A few weeks ago I wrote about our improvement in patient satisfaction scores ("Better Care"). Our people have really been working hard to deliver wonderful care to those we serve and their families.
I am so grateful for how hard our physicians, nurses, other clinicians, and support staff are working. But recently I have gotten some feedback from staff that they are concerned that patients and their families are “getting their way” because of our desire to improve patient satisfaction. At least one person suggested that a test had been ordered when the clinicians knew that it would not help the patient but they ordered it anyway, for fear that the patient would be upset.
I know some people think that my response to this is trite but I am going to say it anyway: “What if it was your daughter?” If it were your daughter, you would not want her to get something where the evidence showed that it was not in her best interest. On the other hand, you would want your daughter to “get her way” if she were talking about comfort, respect, companionship, or anything that made her experience of the care better. It’s true; we want our patient satisfaction scores to be as high as we can get them. It is our duty to do this because that is what we would want for ourselves and our loved ones.
Another thing that I heard as an example of “patients getting their way” is that we are “letting a patient have 5 visitors at a time when our rule is 2”. What is the correct number of visitors at a patient’s bedside? I believe that the correct number is the number that the patient wants…..within reason. Sure, if the room is full so that the caregivers can’t do their work, or if they are disturbing others or if a visitor is clearly sick, we need to act to remove some visitors. We need to do this because of our commitment to improving the patient’s health.
I am concerned that talk about patients “getting their way” is really about some of us having a hard time letting go of a paternalistic view of care-giving. I believe that the patient is in charge until the patient is asking me to do something that I know is not in his or her best interest because of the evidence; or if the patient is requesting something that prevents us from accommodating our other patients.
So, we should start from the premise that we want the patient to “get his way” until we know that we can’t or we shouldn’t. It is impossible to get to our vision of everyone, every time getting the care that we would want for our own loved ones if we don’t.
What do you think?