Hospitality or health care?

When did health care become a hospitality business? I mean, yes, it is a business because there needs to be a profit to ensure facilities remain open and operating. But, when did health care professionals decide to stop educating and help guide patients into making clinically sound decisions? Now, we are expected to just give people what they want to make them happy. A better question is, when did people stop listening to healthcare professionals and decide that they know what is best?

Over the years, I have experienced doctors giving patients false hope when they should have been educating families on what the true prognosis could be. There was a time when given this information that families were able to make the decisions to choose the best environment for their loved ones or keep them comfortable until their time came to transition.

This is in no way attacking doctors or any specialist. As an occupational therapist, there have been occasions where I have attempted to educate a patient/family that because the patients skills were plateauing that it was time to modify the plan of treatment. Unfortunately, many moons ago, this patient was diagnosed with a degenerative disease. Now, at this point the patient was only able to be on therapy services with some…….creative goal writing. At this point, the family was unwilling to accept that this was the time for a new plan. Of course, management was involved but one thing about me, I am going to advocate for myself when I need to. Was I afraid that It would put my job at risk, of course! But when did we stop being allowed to use our clinical judgment? What if I had given in? Where would the cycle have ended? Even in this situation, the end result was not what it should have been. It was beyond the point of needing to have the hard conversation with the family. It was time to guide them to either look into getting the necessary assistance to transition home. Or to look into long term care facilities that could provide the skilled care he needed. Instead, they were told that it would be revisited. So, there really was no problem solving just a continuation of a bad cycle, but who really loses in this situation?

Another example, a patient went to urgent care with a strange rash onset. They informed the nurse on duty what they thought it was from due to past experiences. The nurse did tell the patient that they disagreed with their self diagnosis but the patient seemed to be confident in their opinion. As a result, the nurse treated the patient for what the patient thought the cause was. Of course, the patient was wrong about the diagnosis and ended up having to seek additional more extensive treatment elsewhere. Had the nurse educated the patient on why she disagreed with the self diagnosis perhaps the patient would have been better sooner.

Again, I understand that healthcare is a business and we need to be compensating, flexible, understanding, and compassionate. If we are not we risk negative reviews and losing repeat patients. But does that mean we have to be afraid to say no? Or risk being bullied into making decisions that are not clinically sound or evidenced based?

The squeaky wheel gets the oil, but does it? Or does it get a solution that may be placating but doesn’t solve the issue.

Let’s be honest, there’s a fine line between advocacy and being annoying. Healthcare providers respect advocacy and will encourage it. But when someone becomes annoying I think it hinders the care that can be provided. Care staff may limit interactions with the patient, avoid families, or just be short with the interactions that they do have and no one wins in this situation.

How to guide patients and their families in decision making:

1: Be honest but not dismissive. Understand that the information being given is sometimes new and they may need time to process it. Give them the facts and what is to be expected or what has been seen in your experience.

2: Allow time for follow up questions. When receiving information we can become overwhelmed. Give time for them to process and ask immediate questions. Then provide a way for them to ask follow up questions.

3: Defer to another professional. This is my favorite option. After giving all of the necessary information sometimes allowing another professional to reiterate what has been said and provide necessary resources can be beneficial. There are times that a different communication style is needed.

4: Let them know that they are more than a number. More often than not people just want to know that they are being heard. Yes, you have a heavy caseload and a million other things to do. But no one wants to feel like they aren’t being heard or that their needs don’t matter. What may seem like something small to you may be huge to them.

As a therapist one of the most difficult parts of my job is when the doctor hasn’t been honest with a patient. It hinders , other healthcare professionals from setting realistic expectations. As a result, we are expected to follow the doctor’s lead and just give in to the patients wants instead of what they need. No one wins in this situation and at this time it becomes a hospitality issue and not a medical one

How do you deal with managing the fine line between maintaining business expectations and providing clinically sound services? What tools and resources have you found to be effective.