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Saturday, February 26, 2011

It's all about the patient.

A few months ago, I came across a text of a speech that was meant for the 2010 class graduating from Yale School of Medicine. I was intrigued to find out if the speech was in touch with the reality of every-day hospital life or if it was suited for the naiive, fresh-out-of-college young adults only. The speech pleasantly surprised me.
The speech that Doctor Berwick gave to the Yale Medical School graduating class was inspiring, sincere, and relevant to every practitioner. As I was reading the message, I felt as if Dr. Berwick was addressing his speech to me as well. I was especially touched by Don Berwick’s message, because I believe in patient-centered care; I believe that “all that matters is a person”.
Most of the hospitals have agreed on importance of involving family in patient care. Families are allowed to visit patients in an ICU, encouraged to spend time with the loved ones to help them recover. I think that this involvement should not be limited only to letting the family stay with their loved ones during procedures or preparing fold-out couches for those staying overnight. I think we all need to make an attempt to get to know our patients as people who have a life outside the hospital bed and gown. It is so easy to ask, “Who drew that Get-Well Card for you, Mrs. Jones?” to get Mrs. Jones to talk about her grandchildren, and put her at ease.
I am very lucky to work in the department where I take care of patients one at a time, because it gives me a marvelous opportunity to have conversations with them. Parts of the conversations include follow up care or description of image-guided procedure that we will be performing. Other parts are always about the patient. I ask non-intrusive questions about how they spent their holidays, or what their kids do for a living. As a result, I learn the most amazing life stories, and the patients learn to trust me. Moreover, if I know about the patients’ lifestyle, their hobbies and support systems, I can individualize their care.
In an idealized situation, finding a personal approach to each and every patient can easily be accomplished. Unfortunately, the society that lets practitioners “write rules and build walls” demands the same practitioners to treat a high volume of patients and comply with endless standards. An overworked telemetry nurse would gladly sit down and converse with Mr. Artist about his latest exhibition, but she is expected to finish a five-page admission on one patient, transfuse the second, update the family of the third, notify a physician about a change in reason on the fourth, and attend to the dying fifth… Does being task-oriented make this nurse a bad one? A med-surg nurse asks the family of her very ill patient to leave the room after ten o’clock at night, because the hospital is full and no private rooms are available to accommodate the patient and the family. The room-mate of a patient who is less sick, needs to sleep. Does this action make the nurse heartless? Increasing health care costs and high patient to practitioner ratios place constraints on health care workers.
In conclusion, I would like to note that I enjoyed Dr. Berwick’s speech greatly, and I think that we should treat our patients with respect, recognize their personal preferences and place the patient in the center of care. At the same time, I think the current state of health care does not always allow physicians and other health care workers to be as personal as they can and want to be.

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