Barnes & Noble Review
September 23, 2015
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September 18, 2015
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A few years ago at a meeting of the ad hoc ethics committee at my hospital, we were discussing the issues that arise when treating obese patients. Someone brought up the case of an ICU patient, a young woman who weighed 500 pounds. The ICU nurses complained, sometimes loudly, every time she needed to be moved. Their grousing appalled our chief medical ethicist, but I understood the nurses’ reactions. They likely feared incurring a serious injury from lifting such a heavy patient. This conundrum—how do nurses safely provide high-quality care for people who are obese—will become ever more relevant as the prevalence of obesity in the United States continues to rise.
I am a home hospice nurse, and when I get new patients after they have been discharged from the hospital, the list of drugs included in their paperwork is always wrong. Some mistakes are minor: The list includes a relatively harmless drug the patient no longer needs or it leaves off a minor dose adjustment. But other mistakes are more serious — the list may include an important prescription the patient never knew to fill or may have the patient on two medications that can be dangerous when taken together.
I felt her arms around me, firm and strong. 'This is treatable,' she said, soothing my fear. 'They can cure this'
The diagnosis of cancer, when it comes, is like having a bucket of icy cold water thrown hard into your face. Fine one minute, in the next the vision blurs from the smack of fluid, and the pain from the cold is so sharp the skin feels pierced. There’s a sense of injury, the asking of why, the realization that this unbearable soaking wetness defines the new normal of one’s life.
Most nurses probably don't know enough about the economics of health care and health care policymaking in this country. The idea that the provision of health care occurs within a complex political and economic system barely comes up in nursing schools—even though health care costs make up roughly one-sixth of the U.S. economy, and the public–private system under which health care is financed and provided drives many policy decisions.
October is Breast Cancer Awareness Month, and I have breast cancer. The country is fully pinked out in support of breast cancer screening and research, and though I know all the pink is meant to make me feel good, to tell me that the entire country has my back, I actually find it profoundly alienating. Pink is not a serious color, though cancer is a very serious disease. Pink is about femininity; cancer is about staying alive.
“The conversation between doctor and patient… should be viewed as the single most important tool of medical care,” Danielle Ofri says at the end of her new book, What Patients Say, What Doctors Hear (Beacon Press, 2017). I find her conclusion gratifying, since nurses are trained in the importance of talking with and listening to patients (full disclosure: Ofri quotes me on this topic). In contrast, physicians are trained more in a “chief complaint–solution” model, so conversations often turn into physician monologues. While this is understandable, Ofri says, for the sake of high-quality patient care, it must change.
With the American Health Care Act headed to the Senate — and possibly President Trump’s desk — it’s important to step back from the debate over the bill’s details and recognize two essential truths about American health care.