I recently found myself as a patient in an unknown hospital in a strange city. The experience was disconcerting, to say the least. Fortunately, my stay was short and all is now well. But interestingly, the incident enhanced my perspective towards Collaborative Practice and Mediation. Let me share why.
Like many unexpected hospital stays, mine started in the Emergency Room. There I answered questions about what I was experiencing for the nurse, the resident, the neurology resident, and at least one other person. Based upon my answers, they made a decision to admit me, but started treatment right there in the ER.
Once I was admitted and trying to settle into my room, another nurse wheeled in a cart with a computer and starting asking the same questions that had already been asked – and then some. The neurology resident came back and started talking about administering more medicine later that day – that is, until he learned (much to his surprise) that the ER had already given me the “full” dose for the day, instead of only half. If I had not told him (and shown him written proof of the dose), he would have ordered more.
I tried to settle in some more, only to be subjected to a parade of residents who began to come in to my room. Each one asked the same questions. Though I realized that this was a teaching hospital, I was a bit dismayed that the parade extended until well after midnight!
When I questioned one resident about the number of people who were asking me the same questions, he explained that it was because “they were a team”. A “team?” Not in my mind. This experience felt more like individuals who were focusing individually on their own learning, not working together for the patient. This was not the way teams that I knew worked. When I pointed this out to the resident and indicated my concern that this process did not work for at least one patient (me!), he replied, “We get that a lot.”
At that point, my Collaborative and Mediation mindset was triggered. In my professional experience, team members work together to meet the needs of our clients (a.k.a. “patients”). While the professionals may operate individually, there is a clear coming together for the purpose of sharing relevant information in such a way that the clients know their needs are being addressed. Though the process is controlled by the professionals, it is designed to meet the needs of the clients.
In contrast, in the hospital it seemed that the needs of the patients were secondary to the needs of the professionals. I understand that of course medical personnel need to learn and must experience all aspects of treatment, including patient intake. But did this really need to take place for over 10 hours until well after midnight, when the patient was already tired, obviously not feeling well, and received no indication that her information was being shared???
It was a long night, so I had a lot of time to think -mostly about teamwork and about process. When the attending physician came in with her “team” of residents the next morning, I was ready to share. She, however, was in no mood to listen. After assuring herself that I was feeling better, she made ready to leave. I asked her to wait and told her that I had feedback from the patient’s perspective. The look on her face said, “OK, I will indulge you – but make it quick!” Not very heartening, but I was not to be deterred. I explained how tiring and disconcerting it was to be questioned over and over, and to feel like there was no information being shared or concern for how the process was affecting me. When the face of the attending physician glazed over, I turned to the young residents and continued.
The next day I asked the resident who came to my room early in the morning if there had been any follow-up to our discussion. She was clearly uncomfortable. We talked some more, and she told me that they needed to do the questioning individually so they could get experience. I thought about what she said. I realized the challenge was how to adjust the process so the needs of the patients could be met while still addressing professional development requirements. I had an idea about two small “tweaks” that could be made to the professional process. When the attending physician returned, I was eager to share. She was not interested.
Simultaneously, I worked with the neurology department to determine the best medication dosage and treatment plan for me. They were receptive to adjusting their process to meet my needs, and I was respectful of the basis for their approach. We quickly came up with a plan. This felt collaborative!
I have since responded to a survey of my experience during my hospital stay, and have had a follow-up telephone conference. I am hopeful that my suggestions will be considered and integrated. The process did not work for me, as I suspect it does not work for many patients. What if I had been more disabled, or even unable to speak?
Having been on “the other side” has caused me to think more about my clients and their needs. How do the processes I use help to meet their needs, accomplish their goals, and lead to the outcome they desire? I like to believe that I put them first, and will continue to do so. My approach is to allow the professionals to control the process so that the clients can control the outcome. You can not get to the second goal without being flexible and open with the first.
I realized how much we as professionals need to listen to what our clients say, in all the ways that they speak – both verbally and non-verbally. When under stress – a hospital stay, a divorce – expressing one’s needs is not always easy. So it is our job to read between the lines and pick up on what they are trying to communicate.
The team exists for the client. That is what I tried to share at the hospital. They may not have heard, but I learned from my experience. Putting my training to the test in a situation where my role was the opposite of what I usually play helped me to think about teamwork from a different perspective. I plan to apply that perspective going forward.