Putting the brakes on drive-by medicine

A few weeks ago, after doing postpartum morning rounds, I went to see a friend who was an inpatient on another floor of the hospital. She'd been hospitalized for a few days with shortness of breath and fevers of unknown origin.  They had worked her up for everything imaginable, yet she had few answers was feeling frustrated at her lack of improvement. 

While I was sitting at her bedside, one of the consulting specialists came into the room.The doctor asked a few questions, listened to my friend's lungs, and briefly described her assessment and plan for treatment. After less than four minutes, she was gone. 

My friend looked stunned, trying to process what the physician had said. She had been given no opportunity to ask questions or even describe how she was feeling. Neither of us understood how specialist had come to this plan or even the diagnosis, given the “drive-by” nature of her visit. 

An hour before, during my own rounds, a collaborating physician and I had spent at least 30 minutes with a high-risk antepartum patient who was admitted for preterm premature rupture of membranes. The patient and her family were scared, so we spent time discussing her current status, including her lab values, fetal surveillance, vital signs and other pertinent information. We outlined the current management plan with her and her husband, and answered their many questions, while trying to offer reassurance and emotional support. 

When I contrasted our patient encounter with that of my friend and her specialist, I was angry. As providers, we are all busy. Each of us has hospital rounds, long office hours, patient phone calls and other clinical duties to attend to.  Certainly, we encounter many chatty patients, or patients who want to single-handedly direct their care. Some days, it seems like drive-by medicine is the only way to fit it all in. But most patients only want a little bit of our time and attention, and to feel like their concerns have been heard. 

I know some providers who feel that patient counseling and education is the nurse's job. I strongly disagree. While I expect the nurses to do their part in reinforcing my plan, if I am the one making the management decisions, I should be the one discussing those decisions with the patient. If the plan doesn't come from my mouth, it is all too likely to become like that old game “Telephone” where information gets altered as it's repeated down the line. 

All patients deserve time to ask questions about their care and to voice concerns. Isn't that a crucial part of the puzzle when making a diagnosis and considering treatment? If we expect patient compliance, shouldn't providers be ensuring that the patient understands and is in agreement with the plan of care? 

Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J.

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