“Don’t talk to the patient” (12/16/11)
A Nurse’s Story
You know things are screwy if nurses can lose their jobs for talking to patients.
A nurse I know at the main regional hospital has an excellent record, plus decades of experience on medical wards. She was admonished that she was “wasting” too much time talking to patients.
“They told me to get out of the room quickly. I should tell the patient that I could get someone else to talk to them later.”
Who was this “someone else?” It might be a social worker or psychologist, but not someone with the same medical training of specific knowledge.
“The patients point out to me that I’m there right now, that they have a problem now, and I know about them.”
Directed to Distraction
The December 15th New York Times highlighted an article about how electronic devices may interfere with patient care. Neurosurgeons talk to their families while operating. Half of cardiopulmonary bypass technicians text during procedures; over half chat on cellphones. Anesthesiologists shop on eBay as they pass gas.
Are you surprised? People surf the Net and multitask in bed with their partners; in the middle of “critical” business meetings; while driving. Last week a nurse and I tried walking across the street. The white walk sign flashed right in front of the hospital. A young woman sped by and would have hit us except for our trained hesitation.
“What was she thinking?” the nurse asked me.
“I don’t know. She was texting.”
Half of young drivers text en route. Why should surgeons, nurses, or medical technicians act very differently?
Medical care is presently “data driven.” Go to wards and you’ll discover an eery silence.
Almost everybody is watching computer monitors.
They may be on mobile pads, or on towers at the nursing station. Barring the cacophony of television ads, the patient rooms are mainly quiet.
The medical types are looking at the numbers.
Many pain patients describe the same experience – they’ve come into a physician’s office to be told that “we could not find anything” or that “nothing is wrong.”
“So why do I hurt so much?”
Few of them know of the study done 20 years ago in the New England Journal. A hundred MRIs of the back were reviewed by radiologists and surgeons. Of them, 39% were found to be abnormal. The surgeons wanted to operate on six of the patients, three emergently.
All of the 100 “patients” were asymptomatic.
Physicians today are more statistically literate, less prone to “hunt down” every abnormal lab finding. However, if the numbers are “good” they may question you less. If the numbers are “bad” they “have a diagnostic bias” to try and explain the innumerable symptom complaints they hear.
Putting all the data together is what clinical decision making should be about. But that requires frequent patient discussions – because people provide you information you’re not going to get from the chart.
Reasons to Talk to Patients
There are many reasons nurses, doctors and all medical workers need “face time” with patients rather than to simply peruse electronic records. Here are a few:
1. You get new, often critical information – including otherwise obvious things like bleeding or in terrible pain which patients may not offer during a quick, efficient “patient visit.”
2. While the human body is an extraordinary information processing unit an electronic medical record is a woefully inadequate one, not allowing you to access the many different forms and signs of human communication – eye contact, skin pallor, smell, physical motions, facial gestures – that exist when face to face.
3. Any medical worker can be part of the placebo effect that may be the most important factor for many in getting well.
4. Education – if health is the goal of treatment, then discussing with patients what is wrong and what they can do to prevent future problems is a critical part of care.
The outcome of health care should be health – not just good numbers.
Nurses know that. That’s one of many reasons nurses are going on strike in the Northeast this week – despite severe economic woes.
They are telling the media they need more time to do their jobs. Part of that time is required to talk with patients – to treat them and protect them.
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