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PT and the Greater Good

Have You Walked in Their Shoes?

Published September 6, 2011 5:24 PM by Dean Metz

I posted a few weeks back about qualitative outcomes versus quantitative outcomes. This was in response to an unsettling trend I'm observing here in the UK - that the patient is always right, no matter what. The NHS seems to be abandoning clinical outcomes for warm and fuzzy responses from patients.

Granted, we want patients to be satisfied with their service and we want to treat them with the utmost respect. There are times though when patients are better served by understanding and accepting boundaries. One of the most critical of those times is the distribution of medications by nursing. I got into a discussion this week with doctors, nurses and PTs alike when I presented this article from the BBC about a controversial practice in Kent.

Doctors and PTs thought the vests were a horrible idea, offensive, and right to be removed. Nurses thought they were actually a good idea. Why the difference? Nurses know firsthand how difficult the task of med pours (drug rounds) can be. I know it from shadowing nurses in New York and seeing the complexity of the task.

Doctors and PTs referred to it as "handing out meds." They didn't understand that having responsibility for a whole ward's medications included accounting for every med distributed, ensuring the right pill gets into the right cup and that the right cup gets to the right patient. Imagine being responsible for 15-20 people who are each on multiple medications with varying allergies and daily changes to the routine. It is a tedious and complex task; one distraction could mean that Mrs. Smith gets Mrs. Jones' penicillin (which she is allergic to).

The Institute of Medicine gives a brilliant overview of the problem in the USA. The problem in the UK is no less severe.

 Why am I going on about a "nursing" issue? I recall one of my bloggers writing about non-therapists wondering what therapists were doing with a patient by just sitting on a mat, playing with a ball or standing still in the parallel bars? They didn't understand sitting balance training or weight-bearing to facilitate co-contraction of muscles. To some outsiders, what we do can be erroneously viewed as meaningless or easy. It would be wrong to have those people make policy.

Kent reported 600 medical errors that occurred during medication rounds, which is why they acquired the vests that said, "Do not disturb, drug rounds in progress." Joyce Robbins from Patient Concern, a group instrumental in affecting policy here in the UK, states, "It gives out the wrong message, it's not meant to do this but it actually says ‘don't bother me, I'm too important.' To which I respond, "Actually Ms. Robbins, it says ‘don't bother me because you, the patient, are too important.'"

1 comments

Agree, that is exactly what it says.  It emphasizes the patient's welfare.

There is a balance that is tricky to reach.  While you can point to patient's rights interfering with quality care in the UK, I have two examples within two days of US doctor's egos taking precedence and impeding quality care.  

Really, I suppose it is also ego that stumps us up with the "patient always being right".  Whether we are talking about the doctor or the patient, we are placing more importance on catering to someone's ego than we are on providing quality care.  

Somehow we need to figure out a way to separate "treatment" from "ego".  Then we can retire wealthy!

Janey Goude September 8, 2011 2:19 AM

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About this Blog


    Dean Metz
    Occupation: Staff Development Specialist
    Setting: New York, NY – Newcastle Upon Tyne, Great Britain
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