I had been treating a patient every day for impaired airway clearance. He was now spontaneously breathing via trachie and our treatment included manual hyperinflation (‘bagging’), vibes and suctioning, and having the patient hoisted into a chair – none of which are probably particularly pleasant procedures for this gentleman. However, he has always been compliant, greets me with a smile and answers questions with a thumbs-up. I felt we had built some rapport.
He is certainly very ill, often tired, and always has other health professionals at his bed space – it’s sometimes difficult to find a time when he’s free! On this day I was investigating his charts and notes, whilst someone else was finishing their intervention. One of the other students on my placement approached me about the meaning of an abbreviation I had used in a handover to them – I explained that it meant a history of alcoholism. We had spoken only about the abbreviation and not in relation to any patient, thus the communication was professional.
Just then, my patient became available, but for the first time in two weeks, he refused intervention. He wouldn’t even let me auscultate. I asked was he in pain/ uncomfortable? No. Was he tired? He mouthed ‘a little’, but I got the feeling this wasn’t really the problem. Unfortunately I wasn’t able to convince him to allow me to treat him.. It was the end of the day, so my supervisor suggested handing him over to the evening physio.
At the time I thought that he was probably very tired and perhaps disappointed that he had not been transferred to another ward, which had been the original plan for that day. Whilst this may be true, I also realised later that this patient also has a prior history of alcohol abuse which has almost certainly contributed to his current condition. Perhaps he overheard and assumed we were speaking about him? This may not be the case, but it has really made me aware of any communication which takes place within earshot of a patient (or their family). We really need to remember that even when we think we are being completely professional, communication between health professionals may be easily misinterpreted by patients, and may ultimately affect rapport/ the effectiveness of our treatment. In the future I will endeavour to discuss only issues relevant to the current patient, whenever I may be overheard.
He is certainly very ill, often tired, and always has other health professionals at his bed space – it’s sometimes difficult to find a time when he’s free! On this day I was investigating his charts and notes, whilst someone else was finishing their intervention. One of the other students on my placement approached me about the meaning of an abbreviation I had used in a handover to them – I explained that it meant a history of alcoholism. We had spoken only about the abbreviation and not in relation to any patient, thus the communication was professional.
Just then, my patient became available, but for the first time in two weeks, he refused intervention. He wouldn’t even let me auscultate. I asked was he in pain/ uncomfortable? No. Was he tired? He mouthed ‘a little’, but I got the feeling this wasn’t really the problem. Unfortunately I wasn’t able to convince him to allow me to treat him.. It was the end of the day, so my supervisor suggested handing him over to the evening physio.
At the time I thought that he was probably very tired and perhaps disappointed that he had not been transferred to another ward, which had been the original plan for that day. Whilst this may be true, I also realised later that this patient also has a prior history of alcohol abuse which has almost certainly contributed to his current condition. Perhaps he overheard and assumed we were speaking about him? This may not be the case, but it has really made me aware of any communication which takes place within earshot of a patient (or their family). We really need to remember that even when we think we are being completely professional, communication between health professionals may be easily misinterpreted by patients, and may ultimately affect rapport/ the effectiveness of our treatment. In the future I will endeavour to discuss only issues relevant to the current patient, whenever I may be overheard.
2 comments:
A good point to make Amber. Although he may have overheard you i feel that the likely scenario was frustration of still being on ICU. It is an invasive ward where there is not much privacy. He may have refused physiotherapy as some of the techniques are not that pleasant e.g suctioning. I feel that patients sometimes feel that the physiotherapists will be asking more from them than they feel they are capable of at that point of their recovery and this is why they refuse treatment. Although we must introduce ourselves and our role, explain that you only wish to carry out a short review of their present condition, to aid staff on their progress. Once you have done this the patient may then be more comfortable doing more Rx with the physio.
I agree that we definitely have to be on our guard all the time. It's easy to forget yourself when you become comfortable and this can be a problem particularly when your patients are sensitive. In the first week of my neuro placement I told one of my patients that myself and the other student with me would come back in a little while and she could get herself 'mentally ready'. I only meant that she should start getting in a positive frame of mind, but once we got out of the room the student with me said she couldn't believe I'd said that and it sounded like I thought the patient was crazy or something. So I guess you can't be too careful what you say. I hope your patient is letting you treat him again.
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