Tuesday, February 1, 2011

The Correct Response

I write a lot about what all the crna, my surgeon and the rest of the nursing staff and hospital risk management (OOPS, patient relations) did wrong. For all of the medical types who read this blog, here is what SHOULD HAVE HAPPENED!

Ignoring the facts of what happened to me, beginning with the Versed, and ending with a hospital acquired infection and a second surgery to correct the first. Ignoring all of that because I pretty well have it covered on here, I want to enlighten our medical workers on what would have defused the situation... I am not that different than most people.

First of all when I "awoke" in the PACU already on my feet and creating a danger for myself and everybody else, somebody in a position of authority should have been summoned at once. I should not have been sent a "patient relations" nurse. My complaints and my reaction to being forcibly restrained with a chemical to further more intervention than I had allowed etc. should have been accepted as a legitimate complaint, not glossed over as "standard of care." It isn't a "standard of care" anywhere except maybe at the veterinarians office! There is absolutely NO POINT in antagonizing an already violently aggrieved patient with this kind of nonsense.

I should have had the person in a position of authority in my cubicle chronicling what had happened. There was confusion even among the staff, MY staff, about what had happened and why. I guess they don't have that many patients who 1) tell them what they can and cannot do, and 2) wake up violently angry over their lack of regard for patient rights. Everybody was pretending like they just couldn't understand it. This is the wrong response. Patients need to know that they MATTER! Lying to patients and dismissing their anger is guaranteed to create more anger. The idea that I was so UNWORTHY of good care, honesty and respect regardless of the enormous price tag, was adding fuel to the fire.

The CRNA responsible for the debacle should have been summoned. If he was busy assaulting another patient, then he should have been brought in at the earliest possible moment, so that he could explain himself fully AND to give me the chance to question him about the incident. Preferably before he had the time to make up a story. IE Why did you go ahead with the things I told you not to do? What made you think that I would appreciate Versed? ("I give Versed to all my patients" is NOT an answer when the question is "Why did you give Versed to ME!") Did you think that I would "be happy to wake up and have it all over" when I clearly stated that I wished to remain "awake and alert" and watch the surgery, just like I watched my ORIF femur TWICE? What does the word 'NO' mean to you? I wanted an explanation. Scratch that, I WAS OWED AN EXPLANATION, one that related to me personally, not general platitudes! A tape recorder should have been used while this "interview" was in progress, in order to avoid any misunderstandings or bald faced lies, such as happened with Dr. B's "interview" with me. This should have been a TEAM effort just like the whole incident. My team conspired to treat me without regard, and there should have been a team of authority figures to grill my team. This type of immediate response would have at least made me think that things would be different!

Make no mistake, no amount of passing the buck, telling me that everybody gets Versed, telling me that my DOCTOR wanted this, telling me that it's standard of care, backpedaling, ridiculing me etc. was going to make it better. All this is designed to inflame an already angry patient. Can you see that? Telling me that I asked for it by seeking help is just like telling me that tight jeans are a reason for rape. Its just a man thing, they do that to all their women etc. Nope, wrong is wrong and they were WRONG to treat me like that. NO EXCUSES! My issues with my treatment are VALID and should have been treated as valid.

The people responsible for my debacle reflect badly on the medical center AND on health care workers everywhere. Can you see why this is? Having health care workers sneer at me, accuse me of mental incompetence etc. doesn't help. Why would you think that talk such as this would be calming for an irate patient? Don't try to minimize the event in any way! Take ownership of it and at least pretend that steps will be taken so that this will never happen again.

Chastise those responsible for the event. As far as I know NONE of the people responsible for my debacle knew one thing about it! They all felt they got away with assaulting me. They were fine with it, and there are no repercussions are there? I wanted to see and hear my team being called on the carpet. This would have mollified me somewhat. At the time I was unaware of the poorly done surgical part and the kidney infection I got from them.

I also asked for an adjustment to my bill to reflect the fact that most of the expense was incurred because of the egregious departure from my wishes and consent. This should have been available to me. I should NOT have been billed 800+ dollars for the CRNA who attacked me without a second thought. All those charges for "levels of care?" Gone. The charges for the drugs, other than the Fentanyl, Zofran, antibiotic and lidocaine, gone. The charges for "general anesthetic" gone. Oddly they charged me 280 dollars for writing "general anesthetic" on my chart. That shouldn't have been there in the first place. Do you have any IDEA how infuriating it is to be expected to bankrupt yourself to pay for things you never wanted and had declined? Another thing that patients, already angry, should not be subjected to is the cost associated with the deviation from patient authorized intervention. I didn't ask for any of this and I shouldn't be expected to pay for it. It's insulting! This, if done immediately, would have further defused the situation.

As far as the hospital acquired infection goes... This is not something that should have happened either. With the surgery performed as I wanted (which is actually the PREFERRED method) I would never have had a catheter in the first place. If the hospital staff had the slightest regard for patient safety this wouldn't have happened. The hospital should have reimbursed me for the expenses of treating this infection. What they should NOT have done, is claim that I never had a catheter at all, especially as they KNEW I was in possession of medical records which stated otherwise. Expressing dismay, that this happened to me and assuring me that they were going to have a staff meeting on the importance of hand washing would have gone a long way towards ameliorating the situation.

My surgeon was also in on this. He should have been at my side during the preop interviews instructing my team, reinforcing my wishes and explaining the surgery in detail. It's the law. Don't show such disregard for the patient as to appear 1 1/2 hours late, far too late to explain anything... And far to late to prevent me from being drugged against my will. I wanted my surgeon to be POSSESSIVE over me, as in, "this is MY patient and she will be treated with respect." However, my surgeon had even more disrespect for me than the rest of my team. On top of everything else that happened in that chamber of horror called a hospital, the last thing I needed was shoddy workmanship! I was in a state of panic, bankrupt, suffering from hospital acquired PTSD, kidney infection etc. and then I find that my hand is completely numb and unusable. Screws are sticking out into the tendons, and I can feel those tendons snapping back and forth over the screws. Shooting pains up my arm from the underside of my wrist closest to the Ulna from yet another screw improperly tightened, the incision through the tendons, and my Dr., instead of expressing alarm, or sorrow, tells me that it's just fine and fires me. Wrong answer. Can you see how this would be upsetting? He didn't bother to tell me that these were side effects of the surgery ahead of time, and then he denied them afterward. He should have APOLOGIZED! Some alarm would have been nice and an offer to correct it free of charge, or at least not charge me for the original surgery. He knew that it couldn't stay that way without serious repercussions, even if he wouldn't admit it! As an aside, there is no way I would trust this person to operate again, especially since he threatened me with Versed and g/a at this point. This is not the way to treat a patient. He should have threatened me with Versed and g/a during our "consultation." That way I wouldn't have had the surgery... Using this kind of threat on an already distraught patient doesn't help the situation at all.

To sum it up, here are the tools to alleviate a bad situation from a patients perspective, after the fact... 1) Own up to the situation. Don't make excuses or try to defend the indefensible. Don't blame the patient or minimize what happened in any way. It's unprofessional and inflammatory.
2) Get upper management involved to show the patient that this is NOT business as usual and to prevent the appearance of CYA machinations. Bring in the responsible parties ASAP for an interview in the presence of the patient. Use a tape recorder so that there is no (further) misunderstanding. Give the patient a copy.
3) Assure the patient that this behavior will not be tolerated in the establishment and that the miscreants will be dealt with severely. Tell the patient what changes in hospital policy will be implemented due to this incident. If you are really good at this, you can THANK THE PATIENT for bringing this to the attention of management.
4) Adjust the bill or forgive it completely with apologies. If the patient needs further medical attention as a direct result of the incident, offer to help pay for it. Whether it's treatment for a hospital acquired infection, additional surgery or counseling, offer to help! Just suggesting a different Dr. to consult with would be welcomed by a freaked out patient! Even if the patient decides to sue later, this will go a long ways to impress the judge or jury of your intentions...
5) Do NOT leave the angry, frustrated and upset patient alone to stew in their own juices. Believe me, ignoring the situation and/or making light of it is not the way to go. Personal calls, e-mails, just the appearance of caring can help a patient "get over it." If you can get each member of the team, from the OR nurse who failed to advocate for the patient, to the crna and his/her supervisor to apologise that will be helpful. It is not an admission of guilt per se! It's an admission that the system failed and that the patient wasn't treated in a way that they wanted and expected. Everybody has to say they are sorry, it was inexcusable, and it won't happen again at some point in their lives. Even if it is readily apparent to the patient that these people AREN'T sorry, just the fact that THEY were forced into something they didn't want is like payback! Do you get it? Patients want to feel empowered again after an incident like mine. They want to feel that there will be justice, and that this won't keep on happening.

Saying "We're sorry you are upset" isn't the same as saying "We are sorry this happened to you and we are taking steps to make sure it never happens again!" The first is an insult and the latter is an exhibition of patient care. If your goal is patient care and satisfaction these simple steps I have outlined will probably keep you out of court. They would also have prevented ME from sitting here at my computer and tar-and-feathering the whole medical community!


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