What scares me about entering a healthcare institution for services (i.e. as a patient or a parent) is that you're no longer in charge of yourself. You have to place your trust in people and institutions you don't know. You're subject to hospital policies and procedures when you sign the consent for admission and treatment. You're the subject of decisions by your doctor, who you hopefully know, and by whoever's covering for them, who you may not. You're subject to the decisions of nurses and nurse's aides whose education, skills, biases, and thinking ability you don't get to review before they enter the room. You're subject to a host of clinical decisions that you will never even see happen: the house supervisor might understaff the floor; the tired imaging tech who wants to go home might push your study off till tomorrow; the weekend pulmonologist might decide you can wait till Monday to get off the ventilator, even though you're ready to wean; the janitorial staff might've not sufficiently cleaned the C. difficile out of your bed. It's not cool.
My main contact with healthcare as a patient has been with midwives and with our family doctor. In both cases we've been able to discuss thoroughly where we're coming from, what our concerns are, what our priorities are, what will happen when this or that case arises. In other words, we got to know each other. Especially with the midwives—the interviewing and education process is extensive, since (unlike, unfortunately, most obstetric offices) it's one-on-one, occurs in the comfort of your own home (i.e. not in a rapid clinical environment where they're too busy for too many questions) and lasts for eight or nine months. And as I explained here, all the midwifery care we received was extremely consent-oriented. This is a model of care I'd like to see implemented in the 'real world' of healthcare. But I don't know how it's ever going to happen.
As a soon-to-be practitioner, it scares me that this busy, impersonal world is where I'll be practicing. But with all this in mind, I hope I'll do well. I've seen firsthand that a good nurse can rapidly establish rapport with a patient and their family, get down to their needs, and fit that into his or her day. Nurses often have to ask what exactly it is we're doing for a patient; then explain this to the patient and their family; and then hear the possible issues or concerns that the patient or family has about this treatment. Nurses, possibly more than any other healthcare staff, are poised to bridge that gap between the impersonal clinical environment of the hospital or office and the kind of personal, experienced patient-clinician relationship that I experienced with midwives or our family doc. The kind that people really need.
be honest--you made a new post instead of using an old one just so you could use that photo. :P
ReplyDeletethe thing about midwifery is not only that it's patient-consent oriented, but that there's an assumption that the type of women who would seek out midwives are, to an extent, self-educated about pregnancy and childbirth. it's gotta be a two-way street. doctors can want (though I'm not saying all would) to seek consent, but are probably used to patients who are all too willing to hand all decisions entirely over to them.
A good nurse changes everything for the better. They truly do.
ReplyDelete(With much experience here being the patient, both in hospital and out.)
The way to make time for your patient who needs to talk is to be proficient in the bullshit work. Get that all done. Cause you never know when the guy in bed 18 wants to talk about his death that is coming in 6 months according to his Doctor who just left the room. If you are a good nurse you stop and listen. If you have taken care of most of your bullshit work and/or delegated it to the nurses aids, then you are ready for him.
ReplyDelete