Saturday, January 26, 2013

The Syndrome of Overmedicalization

An awful lot of patients are truly terrified when they need to receive even routine care.
    In Nursing, we have something we call, establishing a nursing diagnosis.  Whereas, a physician might diagnose a specific illness, a nurse would additionally note and diagnose the patient's response to disease or treatment, or sometimes, a proneness to a particular complication.  For example, a physician might diagnose nerve deafness, while a nurse would diagnose a "Communication deficit secondary to newly diagnosed nerve deafness".  The hope is that while the physician works on the actual medical problem, we are working on coping with the deficits it brings and in introducing coping mechanisms etc. Ideally, if the patient gets the benefit of both of us, the outcomes are much better.  When hospitals were staffed adequately, the system did indeed work.
               This is not an actual Nursing Diagnosis as yet but I am wondering if it should be.  I call it the Syndrome of Overmedicalization.  When a young child comes to the hospital for treatment of Lyme Disease, leukemia, or something else which is likely to be difficult and somewhat invasive, attention is paid to limiting stress, pain and fear.  This is important because a child who is absolutely terrified in association with medical treatment at three, isn't going to come back when he's eighteen or twenty-one, and we could lose him to a manageable problem then.  However, in medicine, the same effort is not undertaken to spare older children, teens, young adults, adults or the elderly from the same trauma.   I cannot tell you how many stories of medical trauma young people and adults tell me about their prior hospitalizations.  I do understand that a certain amount of medical intervention is going to be less than pleasant, but it does not need to be so wholly traumatic that the patient is terrified of anyone in scrubs forever after.  We have an obligation to use as few physicians and nurses as possible for each patient. Let them get to know and establish some trust with a team who will be treating them. Understand that to recover from their illness and to undergo treatment, the patient has to be able to accept and complete their treatment.  If they leave the hospital against medical advice, that's not going to happen.  When physicians set out alternatives for treatment, they can do so, including the potential side effects without terrifying the patient.    Certainly, a nerve block might create a potential for infection, but this is unusual, and chances are, a short run of antibiotics would be given if the patient develops a fever within so many hours of such a procedure.  We also need to limit the number of marginally trained medical assistants and aides who erroneously refer to themselves as nurses.  Before my mother died, she talked a lot about her "nurses".  In point of fact, only one of the people she encountered was a Registered Nurse, and one other was a Licensed Practical Nurse.  Everyone else was a Patient Care Technician and most of them understood absolutely nothing of her condition and of her medications, and yet she hung on their words, thinking they were nurses, and expecting a modicum of professionalism that she simply did not receive.
             When I see people at the clinic, they come for many reasons. Some come because they need the services of a free clinic and they don't have insurance. Others come because they don't have a regular physician, and they want somewhere that can not only care for an urgent issue, but can make phone calls to arrange their continuing or complex care elsewhere at low cost.  However, many of them come to us because conventional physicians, hospitals and their nurses have failed them.   They have a medical issue, and rather than employing the patient in the decision making and cooperation with their care, someone has terrified them beyond belief.   The truth is that there has never been a better time to have Type II diabetes mellitus.  Blood sugar determinations can be made by the patient inexpensively using a meter and strips available at the Wal-Mart for little money.  Oral medications and diet can control the disease for some.  Insulin can control it for others.  It is possible to live a completely normal life expectancy with diabetes if the patient is correctly taught to manage it, and the potential complications.  I have Type II diabetic patients who are 96 !    They come to us because somewhere some physician told them that if they didn't do as he said, that they would lose each leg inches at a time, while they were begging for help after a stroke !   Patients who are told the truth carefully and properly cooperate with their care, and do well.   Patients who are terrified by the unfair and exaggerated visions of an angry physician do not.    Type I diabetics are tougher to manage, and it's a different illness, but they too have been tortured by the system many times.
             I don't think good or accurate statistics are kept on this, but I often wonder how many patients had a serious illness as a young person, and then in later life, cannot psychologically submit to needed medical care for another issue.  Even I have limited trust sometimes when I think about how my gangrenous gallbladder was missed, nearly taking my life at 28, because I was slim, and the mistaken physicians did not realize that thin people can have diseased gallbladders as often as others !    How many deaths occur because a patient is too terrified now, to have a manageable problem assessed and treated ? Their prior problem was overmedicalized to the point that the patient now fears and mistrusts medical professionals, the good as well as the not-so-good ones.
                We need to care for patients properly and inform them as they are able to absorb the basics and then the nuances of their own care. We don't need to treat them as if they are physician or insurance company owned or as if their body will be rapidly repossessed if they deviate from their physician's plan of care.  Your physician and your nurse are professionals who are supposed to be aiding you in maintaining your health as you move through life. You are to be a contributor to such a plan.  They are not the owners of your pink shell who will decide to repossess should they perceive you to be non-compliant.
              If you don't feel that your physician, your nurse practitioner or your physician's assistant is occupying the role of a health promotions expert in your life then as soon as you can,  find someone else who will be !

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