Highlights of Life

Being quite familiar with the medical profession, I am more aware and educated than the average patient.   Unfortunately yesterday was a day that tested my abilities in communication skills as well as assertiveness skills when I was on the other side of the desk. 

In general, I think most patients, and especially the immigrant population tend to approach the medical profession with a paternalistic attitude.  “Yes doctor… no doctor… whatever you say doctor” approach makes some patients feel comfortable.  And to some degree, some patients even expect and demand this is the type of relationship with their care providers.

However, as baby boomers age, and people become more educated, this paternalistic model of relating to one’s health care providers is changing.  I think more and more people are demanding to be an active participant in their care plan.  It is becoming more collegial and less paternalistic.  I think you see this shift in relationship as the population becomes more Caucasian, educated or fluent in the English language.  They have more questions, and want to know more.  Personally, I think it is only a good thing when a patient wants and desires to be an active participant in their plan of care.  They are learning to take responsibility for their own health.

Personally for me, I am of the latter group, and prefer to know my options.  I prefer to make an educated choice on my plan of care.  I prefer not to be treated like a child, and told what needs to be done without any rationale or reasoning.  Unfortunately in both Canada and the US, there are still physicians out there still practicing medicine with a paternalistic attitude.  Usually, those are the ones I mentally think, “what a bad doctor” and silently vow to never book another appointment with.

In health care, patients need to realize that they always have a choice.  Unfortunately there are some unscrupulous people out there who blatantly lie and tell the patient there is no choice. 

Here are few examples of what I have seen 2nd hand or noticed occuring, that simply rubs me the wrong way:

1.  1st time pregnancy and labour for a couple.  They are admitted to a teaching hospital for the delivery of the baby.  The couple feels they have no choice in voicing their feelings and unease over a resident (i.e. medical student) delivering their child, while the attending physician looks on (i.e. does other things).  As complications develop in the early stages, things get delayed, as it becomes more of a learning opportunity for the student rather than timely intervention by the health care professional.  Does the couple have the right to say, “we want the attending physician to deliver our child instead of the resident or intern”?

2.  Patient needs to recieve IV antibiotics and the RN is trying establish an IV line.  Unfortunately this is an inexperienced RN, and he/she starts poking and moving the needle around, causing much pain to the patient.  The patient tries to give the RN the benefit of doubt as RN fumbles around.  The first try is unsuccessful.  She is about to try the 2nd time around.  Does the patient have the right to request a different RN to do the procedure, or must the patient wait till the RN tries several more times before it becomes evident to all how incompetent he/she is?

The above situations are not my personal experiences.  However they are stories recanted to me by other people.  Would you believe that in the first situation, the couple waited patiently for the resident to their proper job, all the while having feelings of unease about the whole deal?  Would you believe that the soon to-be father was also a medical student in medical school?  Would you believe that complications arose, and developed to the point where a C-section was required, and it was only at that point that the attending stepped in?

In the 2nd situation, the poor patient felt the RN was incompetent from the get go.  Unfortunately she didn’t speak up until the RN was trying to get an IV line the THRID time around - unsucessfuly I might add.  When a more experienced RN came, she was able to get a line with the first try, with little effort.

What are the patients’ rights?  When can they speak up?  In a good provider-patient relationship, the patient will always feel at ease and comfortable enough to ask questions when it arises.  The patient will feel that they have options and control over their care plan.  They will know they can always speak up, and voice their concerns… and it is always their right to ask for a different health care provider.