Wednesday, April 11, 2007

sympathy vs empathy

I know some medical bloggers like to discuss medical cases in detail but I like to think about how we deal with patients as people first.
I am as guilty as anyone in labeling patients by their diagnosis but I think on the whole I remember them by personality too. The majority of my patients aren't very nice. They have a very real excuse for being less than good company. They are deeply afraid of everything and I don't blame them.
We fail patients because we fail to educate them. Doctors gloss over the risks.
Hasn't everyone heard the risk of anesthesia speech? The bleeding, stroke, death speech done so quickly you aren't sure you heard it. Then the "oh, don't worry, the risk is only 1%". What does that really mean anyway? The doc says nothing about the pain. They always say it's not bad, hell I have had some surgeons tell patients they won't have any pain at all!
So, the patient wakes up and it hurts. They are terrified cause the doc said it wouldn't hurt but it does so obviously this means they are going to die, immediately. Cue the howling and whining.
This is where I get irritated.
I have been a patient, more than once. I have woke from anesthesia and been in pain. I have never called my nurse a bitch and screamed for the doctor.
Back when I still thought I was super nurse I would try to settle these patients with pain medications and soft words. Now I call the doctor. He makes more than I do, let him get screamed at.
What is endlessly fascinating is the personality change when the doc enters the room. Suddenly the shy grin and the apology for causing trouble. Then the vicious slander shot the nurses way. Always we are incompetent or stupid. I can't tell you how many times an ------- has insulted me so badly I considered litigation.
There are ethnic groups that when they become patients ratchet up the entitlement game to terrifying levels. ------- are the scariest of the bunch. The patient is demanding and rude but the family is always aggressive to the point of threatening and they always hate the nurses and take every opportunity to insult the staff when the doctor is anywhere near.
I wish I could say this is an over generalization but in all my years of nursing I have never had a good experience with an -------- family. I am sure they are fine people outside the doors of the hospital because I know lots of -------. In day to day life you would never, ever suspect what terrors they are capable of.
--------- will actually announce their refusal to open doors or answer phones and will demand that the nurses wander the hospital opening doors as they breeze through them, they eat meals we prepare because they want dinner when they come to visit Grandma . When did this become the nurses problem?
Why should I have to leave the bedside of a critically ill ventilator dependent patient because of some bizarre ritual that is a complete contradiction. If it is somehow illegal for you to drive or use "technology" once a week or all the time why is it just fine to keep your 98 year old great grandmother hooked to a ventilator and a dialysis machine?. Isn't it a bit hypocritical? If this ritual is so damn important maybe we should turn off Grandma's vent over night too. I say if the patient is dependent on that evil technology you can open your own damn door okay?
This is what entitlement creates.
The moment someone said I need you to kow tow to my obscure religious practices we should have said NO.
Nurses and Doctors are busy. We are busy trying to keep people alive.
Listen, if we had one nurse for every two patients? I would say hey! weird religious OCD? No problem. Let me get that door for you but in the real world nurses can have six patients at a time, when their partner has lunch they have twelve patients. The ---- solution is don't let nurses eat. I am not kidding, we have actual complaints about nurses having the gall to go for lunch. Fuck that, I deserve lunch.
It may seem like I am picking on one group but there are a bunch more.
----- families that take over the waiting room wailing and eating huge picnic lunches and acting like it's a family reunion. When restricted to immediate family suddenly the patient has thirty four children, some older that they are. House is right, patients lie, families lie.
The ------ family, oh dear God... always the ex-wife, the new wife and the girlfriend. The children that hate the patient but love the potential drama of all those wives.
I have actually created a visiting timetable to prevent bloodshed. The patient is always an over friendly bear of a guy full of obscene jokes but still funny. A kind guy, you know but not that bright. I guess some women just like the type.
I know patients want us to see them as the individuals they are but what they don't understand is they aren't that special. Everyone belongs to a group. Their behaviour can be predicted because we have seen these groups over and over again.
That is not a bad thing.
It is very helpful to me. I can predict how you are going to behave and I can tailor my care to this. If I know you are an entitlement freak that demands everyone do everything they are told "right now bitch" I am prepared. I used to be shocked, insulted, now I laugh and call the surgeon and hand the family the phone. Let the docs handle them. They hate nurses anyway so get out of the way. It costs you nothing and sometimes it gets the family off your back for ten minutes.

About five percent of my patients make the job worthwhile. They are patient. They speak up right away when something is bothering them instead of stewing for hours until their family gets there and then bursting into tears announcing "that bitch nurse has been trying to kill me". My favorite patients are of course the ones that just want to get on with it. They accept that this whole thing is going to be uncomfortable and upsetting but they suck it up.
They have educated themselves before being operated on so they understand what the process is.

You could skip educating yourself about your illness if you brought kindness and etiquette...I would be willing to help you out if you asked nicely.

You can fill in the blanks yourself, you will be wrong though.


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