The Oath is 'First, Do No Harm' (Not First, Do Not Disappoint)

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Specializes in I/DD.

Feel free to share on your appropriate social media platforms. Found this gem in the break room during lunch.

Viewpoint: The Oath is 'First, Do No Harm' (Not First, Do Not Disappoint)

Emergency Medicine News . 35(9A) Supplement 1Page #], 10 September 2013.

Horana, Lasanta S. MD

Once upon a time, no one cared about the patient's opinion, and he had little ability to negotiate his physician encounter. What the physician said was near-absolute, and the patient had no recourse. And so the patient bill of rights was born.That was taken a step further when we didn't just empower the patient but asked, is he satisfied? This innocent question made the pendulum swing completely to the opposite direction. Now, as an emergency physician, I stand with no recourse and await the day when the physician's bill of rights comes out. When will someone empower physicians?...

...The problem as I see it is that we mislabeled the process as patient satisfaction. The problem is inherent in the term. It implies that our job is to satisfy the patient. If a patient was not satisfied, we failed. This is quite contrary to our training in emergency medicine....

...Satisfaction is an obligation or even a promise we make that means we will deliver satisfaction. This is not realistic when we consider all the moving parts that go into one ED encounter. This is not Disney, and I am not selling vacuum cleaners. No matter how much the patient satisfaction guru wants us to adopt the customer service model of Disney, the ED is not Magic Kingdom. We should label these surveys "Patient Feedback Surveys." Feedback does not imply a pre-expectation; it implies a process that already occurred and now seeks constructive criticism or suggestions for improvement, not a rant about how I never should have been licensed to practice medicine...

..We need our leaders in emergency medicine to advocate for the physicians, and the Emergency Nurses Association should do the same for the nurses. We need to draft a bill of rights that is supported by hospital administration saying that we will not tolerate frank disrespect, foul language, or threats! Once in a while, it would be nice if administration and medical leadership actually sided with us and defended us. Once in a while, it's OK to say that someone was out of line, that this kind of behavior will not be tolerated. Our job security is not based on three complaints and disregard for the other 397 patients I served and satisfied this month. Let's get some perspective that two of my 15 surveys were negative, making me fall out of the 95% patient satisfaction expectation although my other 350 satisfied patients failed to fill out a survey. Let's change the surveys. Empower me, give me some recourse, and defend me! After all, the oath that I took was first, do no harm, not first, do not disappoint.

http://mobile.journals.lww.com/em-news/_layouts/oaks.journals.mobile/articleviewer.aspx?year=2013&issue=09101&article=00002

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Specializes in LTC, assisted living, med-surg, psych.

That's what a lot of us nurses don't appreciate sometimes......physicians are often treated as badly by the "customer service" model of healthcare as we are, and the average doctor has no more power to fix this broken system than we do.

Like us, their time is also wasted on ridiculous exercises which make administration happy, but cut short the actual therapeutic time that used to be spent taking care of the patient.For example, every three months when I see my psychiatrist, he has to ask me about my blood sugars because I'm a diabetic who's taking a type of medication that can raise them pretty significantly. Then he has to "educate" me about the risks of taking the drug---something he knows I understand every bit as well as he does since we're both clinicians---and fill out a form that we both have to sign to prove that we've gone over the material.

Now you know this obviously had to have come from some "unsatisfied customer" who developed diabetes while taking one of these meds and claimed the doctor never informed him/her of the risks. In the meantime, it's cutting into MY 50 minutes for therapy and med management, which makes ME an "unsatisfied customer". The difference is, I don't blame my doctor for it.....he's only doing what he has to do, just like we nurses do. And while he may not have to serve Coke to the fifteen family members in one patient's room, he does have to put up with verbal abuse and threats of violence and lawsuits, and there's nothing he can do about it. (Which is why he's going back to private practice.)

Good article. Thanks for sharing it.

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Agree.

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Specializes in Pediatric Pulmonology and Allergy.
Many ED visits are not satisfying for the patient no matter how much we try. There is nothing satisfactory about the patient not being placed on a Versed drip that he requested for his chronic back pain. There is no satisfaction in my not being able to magically find the cause of abdominal pain a patient has had for eight years and that has befuddled 19 previous emergency physicians.

nailed it

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

And there is no satisfaction in being given the news that you ARE diabetic. I'm sorry you're unhappy with your diagnosis, but it is what it is. There's no satisfaction in being told that you have to follow a diet and take the medications prescribed in order to NOT return to the ER on a frequent basis with exacerbations of your symptoms. There's no satisfaction in being told that your teen child, in the ER after a senseless motor vehicle "accident" will not survive. Sometimes clinicians give bad news; there's no way around that. Bad news does not result in "customer satisfaction". Does that mean we should sugar coat it to the point where it's unrecognizable? Or fail to deliver it at all? Hopefully the pendulum will swing away from this customer service mentality before much longer!

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Specializes in Pediatrics, Emergency, Trauma.

Hopefully the pendulum will swing away from this customer service mentality before much longer!

I hope so too...healthcare is a business in promoting "health" not "customer satisfaction"...people come to us is such disrepair at times...we don't "fix it and that's the end!"

It will NEVER be that simple; when there was a push to redefine the definition of "health", I was grateful for the illusion to be smashed enough...now, I remind my patients, their families and my peers (the ones who are fearful of violating patients "right) that with every right, there come responsibility...so far, it has not impacted enough scores; so I will carry on...:whistling:

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The difference between the Nurses and MD's is that they will fire a Nurse without blinking an eye. I'm pretty sure the MD's have much better job security.

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I read all those ED's as Erectile Dysfunction the first time, I need more coffee

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You can make your day so much happier by making the patient and family happy just like you make yourself and your family happy. It comes back to you tenfold. Spread the kind of love that you give your family to the patient and family in need. It's pretty much why you are there in the first place. The care the compassion. What mucks it up is the unrealistic expectations of too many patients and unhealthy work lifestyle. You'll always be able to sleep when you can look your patient in the eyes/reason why youre a nurse everyday and say hey I'm here for you and I'm gonna do what I can to get it done. You're gonna feel better by the end of my shift." If something gets in the way of that it's a managerial reason. Too many interruptions, too many things piled up... but I will get what my patient wants and needs despite it because that is why I'm here. When I can't do that and my teammembers can't ...then we have to make changes... together as a team or "quit complaining"/ make changes personally. It won't get better with the latter action plan.

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
You can make your day so much happier by making the patient and family happy just like you make yourself and your family happy. It comes back to you tenfold. Spread the kind of love that you give your family to the patient and family in need. It's pretty much why you are there in the first place. The care the compassion. What mucks it up is the unrealistic expectations of too many patients and unhealthy work lifestyle. You'll always be able to sleep when you can look your patient in the eyes/reason why youre a nurse everyday and say hey I'm here for you and I'm gonna do what I can to get it done. You're gonna feel better by the end of my shift." If something gets in the way of that it's a managerial reason. Too many interruptions, too many things piled up... but I will get what my patient wants and needs despite it because that is why I'm here. When I can't do that and my teammembers can't ...then we have to make changes... together as a team or "quit complaining"/ make changes personally. It won't get better with the latter action plan.

There's a difference between what your patient may want and what he may need. That's the point so many of us are trying to make. He may WANT a cheeseburger and fries, but he's NPO. He may NEED a NG tube and his stomach sucked out. If you're more concerned with making him happy by giving him what he WANTS and "making him feel better," then you're not doing your job. And that aint's a managerial reason.

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Ruby you are so right on your points. That person is AMA and there are communication orders that tell you to contact MD if this happens. You do it so the patient doesnt hurt themselves under your care. NPO orders are supposed to be told to the patient. When this happens and the pt does baddies then RN tells MD in order to avert bad situation. No Rn should be accountable for this. If said RN gets in trouble because this patient did not listen to said RN, then RN has right to refute an adversarial outcome of said situation, whatever that may be. Just document you educated patient and patient ate something and you told MD about it. Don't place all the patients actions and responsibilities on you. This is why nursing is so crazy! You can't control people. You can only offer treatment to make them better per an MD with the time you have.

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Ruby you are so right on your points. That person is AMA and there are communication orders that tell you to contact MD if this happens. You do it so the patient doesnt hurt themselves under your care. NPO orders are supposed to be told to the patient. When this happens and the pt does baddies then RN tells MD in order to avert bad situation. No Rn should be accountable for this. If said RN gets in trouble because this patient did not listen to said RN, then RN has right to refute an adversarial outcome of said situation, whatever that may be. Just document you educated patient and patient ate something and you told MD about it. Don't place all the patients actions and responsibilities on you. This is why nursing is so crazy! You can't control people. You can only offer treatment to make them better per an MD with the time you have.

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