary language. We are professionals with good brains. Hmmm. Maybe you think we are clueless about hospital protocols, doctor:patient relationships, rules and regulations, and/or common courtesy. Maybe we are female. Maybe we are shorter than you.
But that does not give you the authority to hide information from the family. It does not give you permission to neglect to give Informed Consent for every procedure. It does not absolve you from letting us speak to a M.D. or to allow you to neglect the Standard of Care.
I just have to wonder: is this how you treat all your patients? Doing procedures without telling the family? Or do you just do this if you think we don't speak English? Didn't you get an Inservice about providing Informed Consent, and aren't you supposed to offer the Blood Transfusion Brochure at the time of signing for a blood transfusion?
Is it just me?
It can not just be me. I think you must be doing this to many other patients. It is not right. So here it is for all to see.
It is okay to ask questions. It is your right to get Informed Consent before any Procedure. Hat's off to the families that Wait and Wait and Wait in the Waiting Room....hat's off to you.
Pre-Medical Students: Respect and Dignity for the Patient are also exhibited by extending courtesy to the family.
Medical Students: Sometimes, it is not all just about the Patient. You give dignity to the Patient by extending courtesy to the Family as well.
Interns: You may not realize how rewarding it is to spend 2 minutes with the Family and make a generation (or 2) of loved ones cherish every single word that comes out of your mouth. This is one of those times when you 'receive' a blessing.
Residents: Teach your Medical Students and Interns compassion and courtesy.
Chief Residents: Common courtesy, the Standard of Care, and the Patient's Bill of Rights. The Patient is represented by the Family, who now serves as an Advocate for a Patient (especially if the Patient is sedated, comatose, and/or intubated).
Fellows: Gather your Housestaff to speak to the Family. Teach your Housestaff by example.
Patient Dignity. When you give the Patient Dignity, you honor the medical profession....and the human race as well.
Good article---my daughter was recently hospitalized and we had this nurse with the most annoying condescending attitude. Here is a link to our story http://p-o-t-s-andplans.blogspot.com/2012/01/cmon-get-up.html---I ended up reporting this nurse because after 2 days with her---I had enough. My daughter like every POTS and EDS patient out there experience real pain everyday and it's time forf our medical professionals to believe and know that everything isn't always black and white. Thanks for exposing more of what happens in this setting.
ReplyDeleteI am so sorry you had to go through this and that your daughter was exposed to what sounds like a bad experience.
ReplyDeleteIt is time for the Pre-medical Students, the Medical Students, Interns, Residents, Chief Residents and Fellows to know that bedside manner is The Art of Medicine.
Patients can not always advocate for themselves. Some one has to be there to go through the patient's experience with them. In being there for your daughter, you put yourself through her pain too.
Hat's off to you, Mother! We do need to speak up if we sense real animosity that is completely unnecessary.
For the nursing staff, remember that there is one nurse assigned to one patient. There is a Charge Nurse that is in "Charge" of all the Nurses.
So if you have an issue with the Nurse, please feel free to ask to speak to the Charge Nurse. You can do this discreetly so that the patient retains dignity and confidentiality.
The Charge Nurse is there for you. Please utilize him/her, as it is not surprising that if one hospital Staff person is treating a patient with less than the Standard of Care, that same Staff person is doing it to other people, too.
So you do a favor by bumping this up to the next level.
Now Onward and Forward to another day, and another lesson learned...replacing bad memories with good ones is the best part of life, and I know you can do it!