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I've had a very frustrating weekend with hospice. Usually it's my co-irkers that give me the most grief, but occasionally the patients or their families give me an equal amount of grief.
It gave me pause for thought about some really simple things patients and/or their families can do when interacting with members of the health care system to avoid unnecessary drama and trauma.
Bear in mind, I do understand that there are instances of bad behavior among health care providers. We've talked about quite a few in other threads.
But this IS Customers Suck!, and so my focus is on the customer, rather than the service provider in this thread.
1. Have Realistic Expectations.
Understand folks . . . medicine is not an empirical science. There is a LOT about the human body and how it functions that we still don't completely understand.
It may take a lot of testing and evaluation for the doctor to figure out what it wrong with you. A lot of times, it is less an issue of crunching the numbers and more of an issue of the doctor's gut instinct and experience. It would help matters if you come to his office with a coherent description of what your symptoms actually are: what are they, when did they start, what makes them better, what makes them worse, how bad are they.
Don't expect your symptoms to get better if you ignore your doctor's instructions, or try to self medicate. I don't care what you've read on the Internet, you canNOT diagnose yourself better than a physician can!
A nurse is no substitute for a physician. We can sometimes give you a rough idea on what MIGHT be wrong, or help you interpret what he actually told you. We can give you sensible suggestions on symptom management outside of your medications, and some information on how to take meds safely. But we're nurses not doctors. Diagnosis and medical treatment is not what we do.
Nursing assistants and medical assistants are even worse people to ask for advice or information. They are technicians with no training in pathophysiology. But they will often act like they know more than they do, mostly because they observe a lot of things in their clinical settings. Some may seem quite knowledgeable. They still are not trustworthy to ask for diagnosis, treatment information, how to take meds, or how to care for an illness. No disrespect to the MAs I know who are here . . . but I must point out the limitations in scope of practice for safety reasons.
Pharmacists are PERFECT for asking questions about medications, and how to take them safely. I encourage patients to ask more questions of their pharmacist, and most LOVE to teach and interact with patients/customers (the ones I know do, anyway). But they are not substitutes for physicians. Don't try to use them to get out of seeing your doctor.
Your doctor really is doing his best to diagnose you. He's not incompetent just because you have a difficult diagnosis. Some patients never get a diagnosis . . . because medicine is not an empirical science.
Have Realistic Expectations, Part Deux
Understand that just because the doctor has recommended a course of treatment or written a prescription, that does not mean that your insurance company will authorize it. Saying, "but the doctor saaaaiiiid" will not change this fact. You may have to pay for some things out of pocket. Insurance is not an entitlement program.
Understand that even if your treatment/medication/equipment is covered by your insurance, does not mean that you will necessarily get it that day. Some medications are so expensive and so infrequently used, pharmacies don't stock them and have to order them. Medical equipment companies have limited supplies of things like tube feeding pumps and IV pumps. If they are all being used by other patients, they may have to scrounge from other cities they contract in to get one. These things take time. If your doctor thought you would die waiting, he wouldn't have sent you home. Please be patient, and don't rip the head off the poor triage nurse/medical company rep who is really, really trying to help you.
Understand the difference between being informed and being obnoxious
There are days when I absolutely hate the Internet.
Folks, please understand that both doctors and nurses are very well trained on common medical problems, their diagnosis, and treatment. We get it. We really do. You don't have to tell us Grandpa's heart will go crazy if he doesn't get his blood pressure medicine. We get it, and we're working on it as best we can. But we're not magicians and we can't be in 10 places at once. We have to organize and prioritize what we do, and if you are not #1 on our list it is because some other poor bastard is even sicker than Grandpa. Yes, we know you don't care about someone else's Grandpa. We do.
If you have some odd rare disease, then by all means bring the medical records with you. They are actually quite helpful. We will believe you when you tell us X, Y, and Z, especially when you tell us your kid is not acting right. We really do believe you. We know some other jerk didn't believe you, and bad things happened. We're human too, and sometimes make bad calls. But most of us will believe you . . . please don't bite our heads off cuz some poor idiot/jerk didn't. Give us a chance.
3. Please be patient.
We really are trying as hard as we can to get things done. Like I said, sometimes we have to set priorities. We use a simple rule: ABC's
Airway
Breathing
Circulation
If someone is not breathing well, I will attend to that need before I attend to your need for a snack, even if you are diabetic. You are not likely to go unconscious before I keep the guy with the breathing problem from croaking.
But I really do want to get you that snack, and I will do it as quick as I can.
4. Understand I am not perfect
I'm sorry I screwed up and forgot to get you that snack. I didn't do on purpose, or out of malice. I just got overwhelmed and forgot. I'm trying to make it right.
Please don't get upset if I don't get your IV on the first stick. I really am very good at this . . . but I am not perfect. Sometimes I miss. I'm not digging around because I am secretly a sadist. If it gets too bad, just say, "please stop." Don't scream, "Get out and get me someone competent!"
It's OK to ask nicely for another nurse after the 2nd unsuccessful stick . . . or even the first if you are a hard stick. It is also OK to tell us what works for you. Preface it, "It usually works best when the nurses do XYZ," rather than, "You people can never get it right, you better get it on one try.:
Please listen
We are happy to answer your questions, and tell you everything you need to know. But please let us get a word in edgewise. When you interrupt and go on and on about something we have no control over, you make it that much harder for us to do the real job of helping you.
Please give us complete information . . . but keep it on topic
We really do need to know about all the medications you take: dose, times, last dose, any problems it causes you. We don't need to know about how these medication affected Great Aunt Ginny. We're not treating her. Likewise, I don't need to talk about your toe jam if you are complaining about chest pain.
I'm sure my colleagues will come up with a few to add. This is enough to get me started for tonight.
It gave me pause for thought about some really simple things patients and/or their families can do when interacting with members of the health care system to avoid unnecessary drama and trauma.
Bear in mind, I do understand that there are instances of bad behavior among health care providers. We've talked about quite a few in other threads.
But this IS Customers Suck!, and so my focus is on the customer, rather than the service provider in this thread.
1. Have Realistic Expectations.
Understand folks . . . medicine is not an empirical science. There is a LOT about the human body and how it functions that we still don't completely understand.
It may take a lot of testing and evaluation for the doctor to figure out what it wrong with you. A lot of times, it is less an issue of crunching the numbers and more of an issue of the doctor's gut instinct and experience. It would help matters if you come to his office with a coherent description of what your symptoms actually are: what are they, when did they start, what makes them better, what makes them worse, how bad are they.
Don't expect your symptoms to get better if you ignore your doctor's instructions, or try to self medicate. I don't care what you've read on the Internet, you canNOT diagnose yourself better than a physician can!
A nurse is no substitute for a physician. We can sometimes give you a rough idea on what MIGHT be wrong, or help you interpret what he actually told you. We can give you sensible suggestions on symptom management outside of your medications, and some information on how to take meds safely. But we're nurses not doctors. Diagnosis and medical treatment is not what we do.
Nursing assistants and medical assistants are even worse people to ask for advice or information. They are technicians with no training in pathophysiology. But they will often act like they know more than they do, mostly because they observe a lot of things in their clinical settings. Some may seem quite knowledgeable. They still are not trustworthy to ask for diagnosis, treatment information, how to take meds, or how to care for an illness. No disrespect to the MAs I know who are here . . . but I must point out the limitations in scope of practice for safety reasons.
Pharmacists are PERFECT for asking questions about medications, and how to take them safely. I encourage patients to ask more questions of their pharmacist, and most LOVE to teach and interact with patients/customers (the ones I know do, anyway). But they are not substitutes for physicians. Don't try to use them to get out of seeing your doctor.
Your doctor really is doing his best to diagnose you. He's not incompetent just because you have a difficult diagnosis. Some patients never get a diagnosis . . . because medicine is not an empirical science.
Have Realistic Expectations, Part Deux
Understand that just because the doctor has recommended a course of treatment or written a prescription, that does not mean that your insurance company will authorize it. Saying, "but the doctor saaaaiiiid" will not change this fact. You may have to pay for some things out of pocket. Insurance is not an entitlement program.
Understand that even if your treatment/medication/equipment is covered by your insurance, does not mean that you will necessarily get it that day. Some medications are so expensive and so infrequently used, pharmacies don't stock them and have to order them. Medical equipment companies have limited supplies of things like tube feeding pumps and IV pumps. If they are all being used by other patients, they may have to scrounge from other cities they contract in to get one. These things take time. If your doctor thought you would die waiting, he wouldn't have sent you home. Please be patient, and don't rip the head off the poor triage nurse/medical company rep who is really, really trying to help you.
Understand the difference between being informed and being obnoxious
There are days when I absolutely hate the Internet.
Folks, please understand that both doctors and nurses are very well trained on common medical problems, their diagnosis, and treatment. We get it. We really do. You don't have to tell us Grandpa's heart will go crazy if he doesn't get his blood pressure medicine. We get it, and we're working on it as best we can. But we're not magicians and we can't be in 10 places at once. We have to organize and prioritize what we do, and if you are not #1 on our list it is because some other poor bastard is even sicker than Grandpa. Yes, we know you don't care about someone else's Grandpa. We do.
If you have some odd rare disease, then by all means bring the medical records with you. They are actually quite helpful. We will believe you when you tell us X, Y, and Z, especially when you tell us your kid is not acting right. We really do believe you. We know some other jerk didn't believe you, and bad things happened. We're human too, and sometimes make bad calls. But most of us will believe you . . . please don't bite our heads off cuz some poor idiot/jerk didn't. Give us a chance.
3. Please be patient.
We really are trying as hard as we can to get things done. Like I said, sometimes we have to set priorities. We use a simple rule: ABC's
Airway
Breathing
Circulation
If someone is not breathing well, I will attend to that need before I attend to your need for a snack, even if you are diabetic. You are not likely to go unconscious before I keep the guy with the breathing problem from croaking.
But I really do want to get you that snack, and I will do it as quick as I can.
4. Understand I am not perfect
I'm sorry I screwed up and forgot to get you that snack. I didn't do on purpose, or out of malice. I just got overwhelmed and forgot. I'm trying to make it right.
Please don't get upset if I don't get your IV on the first stick. I really am very good at this . . . but I am not perfect. Sometimes I miss. I'm not digging around because I am secretly a sadist. If it gets too bad, just say, "please stop." Don't scream, "Get out and get me someone competent!"
It's OK to ask nicely for another nurse after the 2nd unsuccessful stick . . . or even the first if you are a hard stick. It is also OK to tell us what works for you. Preface it, "It usually works best when the nurses do XYZ," rather than, "You people can never get it right, you better get it on one try.:
Please listen
We are happy to answer your questions, and tell you everything you need to know. But please let us get a word in edgewise. When you interrupt and go on and on about something we have no control over, you make it that much harder for us to do the real job of helping you.
Please give us complete information . . . but keep it on topic
We really do need to know about all the medications you take: dose, times, last dose, any problems it causes you. We don't need to know about how these medication affected Great Aunt Ginny. We're not treating her. Likewise, I don't need to talk about your toe jam if you are complaining about chest pain.
I'm sure my colleagues will come up with a few to add. This is enough to get me started for tonight.
(if you need/want it)
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