Do some patients deserve special treatment?

[CNL2B]

Patient some time ago in my SICU was admitted after what was supposed to be an anterior approach back surgery of some type. Orthopedic surgeons made a horrific technical error (blamed it on a retraction device used, another story and issue altogether) and tore this patients aorta wide open. Patient also had some bowel damage/perforation from the device. Needless to say, patient nearly died intra-op. He came to the ICU after something like 40-50 units of blood products with a nearly 18 inch abdominal wound and a colostomy. This patient was an early 40-something male, narcotic dependent because of the back pain.

Had a prolonged recovery over several months. The hospital admitted to a grievous error and agreed (without attorney involvement, that's how bad it was) to cover 100% of the hospital bill/related costs, and I think a lump sum settlement was awarded as well but I can't verify that for sure -- they don't let that kind of info trickle down to staff very often, but that was the rumor.

Patient and family were horrible. Obviously they were stunned and upset over what happened, but I think even had things not gone that way, they were the wait-on-me-hand-and-foot type. Management went way over what is normally done, giving the patient's wife the direct number to the nursing supervisor after hours, pager numbers for residents, etc. There were multiple complaints against many nurses during their stay for BS reasons. Management pretty much backed up the family.

My question to you -- does this patient/family deserve to be treated differently/better than everyone else? I've still not really formulated an opinion on what should have been done in this scenario (or others like this) and really want to know what you think.

[sharpeimom]

how would you feel had the patient and his family not been so difficult? is that coloring your feeling that this patient does not deserve going the extra mile?

[SaltyNurse]

IMO going extra mile is appropriate, but allowing unreasonable concessions or being a punching bag is not. It's understandable that the patient and his family are angry, but they are definitely coping maladaptively by taking it out on everyone else. It's a delicate situation. I wonder if the administration offered a transfer to a different hospital?

[sharpeimom]

i suspect that neither this patient or his family is going to be very pleased with much of anything anyone in the current hospital does. i agree that transfer to a different hospital is best.

i will go above and beyond for some patients but will not become a punching bag for any patientor family member... ever.

[CNL2B]

how would you feel had the patient and his family not been so difficult? is that coloring your feeling that this patient does not deserve going the extra mile?

i didn't say he didn't deserve going the extra mile. i was asking for opinions.

as far as transferring to another hospital, i don't think that was a possibility due to reimbursement reasons, although, if the responsible hospital was already going to pick up 100% of the tab, i don't know why they wouldn't somewhere else, either. regardless, patient's family did not ask for transfer and i don't believe it was offered by management.

[sharpeimom]

i didn't say he didn't deserve going the extra mile. i was asking for opinions.

as far as transferring to another hospital, i don't think that was a possibility due to reimbursement reasons, although, if the responsible hospital was already going to pick up 100% of the tab, i don't know why they wouldn't somewhere else, either. regardless, patient's family did not ask for transfer and i don't believe it was offered by management.

sometimes (often?) patients have absolutely no idea what their options are when they need medical care.

we tend to become child-like when we are hospitalized.

when i was hospitalized six years ago because i was hemorrhaging from an ulcer no one knew i had, i was generally treated like a six year old. i had had absolutely no ulcer-type symptoms and poof! this unreal bleeding began all of a sudden. i was tested for leukemia, a-plastic amemia, to name a few things.

i was too ill to be difficult with anyone but i was treated like a kid nonetheless. i suspect it was because the nursing staff felt my internist had blown it somehow. at that point, i felt too miserable to participate much in my own care and expecting much from my husband right then wasn't realistic because his ocd kicked into high gear, and instead of becoming difficult, he hit red alert panic mode instead.

i'm rambling at this point, but i hope some small part of what i said has made sense.

[Woodenpug, BSN]

Each patient deserves special treatment. Every case is unique. After all, that's why we cannot be replaced by machines and/or "institution-trained" lay-persons. But yes, being given phone numbers and catering to unreasonable demands is not to their benefit, potentially decreases the quality of care given to other patients and is unlikely to absolve the surgeons of their legal responsibility. Still, what else do you expect from nursing "leadership?"

[lylenrn]

It has been my experience that anytime a hospital makes a mistake and a patient suffers, the family makes demands.

EX: We had a surgeon do an abdominal surgery that left pt with open abdominal wound, copious amounts of drainage (surgeon messed up). Family mentioned lawsuit and alll demands were met including licensed 1:1 sitter. Of course all costs for these demands were covered by hospital. I believe after all was said and done the family still sued the hospital not sure how that turned out. Eventually the surgeon lost priviledges at our hospital, probably not because of this one incident but others including a verbal altercation with another surgeon over who was allowed to use a surgical suite.

[caliotter3]

My personal opinion: I don't care how the family acts, if you screwed up, then you owe it to the patient, and to some extent the family, to attempt to alleviate things. We kiss their behinds on day to day little things as it is; when it is warranted, people should realize that no one deserves mistakes and screw-ups, so make it right, or try to make it up, no matter who the people are or how they act. Not everyone is grace under pressure all the time. This is my personal opinion only.

[caliotter3]

sometimes (often?) patients have absolutely no idea what their options are when they need medical care.

we tend to become child-like when we are hospitalized.

when i was hospitalized six years ago because i was hemorrhaging from an ulcer no one knew i had, i was generally treated like a six year old. i had had absolutely no ulcer-type symptoms and poof! this unreal bleeding began all of a sudden. i was tested for leukemia, a-plastic amemia, to name a few things.

i was too ill to be difficult with anyone but i was treated like a kid nonetheless. i suspect it was because the nursing staff felt my internist had blown it somehow. at that point, i felt too miserable to participate much in my own care and expecting much from my husband right then wasn't realistic because his ocd kicked into high gear, and instead of becoming difficult, he hit red alert panic mode instead.

i'm rambling at this point, but i hope some small part of what i said has made sense.

your entire post makes sense. when we are deathly sick or injured we can't think straight and neither do most of our relatives and friends. medical personnel need to remember this and should learn how to deal with unstraight thinking, acting patterns. unfortunately this is a topic that is only glossed over in school. ability to deal with unreasonable expectations normally only comes with the wisdom of experience on the job.

[purplerabbit2012]

Not that I'm justifying the patient's and patient's family's actions but the fact is the hospital staff messed up. On the grand scheme of things a little annoyance is still better than a lawsuit. If the pt sues the hospital that would cost the hospital a lot of money which means they will have less revenue which means less money for employee wages, for example.

So what I would personally do, if I was ever on this position is to treat them with extra respect and extra "niceness" (for lack of a better term) that way they can be less annoying and management can get off your back. Just an opinion.

[Neveranurseagain, RN]

My husband died of a medical incident. I did not expect to be treated better or differently than other families of critically ill patients, but what I did expect was some compassion and normal nursing care while he was on life support. Instead, the staff/MD's were so afraid to talk to me that very little was said, except from a few nurses. Here I was, among what I thought was my sisterhood of nurses, and was treated with silence. And my actions and attitude did not have anything to do with it. I realized he was dying and wanted him to die in peace, not be surrounded by anger and harsh words.

So do some patients deserve better care? No, as every pt. should be treated according to the nursing standards of care, which includes compassion.