Wednesday, August 29, 2007

So Speak Up Already

An interesting article in Monday’s Boston Globe called “Patient, Protect Thyself” covered ways hospital staff and patients alike can combat a serious and often preventable problem: infectious disease in hospitals. From making sure everyone who enters a patient room washes his or her hands to maintaining vigilance over the amount of time tubes are left in the body, there are all sorts of ways to reduce the threat of infections.

Questions of communicable agents and preventative practices aside, the article touched on a larger theme that resonates with me, the idea that patients not only have the right to question their health care providers but that such queries are an essential part of optimal care.

Perhaps the meaning of “Patient, Protect Thyself” is really “Patient, Assert Thyself.”

This semantic difference isn’t what really concerns me, though. I’m much more interested in why it can be so hard to do that, especially considering it is our health at stake. Maybe some of you aren’t ever plagued with momentary meekness, but I’ve definitely had encounters where I’ve had to double check or question something and before the words are out of my mouth my face is flushing a bit.

I don’t want to be annoying. Or condescending. They are the ones with medical training, not me.

(And do I really want to annoy someone who’s coming at me with a needle?)

I trip over my own words with “I don’t mean to be a pain” and “I just have a quick question” and “I’m not sure, but I think…” when of course, I am pretty sure. I’ve been through the revolving door of hospitals and doctors’ offices my entire life. I’ve learned some things along the way, like where the best veins for IV lines are, how many nebulizer treatments I need to have before they actually start to help, or that one medicine in particular is the only one that stops my nausea after anesthesia.

There are the obvious times when it’s easy to be assertive, like the time I was sent for the wrong test on the wrong body part with the wrong patient ID number (hello, HIPAA!), or the time my doctor ordered chest PT three times a day while I was an inpatient and I hadn’t gotten any. But the less egregious encounters are the awkward ones...which is weird, right? I mean, I don’t have a problem sending back the wrong coffee order, or double-checking that the security tags have been removed from newly purchased clothes, or repeating the take-order over the phone when I sense the person on the other end may have missed something.

Surely looking out for my body is more important than latte orders, security tags, or garden salad versus spinach salad?

And that’s exactly the problem—it is so much more important. One could argue that part of the problem is the leftover vestige of the patient-practitioner hierarchy where the patient’s job is to sit still and defer all authority, but I don’t think that explains it. I think deep down it’s a question of vulnerability, too. Despite how much we know and the wisdom we’ve accumulated, in these situations we still need to rely on someone else to do what we need done to feel better. Once you’ve crossed over that very real physical boundary and let someone in, it’s not always easy to admit a lack of confidence in what they’re doing.

* * *

On another note, Grand Rounds is up at Rickety Contrivances of Doing Good, where my post on the role narrative plays in the doctor-patient relationship is featured as the first post. Susan did a great job with a really compelling theme, so be sure to check out the posts.


Get It Right said...

1st - I like your writing style. It is sophisticated w/o excessive weightiness.

As to the content, I share your comments. As I reflected on your words, a phrase came to mind from the crime shows 'Exactly who is the Victim?'. Very often crime victims and patients receive the same kind of treatment. In both cases, a person with knowledge of the problem (think Asst DA & Resident/Attending)proceed to lead the victim through a series of steps that are confusing, half hearted, of no real purpose, limited, and most of all generalized. Seldom do you hear of either professions focusing on the individual factors that should determine how to best proceed. Add to that the often dismissive, 'I’m the expert' attitude that discourages questioning. Over and over I see medical personnel casually lumping the patient into a category w/o judging the individual. In yesterdays WSJ, a columnist spoke of the first doctor her mother met versus the 2nd. One was dismissive and the 2nd was both hopeful and helpful. In another article, the author spoke about the critical need for the patient not to accept but to question. In two family instances, i saw the real benefit of not just one 2nd opinion but rather 5 opinions; and why the first answers were wasteful and incorrect.

In any event, please keep writing.

Anonymous said...

This is an issue all Chronic Situationers deal with. It's the old "doctor is god" mentality. I'm working hard at being more assertive without being angry and frustrated. Dealing with the medical community in a whole can make you that way!

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