Wednesday, May 30, 2012

Patient Modesty: Volume 49

I think the last two postings on Patient Modesty: Volume 48 set the problem of the current medical system followed by a explanation of why the problem is present.  Both and together I think, are worthy preface to begin Patient Modesty: Volume 49. ..Maurice.

From Anonymous:

As a woman, I've appalled with the way the general medical profession handles (or doesn't handle) patient modesty, and their seeming obsession with having access to the genital area. In the past I have been denied everything from allergy tests to antibiotics for ear infections due to my refusal to submit to a PAP smear. So be it, I now turn to alternative medicine for what I can, and suffer through the rest.
My 60-year-old husband never quite understood my views since he'd only gone for random physicals and never experienced anything untoward. However, he rcently underwent an outpatient surgery to have an ICD device placed in his shoulder, and now he understands. 
He was required to check in to the hospital 2 hours before his scheduled surgery time. A nurse came in and gave him a gown and told him to remove everything including his underwear. She wrote something on a chart and repeated "Now don't forget your underwear." Then she adjusted the bed and a third time said "Remember to take off your underwear." I could tell she was making him very uncomfortable with her repeated focus on his underwear, so I firmly told her to Back Off. I told her he was neither deaf nor mentally impared so I was certain that he understood her directions, and I asked her to leave. She left, but he was visibly shaking as he got changed. And then we sat there in that room for 2 hours, with literally nothing else happening beside a nurse coming in 1 time to take his blood pressure (which was higher than usual). Finally nerves got the better of him, and he slipped his pants back on so he could walk around the room a bit. Like she had radar, a nurse came in shortly after and berated him for not having all his clothes off. So he took off his pants again and laid in the bed for 2 more hours while nothing happened.
Finally a man came in to take him down to the pre-op room. My husband was allowed to go to the bathroom before being wheeled downstairs. And as he asked me, WHY did they insist on him being nude under a butt-revealing short gown for all that time? Could he not have just been told to change when he went to the bathroom? It seemed like nothing more than a tactic to upset him and make him submissive.
Once in the staging area, a nurse cleaned the shoulder area, inserted an antibiotic IV, and jokingly told him not to go anywhere. The she flipped up his sheet a little and joked "Not that you're dressed to make an escape anyway, right?" before she left the room. Wow, what a way to humiliate a frightened man and emphasize his vulnerability. My husband went a little nutters at that point, asking me to remove his IV and bring him his clothes so he could leave. I had to beg him to go ahead with the potentially lifesaving procedure.
Afterwards he was supposed to stay in recovery for an hour (where I wasnt allowed to be)before being returned to his room, but it didn't work out that way. I don't know what happened in recovery, but he came walking up to me in his gown and asked for his clothes. I gave them to him, he changed in a bathroom, and we left.
Now he says that when the battery on the ICD wears out, he won't go back to have it replaced. He says the thing can just "Sit in his chest doing nothing" because it "isn't worth it" to have to go through all that.
Nornally my husband is the apitome of a rational thinker, so obviously their techniques really upset him. I'm sure he wouldn't have made such a rash end decision if they hadn't insisted on making him lay around for 4 hours feeling humiliated with those 2 nurses making an issue of it, when there was no need for it. And they wonder why people don't go in for needed tests and procedures? What's wrong with our medical society?

And from BJTNT:

When you work for the demi-god, you are an angel and patients are mere mortals. This culture has evolved into the PCC syndrome - Power, Control, and Convenience for the medical operations employees. Assume this premise and see how much this describes what you observe in medical operations.
The unfortunate element of the PCC syndrome is that the employees can practive it with impunity. There is no management to crack down on them. The MO administrators are only concerned with implementing the medical committees and ownership policies. The supervisors are promoted employees with the PCC mindset. And MDs only want to "see patients". So, the kids get to run the candy store.
On the other hand, as POGO stated in the Walt Kelley cartoon of the same name "We have found the enemy and he is us." We expect [and I think rightly so] high standards from medical operations{MO} because our health and even our life can be at stake. But, to the MO employees it's just a job. It's just a job with some nice perks {PCC}.

Graphic: From Google Images and modified by me with Artrage and Picasa3.


Monday, May 14, 2012

A Change of the Medical System to Patient-Centered Consumerism: Is that What You Want?

Here is what Donald M. Berwick, writing in Health Affairs May 2012 suggests a the way the medical system can really become "patient-centered" and not present only partial changes in that direction but, in my words, "not half cocked but going the whole way". So now look at this list of changes and see if this is how you would want your doctor, nurse, hospital and the whole system to behave.

(1) Hospitals would have no restrictions on visiting—no restrictions of place or time or person, except restrictions chosen by and under the control of each individual patient. (2) Patients would determine what food they eat and what clothes they wear in hospitals (to the extent that health status allows). (3) Patients and family members would participate in rounds. (4) Patients and families would participate in the design of health care processes and services. (5) Medical records would belong to patients. Clinicians, rather than patients, would need to have permission to gain access to them. (6) Shared decision-making technologies would be used universally. (7) Operating room schedules would conform to ideal queuing theory designs aimed at minimizing waiting time, rather than to the convenience of clinicians. (8) Patients physically capable of self-care would, in all situations, have the option to do it. 

This might be just the beginning of suggested changes just as sweeping as the ones that Berwick suggests.  Read the entire article and then return and tell us what changes would you as a patient and a consumer would additionally want to see? Also, do you have any criticism of the changes noted above or by my visitors? ..Maurice.

Saturday, May 12, 2012

If You Were A Medical Student: How Would You Respond?

Think about being a 23 year old student who was in his or her first few weeks of medical school with the only experience in medicine as an occasional patient with a minor illness or having experienced the reactions to significant illness in the family. You are challenged in these early days of becoming a doctor to sit across from a real patient lying in a hospital bed and told to take a medical history with no immediate assistance by an instructor. When the history is completed, the instructor will discuss with you about your experience. You have already been instructed regarding the composition of the history though prior education of the details of how you should react to all situations which develop during the interview can never be complete. Therefore, when faced, at the time of the interview, with a decision of what to do or say next, what would be your response?  As a student, how would you handle the following three scenarios?  As the student's instructor, after the student tells you what happened, how would you support and further educate the student regarding the event?  By the way, as an instructor, I have been informed about each of these three scenarios later as brought to my attention by students looking for advice.  ..Maurice.


1. You are interviewing a 68 year old apparently competent woman patient with pneumonia and her 45 year old son is in the room who repeatedly interrupts your attempts to have his mother give the history herself by immediately responding with what he knows to each question. What would you do and what would you say?

2. You are interviewing a 33 year old red headed female flight attendant who is to have repeat right shoulder surgery by a different orthopedic surgeon because as she says the initial surgeon "botched the job". She says that she was left with more  pain and limitation of motion of the right shoulder after the first surgery. She tells you what she knows about the surgery and her subsequent symptoms and then asks you directly "What do you think about how my surgeon treated me?" What would you then say to her?

3. You are interviewing a 28 year old female 3rd year medical student from a medical school in another state. She is very sick with leukemia and appears very weak, pale with multiple bruise-lie spots on her skin and is short of breath with repeated spells of coughing, raising bloody sputum as she tries to move in bed. She doesn't seem to be able to cope with her illness now and is very restless and depressed.  She talks about her fear of dying and seems to be asking you, a first year medial student, to somehow give her some emotional support even though he had never met you before.  You, yourself, are very upset about what you see and know. There is a "lump" feeling in your throat and you are beginning to feel nervous and weepy with tears welling up in your eyes. What would you do at this point and what would you say?