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Toni Talks about PT Today

The Squeaky Patient Gets the Oil

Published March 20, 2008 9:58 AM by Toni Patt
There's an old saying that says "the squeaky wheel will get the oil."  I think a similar saying exists in health care. It says "the patient who complains the loudest gets the most attention." I've never seen it fail. As soon as a patient starts complaining, everyone will bend over backwards to make that complainer happy. It doesn't matter how ridiculous the problem is. It doesn't matter if the resolution comes at the expense of staff. The patient must be happy. The universal rule for health care used to be "do no harm." Now it seems to be "never say no to a patient."

Physical therapy is no different. I had one of those patients today. I needed to change her VAC. I've done this many times without incident. I knew I was in trouble the minute I walked into the room. She wanted to know where "W," the other therapist, was. Nothing I did made her happy including completely removing and reapplying the entire VAC set up. As soon as I left the room, she was on the phone to the rehab manger complaining about me and how she never wanted me in the room again. In an ideal world, the manager would apologize to the patient and stand up for the therapist. In this situation, the manager sent a tech in to switch the VAC once again. Naturally, the patient was happy. I was happy I didn't have to deal with her. 

There was no therapeutic reason for that VAC to have been changed so many times. It was functioning properly the first time I put it on. The problem was I didn't put it on like "W."  My inclination was to tell her "I'm sorry, W is out. The VAC is working properly. When he gets back tomorrow he can take a look at it."  Obviously, that could never happen.  Not only would saying that be common sense, it would be telling a patient "no." When did it become wrong to tell a patient "no"?

I don't understand this. Telling someone no to an unreasonable request isn't a bad thing. Patients are always asking to be seen at  a specific time. We tell them the best we can do is a.m. or p.m. Any therapist knows it's impossible to follow a tight time schedule. But let administration hear the request and that patient will have treatment scheduled every day at a specific time. It seems like the more difficult the patient, the more effort is devoted to making that individual happy, usually at the expense of other patients. This frustrates staff to no end. When someone is resorting to attention-seeking behavior, the best response is to ignore the behavior.  When it doesn't work the behavior will stop.

What's the worst that can happen if a patient is unhappy, assuming all medical and ethical issues are being appropriately addressed? The worst case scenario is the patient leaves the facility. I say let them go. In fact, offer to hold the elevator for them so they can leave that much faster. I don't think anyone will go bankrupt because an unhappy patient decided to leave. The morale boost to the staff is more than worth the action. Too bad administration never sees it that way. When I was a manager I dared to say no. Each time there was a good reason. Each time I was constantly pestered and occasionally badgered to relent and let the patient have whatever was at issue. At times it got ugly. Ask yourself, "What could rehab offer that would make such a difference to someone?" Other than treatment itself, I can't think of anything. I often wonder what those people do when they don't get their way outside of the hospital. It can't be pretty. Until someone comes to their senses, we will have to continue to oil the squeaky patient and bite our tongues. 


I respect your candidness of what happens everywhere.  In schools, healthcare, etc.  So important to name the problem if it repeats itself with a patient, this is where the healthcare team must decide its individualized approach for that person.  Healthcare delivery must continue to be consensus building, but not at the expense of wasting staff time or respect for clinician's opinions.  

Betsy Daniels April 22, 2008 12:30 PM

yes, lots of this going on.  One place bought KFC for a patient because they did not like the meal served.  

Like society as a whole we will "give in" to a small group of unhappy folks.  

Lets switch for a moment.  You become unhappy with a company.  For public relations they will probally do what you want or else you will blog about the situation and a lot of people will read it.  

Is it fair?  But you got what you want, your happy, you will blog beautiful things about the company.  Public relations.

jason, PTA March 29, 2008 1:37 PM

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