It's when a patient's story is told by someone other than the patient and that story is somehow distorted.
Brian Goldman used an example of this in his talk I attended. From what I remember, the paramedics believed that the patient was on drugs, nurses thought he had borderline personality disorder. When the doc saw the patient, he believed the patient needed a head CT. This patient died of a head bleed in the CT machine. It could be that he had a personality disorder as well as the brain bleed.
When working in a rural ER, I noticed that a patient had been triaged number 5 - blue. I've never seen the lowest level of triage used before. This patient had been waiting for hours and I wanted to see why.
The nurses who had seen the patient said that it was a waste of ER space, that she just had a little cold and there was no reason to be here. I don't mind seeing kids with colds. When I asked why she and her aunt had come to the hospital, it was that they wanted to know if it was OK for the girl to see her father (dying of cancer) in the hospital or if she would make him ill.
While it's true that this wasn't an emergency, it was worth a visit for immediate help.
Last night, a patient came into the ED with "trauma". He tried to explain to the triage nurse what was happening, but she wasn't able to understand and chalked it up to "he doesn't speak English well". Same thing when he came to Fast Track, the nurse rolled her eyes and didn't understand why he was here.
I went to talk to him and asked him why he had come to hospital. He told me that he had a lot of pressure in one of his toes from trauma 1 and a half weeks ago.
In the past when he had a similar injury he had been told that he needed the pressure taken off to avoid the nail falling off. He had a whole story in his head for how it made sense. Pink finger was stage one, blue was stage 2 and a black finger was stage 3. He was stage one but didn't want to lose his nail.
His expectation for this visit was that his nail would be pierced and the pressure taken off the nail. He was afraid of losing his nail. This information made things make so much more sense and now I had something I could do.
By explaining to him how his body works and explaining how I knew that things were ok, he was happy and no longer worried. He will likely not access the health care system for something like this in the future but I armed him with red flags to show back up for.
This interaction could have easily been unsatisfactory for me and the patient if I had decided he was a drug seeker or a malingerer as he was framed to me. Instead, he left with more knowledge and I got to teach a patient about his body, something I love to do.
I'm hoping I always take the time to FIFE my patients. (Feelings Ideas Function Expectation) It's important to me and lets me sleep at night. Patients need to be heard. I need to listen to provide them the care they need.
No comments:
Post a Comment