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“Don’t talk to the patient” (12/16/11)

December 16, 2011

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?

Ghost Wards

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.

Number Managers

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.
Rest, sleep, Sarasota Sleep Doctor, well-being, regeneration, longevity, body clocks, insomnia, sleep disorders, the rest doctor, matthew edlund, the power of rest, the body clock, psychology today, huffington post, redbook, longboat key news

4 Comments leave one →
  1. December 16, 2011 5:36 PM

    I finally felt I needed to leave the traditional practice of medicine after 22 years because my employers could “not afford” to have me spend more than 8.5 minutes with each patient encounter. As a sleep specialist I found that most of my patients, especially insomnia sufferers, could barely explain what they were going through in that amount of time, let alone explore possible causes and treatment options. Now as an independent coach and consultant I can take the time to listen to my “clients”. It seems to me if you listen long enough, the real answers comes from inside them. Furthermore, the simple act of being heard can be healing in itself. When the business of medicine demands we “don’t talk to the patients” the process of healing has been disrupted.

    • December 19, 2011 1:12 PM

      Dear Patty,
      The doctor – or any health care provider – is also a drug. If people know what to do that becomes empowering itself.

  2. December 17, 2011 3:49 PM

    I am a nurse who totally agrees. I spent my “break” talking w/ an elderly pt. once who couldn’t walk..everytime the therapists came she couldn’t get up. They thought she just was too weak from her illness and were going to send her to rehab instead of discharge. People whizzed in and out of her room, and no one part of the chatting, she shared she had multiple sclerosis, and couldn’t walk without a walker…BEFORE she ever got into the hospital! She was hoping someone would bring a walker! I got her one ordered, and soon she was moving about quite well..with no extra rehab. Everyone said..why didn’t she tell us? Well, she is one of many who need to develop trust before sharing details of their lives. One more reason to actually TALK to the patients.

    • December 19, 2011 1:13 PM

      Sadly, our health care system is falling apart – which makes administrators more prone to look at “quantifiable” measures. Many critical factors in care are not readily quantifiable.

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