A wife calls the floor on which her husband has been admitted at a local hospital. She asks how he’s doing, and amongst other questions, how he’s been eating. The nurse on the phone says he’s had a few bites of each part of the meal he’s been given. The wife arrives later to her husband’s bedside and notices the bedside tray pushed off into the corner – and not a single piece of food had been touched. The nurse, has by any account, lied directly to a family member about the well being of a patient she has been charged with caring for. She went to school, passed tests, and went through orientation which includes bedside care with another nurse. This is a dereliction of duty, and if she documented the same in the chart, she created a false document.
The above scenario did in fact play out in real life recently to a friend of mine. Physicians have historically taken the Hippocratic Oath, and you would think that every healthcare worker would follow the same guide. When I completed my internship as a paramedic, I sat with the 30+ year chief paramedic at National Ambulance for a review of my file, some advice, and the words that every paramedic at that agency heard before they were sent out into the world;
“Go forth and do no harm”
I would surmise that omission of care and ill reporting of care would constitute doing harm, be in conflict with the Hippocratic Oath, and also be immoral and unethical.
Today, most health care facilities employ patient advocates.
The Oxford Dictionary defines an advocate as:
A person who puts a case on someone else’s behalf:
‘care managers can become advocates for their clients’
Patient advocates can speak up for those who can’t, or those who are uncomfortable on a number of topics. Patient care comes to my mind first, and there are a number of areas within patient care that may need someone to speak up for them. Providers spend on average 15 minutes with a patient, and if it’s a complex medical problem, you may have more questions than they have time. If you have other specialty physicians the problem is compounded, and then add in pharmaceutical agents and the questions multiply yet again. I once dated a clinical pharmacist. Her job included going to every floor and confirming that doctors orders for meds were accurate, not conflicting with other meds, and appropriate in dose. I was shocked that every day she found at least one error – albeit 20 years ago now.
Another problem patients and families encounter is billing and insurance, and then follow up with visiting nurse services or admission to rehab facilities. Many people and families lack the intimate knowledge of how the complex system of healthcare works, and therefore can be put at risk, overcharged, have incorrect instructions, and a plethora of other issues that can cause havoc well after the pt has recuperated.
I find it unsettling, immoral, and unethical that hospitals have to hire patient advocates in the first place. Shouldn’t the people who are hired do the right thing from the get go? I know that hospital administrations like to keep their profits high which often means closing floors for a low census, keeping nursing staff at the bare minimum, and charging for everything that is ordered no matter if it was used or not. It is deplorable that in this first world country that this exists in my opinion.
I just watched a short video of a well dressed man on crutches carrying several bags “trip and fall”. Nearly everyone came to his aid. The next segment showed the same man, dressed in homeless appearing attire have the same “trip and fall. This time, the only person that came to his aid was another homeless man.
Does this short video reflect the general condition towards humanity? Are patient advocates a necessity? Where have we gone wrong that this dysfunction exists in America? Is it a generation gap? Is it an apathy toward our fellow man? Are we so set on just doing the bare minimums that we can’t go the extra mile for a stranger anymore?
This autumn I met a new friend from Ireland. I asked her if at Christmas there were any Irish traditions I should know about. Her response was: “You light a candle or leave something lit all night so if a passing stranger passes thru they are welcome. Christmas eve has always a light represented outside the house to welcome a lost soul a lost person or anyone that needs a welcome to their home”.
It’s called practicing medicine because no human is perfect, and medicine itself is ever evolving. However, medical errors are the third leading cause of death in the U.S., only exceeded by cancer and heart disease. Here is a link.
Perhaps I am a bit of a hypocrite myself in the years of practicing medicine. We have some patients that call for an ambulance repeatedly, if not on a daily basis, sometimes multiple times during one day. You get irritated, especially when they really don’t need an ambulance. I have been fortunate for having partners that have brought me back to how I was raised and how to treat people. I admit that it can be difficult, the demands of management and the job itself of long hours. But I did sign up for the job, as did the others in health care.
Perhaps I just answered my own question on why we need patient advocates.