Recently there was article being linked to on Facebook by a few of my coworkers titled “Patient Satisfaction is Overrated” written by Dr. William Sonnenberg. Here’s a link to the article. A few years ago we were called to staff meeting and some changes being made to how Medicare reimburses hospitals and doctors were explained to us. Basically, Medicare is now holding back a portion of what they would normally pay to a hospital or physician for a certain hospital stay or procedure. The hospital or doctor can then earn back that percentage of payment by having high/good patient satisfaction scores. The reasoning is that Medicare wants hospitals and physicians to provide not just mediocre, decent care but quality care. They want health care providers to not just do their job, but to do it well. I can understand that reasoning and in theory completely agree. Hospitals and doctors who skate by and provide just the minimum level of quality of care considered adequate should be told they need to improve. But as with many theories, putting it into practice has a few problems. The biggest ones were hit on perfectly by the author of this article. By being essentially forced to bend over backwards to give the patient exactly what they want and keep them happy, we’re not always giving them the best care we can. Sometimes not even the appropriate care they need, in the case of overprescribing antibiotics when they’re not necessary. It ends up putting the emphasis in the wrong place. It takes the emphasis away from patient teaching and preventative medicine and places it on what amounts to customer satisfaction. While listening to our patients and their needs is definitely a positive thing, making what they think they want and are asking for such a priority is not. It ends up creating frustration in doctors, nurses, and others directly involved in patient care. I’ve seen changes come and go over my years as a nurse. I hope this change goes… the sooner the better.
I first wrote this post on the 5th anniversary of the terrorist attacks on September 11, 2001. I’m reposting it today on the 10th anniversary.
I think every decade or two has an event occur in history that is so momentous that virtually anyone who was alive during that time can tell you exactly where they were when they heard that news. The terrorist attacks on September 11, 2001 were that event in history for the current decade.
I was at work at approximately 6:30 that morning PST in a hospital in Spokane, Washington. I was walking down the hall and glanced into a patient’s room and noticed our charge nurse standing there staring at the television with a stunned expression on her face. This is a nurse who has 30 plus years of experience dealing with life and death situations every day. The fact that whatever was unfolding was stunning her scared me before I even knew what was unfolding. I glanced up at the tv in time to see the second tower of the World Trade Center crash to the ground. As I heard that this was the second tower to fall the charge nurse and I glanced at each other and almost at the same time said “This was no accident.” The patient grabbed my hand and all three of us in the room had tears either in our eyes or streaming down our cheeks. The last hour of that shift until I got off work at 7:30 was the quietest and most somber I’d ever seen the floor I worked on. Staff were concerned about a co-worker of ours who was due to fly back from Boston that morning. Some patients had family and friends in the NYC area and were frantically trying unsuccessfully to reach them. As the day shift staff came in it was apparent right away many of them had been crying recently. At least one staff member was crying as she said she’d tried to reach our co-worker stuck in Boston for the past hour and not been able to reach her cellular phone. All of us expressed feelings of shock and sadness. More that one of us used the word surreal to describe how the whole situation felt. As I left work that morning the news announcer on the radio was announcing it was just becoming clear just how many people were presumed to be dead. I drove home with tears streaming down my face.
Later that morning my mother and I drove to Airway Heights, Washington near Fairchild Air Force Base. The base was locked down, of course. We were approximately three or four miles from the base entrance and within a five minute span saw no less than six local police patrol cars. The fact that the perimeter of the base was being patrolled so closely really made it seem more real to me because that hit so close to home. I went home and cried myself to sleep. I can’t think of a single day in my life when I have shed so many tears in one day. Each year on September 11 I can’t help but remember exactly where I was and how I felt when I heard the tragic news. I imagine that I, like many, many others, will continue to remember that for a very long time.
I came across this news article this evening that at first I was sure had to be hoax. So I did some quick searching and it only took me a moment to find it on a reputable news site (MSNBC). Here is the link to it.
In a nutshell, a 24 yr old Dutch nurse was asked to provide services of a sexual nature for her 42 yr old male disabled patient. She refused, and the patient had the woman fired from his care. The nurses union got involved and has started a nationwide campaign against the practice of patients demanding sexual favors from nurses. There are apparently a number of these patients who claim it is within the standard of care for nurses to provide these services. Oh, but I’m quite sure it is NOT part of the standard of care, and that is just the stance that the nurses union is taking. We, nurses, are NOT prostitutes. What we ARE is professional, educated health care team members. And I can’t believe in this day and age, the public needs to be reminded of that fact… no matter what country you live in. To think that we as nurses are responsible for providing sexual services to our patients is demeaning and insulting. It essentially says we are nothing but prostitutes, who provide those services for pay. I don’t know a single fellow nurse who would at all be ok with being seen this way or treated this way. It’s absurd to me that this topic even needs to be discussed. Helping a patient gain sexual satisfaction is so far across any line of professionalism that it shouldn’t need to even be discussed. It is so incredibly inappropriate that I’m astounded it goes on. But according to the young lady who was fired from this particular patient’s care, it does happen. The news article states that she witnessed “some” of the patients other nurses providing these services to him. I don’t know how many others she witnessed or in what manner they were doing this, but neither of those things are important. What’s important is that this inappropriate, unprofessional and flat out wrong behavior happened. Wow. Apparently, according to the nurses union, the police are now investigating. I’m happy to hear that. So… feel free to add your thoughts and comments. Always happy to hear from my fellow bloggers.
I came across this news story this morning and must say, I’m very much on the fence about what I think. In a nutshell, a brother and sister in their 30s came to the U.S. from their native Argentina on tourist visas in the 1990s. They settled into a nice American Dream life, opening a cafe and volunteering with the local fire department and police department. The problem is, they did not stay in the U.S. legally after their tourist visas were expired. They stayed as what the article refers to as “undocumented” immigrants. Some of us refer to that as an illegal immigrant. In 2005 the sister confessed their status to a friend who was a local police officer. She knew this police officer from her volunteer work as an interpreter for the police department. The police officer helped set up a meeting between the brother, sister, and a person from the U.S. Immigration and Customs Enforcement Agency (ICE). As a result of that meeting, the two were to be given special visas making their status in the U.S. permanent and legal in exchange for the brother and sister helping ICE as undercover informants. The two cooperated from the beginning and were asked initially to do just simple work. The things asked of them began to get more and more dangerous and they began to fear for their lives as this happened. But they continued to the best of their abilities. Eventually ICE felt the information the duo were obtaining wasn’t enough and they were no longer useful as informants. Relieved, the two went on with their lives. Until May 2009, over 4 years after the initial arrangement was made with ICE. Then ICE began to threaten to deport them. In November 2009 the brother was actually taken to jail in handcuffs being told his informant status was lost and the special visa he’d been given no longer valid. They are both still in the U.S. but after that, their work as informants was effectively public knowledge in the community.
I’m torn about this situation. On the one hand, they were in the U.S. illegally. By definition, that means they were breaking laws. But on the other hand, a government agency did make them certain promises and arrangements that they later backed out on. The actions of that government agency put the two in danger. I can’t decide just how I feel about this. What are your thoughts?
HERE is a link the news story.
Recently in Florida a 23-year-old young woman was murdered by a man who had been stalking her for at least two years. A week before her stalker murdered her, Alissa Blanton had been in court requesting an order of protection against him and the presiding judge denied her request. The stalker, Roger Troy, arrived at her place of employment armed and pretty obviously intent on harming Ms. Blanton. After shooting her a several times, he used the same firearm to kill himself. Realistically, the order of protection wouldn’t have been worth the paper it was printed on if Mr. Troy was determined to kill Ms. Blanton. But it is sad that the judge didn’t feel that stalker was dangerous enough to grant the order of protection. In one news article it states that the judge “had not been able to determine whether Troy’s actions met the legal definition of stalking.” But Ms. Blanton actually quit her job and moved out-of-town to get away from him. He continued to e-mail her threatening e mails and show up at her new place of work. I’m not sure how there’s any question about whether that’s stalking or not. I wouldn’t go as far as to say the judge in question is responsible for her death. As I said earlier, an order of protection most likely wouldn’t have stopped Mr. Troy’s actions. But I don’t think it shows very good judgment to have denied that request. And apparently others agree with me, since the judge is now under review by the Judicial Qualifications Commission. Just a tragic, sad story all around. Ms. Blanton had reported the stalking and documented it and requested an order of protection. She’d removed herself from the environment where she first met her stalker and moved away and changed jobs. She’d taken all the right actions to end the stalking only to ultimately die at her stalker’s hands. At only 23 years old. It breaks my heart for her family. Here is a link to the news article I quoted above. AOL news story Feel free to share your comments and thoughts below.
In a town where I lived for greater than 20 years, a criminally insane murderer recently escaped from a state mental hospital while out on a field trip to the county fair. My first thought on hearing this news was “A field trip? Really? C’mon, we’re not in third grade here, people.” Apparently patients at the state mental hospital are routinely taken on fairly well supervised field trips as a way to integrate them back into society. While I agree with that reasoning and it may be appropriate for some patients, I wholeheartedly disagree that it’s in any way appropriate for a violent murderer who is still presumably unstable enough to be discharged from that state mental facility to be out on a field trip. And it’s especially not appropriate for them to be out in a crowd like that filled with children. And apparently I’m not the only one who thinks it’s not really the greatest idea to have this happening. There are news reports that employees of the state mental hospital told administration they had concerns about the type of patients being allowed to go on these field trips. Rules and regulations about this had not been changed, however. There are also news reports that employees supervising the field trip noticed within moments this man’s escape, but it took up to two hours for administration at the hospital to notify law enforcement officials. If that is actually true, it’s inexcusable. As a nurse, I totally understand that a hospital employee’s first priority is patient safety and doing what’s best for the patient. Those concepts drive all patient care. But in this unique setting of a mental hospital where the patients often have a higher than normal propensity for violence, there is public safety to take into account, as well. I’m sure at times it must be difficult to balance the two. But in this case, it seems to me there was a breakdown along the line that lead to the public being put at risk. And that needs to be corrected. Immediately. I have no doubt that by the time the investigation into just how and why this happened is done, some heads are going to roll. Many members of the community are understandably pretty angry about the situation and going to demand some answers. A spokesperson for the state mental facility has said this man is stable on his psych meds for another two weeks. That’s all well and good, but what happens after that time? It’s highly unlikely he has a supply of his meds with him to continue taking. And even if he does have a supply with his, making sure he takes them correctly isn’t really going to be a top priority for him. Are they banking on the fact they’ll find him before the two weeks are up and he decompensates and becomes even more unstable and potentially violent? Are they willing to stake the safety of an entire city on that? That seems like an awfully big risk to be taking.
The patient has been found and is back at the mental hospital without any injury to anyone.
A 32 year old man from Seoul has been fined just over $2,400 for trying to steal a kiss from his 27 year old date… while he thought she was hypnotized. Uh huh. Apparently the man isn’t quite the hypnotist he thinks he is and his date, a woman he was set up with through a matchmaking service, wasn’t really hypnotized. She accused him of sexually harassing her. The article I read on msnbc.com (found here) didn’t mention anything else the man did other than attempt to steal a kiss. It doesn’t even say he was successful at that. So I fail to see just how what he did was worth fining him over $2,000. Sure, if I were the woman I wouldn’t return any further calls from him or ever date him again, but, really? Over $2,000? That just seems a little excessive, unless there was more to his actions that the article didn’t go into.
I just read an article that made me wonder just how some people can do things in such poor taste. I swear some people don’t have a single bit of thought to how their actions or words may come across to others. Or maybe they do, and they do the things they do for shock value. Anyway, Mary Kay Letourneau is hosting a “Hot Teacher Night” at a Seattle area bar this weekend. She’ll be hosting, her husband will be the deejay. For those of you not familiar with the names, Mary Kay was a teacher who went to prison for about 7 and a half years when she had a highly inappropriate with a student of hers. It was a physical relationship when the student was 12 years old and she was 34. The two have two children together and married a year after she was released from prison. Is it just me, or does this hosting this Hot Teacher Night seem as though they’re making light of the situation, maybe exploiting it for attention? And I find that highly inappropriate and distasteful. I’m by no means prudish or uptight, but flaunting the situation like that just crosses a line, I think. And your thoughts?
I read a news article recently about a study conducted by the National Institutes of Health regarding weight loss. They proclaimed the “key” to weight loss is… wait for it… here it comes… cutting calories and getting exercise! Well, DUH! I’ve said for years now that weight loss isn’t magic. It boils down to simple math. Burn more calories than you take in. And now a study conducted by a reputable organization has proven me right. Don’t I feel special? The part I find most laughable (or sad, maybe… pick one) is that grant money was spent and time spent to determine a “key” to weight loss that is simply common sense. Does this seem like a waste of resources to anyone other than me? Let’s research a cure for cancer or diabetes, or research ways to clean our environment and keep it that way. Those would be more worthy causes to use the resources on. Sure, obesity is a huge problem in our society. (Yes, pun fully intended.) It costs us hundreds of thousands of health care dollars to care for the many chronic health issues associated with obesity. I’m not diminishing the severity of the issue. I’m just saying it’s pretty much common sense to figure out that eating less and getting more exercise is going to take bring weight off. Yet someone felt the need to spend who knows how much money and manpower proving this? That just seems like reinventing the wheel… in other words, completely unnecessary.
I have no clue what my deal is with blogging about sad news stories lately… My life is going very well and I’m happier than I’ve been in a while. I guess it’s just the abundance of those tragic news stories out there. Anyway, this 16 year old boy in California was recently found in just just boxer briefs with a shackle on his ankle and covered in soot and looking very emaciated. He had escaped from the home where he had been kept captive for approximately a year and walked into a gym in search of help. The couple who kept him against his will are in jail and charged with multiple felony counts. They beat his knees with a baseball bat and burned him with a metal baseball bat heated in a fireplace. As the story unfolds, he came to their home by way of his aunt who had legal custody of him. It turns out she had been given legal custody because his father had been found guilty of beating him! What tragic irony that he’d been removed from one abusive situation only to find himself in another living hell. I can only hope someone realizes how important some professional mental health help is going to be to this boy in his future. Not one but a total of four adults he should have been able to trust to protect him abused him in horrible ways. There’s no way that can’t leave some serious psychological scars.