Are the days that patients follow physician's orders, instead of physicians following patient's recommendations over? With an epidemic of unnecessary medical care threatening the healthcare field, and the push for patient satisfaction, along with the free market choice of doctors and hospitals, physicians and nurses are now practicing defensively.
With liability, lawsuits, malpractice, patient surveys... are caregivers and providers afraid of being aggressive with their patients?
Note there is difference between preventative medicine and practicing on the defense.
If your patient is not satisfied with the care, they can just walk down the road and receive the care they want with providers willing to give it. Where does evidence-based practices fall in, and online Google search diagnosis fall out?
A recent article by the New Yorker addressed the issue calling it "no-value" medicine. Reporting that a researchers have shown how often patients receive unnecessary care, that can actually be harmful for the patient, for example getting a CT scan for lower back pain for patients that presented with no other neurological problems. Studies Reeves that adding unnecessary scans adds no benefits for the patient, just raises the cost.
In a single year, 25-42% of the Medicare patients had received at least one unnecessary scans. The Institute of Medicine reported that these wasted exams accounted for about $750 billion dollars per year.
Educating the patients is a start, but with physicians working with patient overload, and averaging 15 minutes per patient, and nurses working with high patient-nurse ratios, their education times are limited. Plus with the culture of "it's my money and I need it NOW!" is hard to control impulsive shopping for the desired care, and prescription drugs are also a big player in the overuse of "no-value" medicine. Patient's pain is no longer being controlled by NSAIDs, they are demanding morphine, percocet and dilaudid, stronger medications with higher risks of misuse.
I have witnessed a patient with extensive prescription pain medication abuse and cocaine use, being discharged home with a month's supply of Percocet for chest pain, after all cardiac exams being negative. Not to undermine the patient's pain, but actually serving as the patient advocate and having her safety and best interest in mind, I spoke up. At the end, in her perception I was the worst nurse ever, and the physician was an a**hole. Our HCAHPS probably took a hit with her, but we prevented complications from narcotics misuse.
The culture should change a little bit and have people be held accountable for their own health, as we are held accountable for their health. If a patient is readmitted within 30 days, but they followed precise recommendations and still so happened to have to come back to the hospital, fine! Maine there was something we could've done better. But to take excellent care of patients, do everything necessary to ensure they recover, and have the same patients come back due to noncompliance, is quite frustrating.
Providers need to stand their grounds, and practice the medicine they learned. Also, nurses have the same responsibility, providing evidence-based care, and dealing with frustrated patients, but explaining the why behind the why. But the powers need to be shared between both providers and patients, allow and encourage caregivers to be firm with the direction of care.
The Dude Nurse
Klaus Campos, BSN-RN