Patient only kinda knows best 

Halfway across the country now, making my way to my final destination. On my way to at least another full week of orientation. 

What can I say about my time at home? Things were exactly as I recalled them, and people were as welcoming and surprised to have me back as I expected. No, I’m not home to stay. No, I’ll not be giving up traveling. But a girl’s gotta eat even when she’s taking a break from traveling. 

So I have many thoughts about my old/new job back home, but I’ll let them percolate a bit longer before I reveal them. 

One thing I’d like to touch on briefly that was inspired by my jaunt home is patient compliance, patient knowledge of their diease process, and readmission. 

It was discussed in my recent orientation that patients are smarter than their nurse or clinician immediately following their diagnosis. At the risk of being crucified for saying this, I very politely disagree. 

Take myself just as a patient with a high level of medical experience (4 years bachelors degree in nursing and 2 years of master level education plus nearly 10 years as a nurse). When I get a weird rash or head thing, I go to webmd and enter my symptoms. A list of every possible disease process returns so I read and read and read. I have gathered knowledge, but I’ve also started to freak myself out because I’m positive I’m about to die of Ebola. I’m freaking out, y’all!

I have a lot of knowledge, but no real understanding. 

Understanding comes from things being broken down in plain speak, my mind having time to process my diagnosis, and my fears settling. That comes after you’ve spoken with a clinician or someone with a greater knowledge base than your own. Someone who truly understands the pathology, prognosis, and recovery on a cellular level. Someone who understands how the medicine affects your system and improves your help. 

Once you’ve passed the initial stages of shock that comes with a new disease, then (and only then) can you learn what you need to know to have a handle on your particular syndrome. 

Those with chronic illnesses have a handle on their disease. Parents with kids with long time illnesses know a whole heck of a lot about that because they need to.  Countless appointments bring more knowledge

So, no, I don’t believe a newly diagnosed patient understands more than I do about their diagnoses. Just as I don’t think a diabetic mom truly understands the why of keeping their sugars under control outside of the understanding that their baby will get too big. Not that they don’t care just that I have a deeper understanding of why 

Which leads to my next points… Patient compliance and readmissions 

One of my petpeeves when I taught was how the program was penalized when students failed to pass boards on the first try following graduation. I took offense to the notion that we were at fault for what is one part chance and one part the test taking skills of a student. They met standards for graduation, why am I being punched in the gut for their failure. 

Patient (non)compliance and readmissions feel the same way. There is a window of time that if a patient is readmitted, the hospital receives no reimbursement for their stay. 

This goes back to knowledge. Patients have a certain understanding of their disease process and comply as they see fit. We can educate, but for whatever reason they return because they can’t or won’t care for themselves. Back to that totally non compliant diabetic mom with sugars in the 500s. We say she should know better or think of her unborn child at the very least. But maybe her understanding truly isn’t there? 

So how can we provide quality care for those patients? 

Explore the source of their lack of understanding or non compliance. We are human and it’s easy to get frustrated with the bad behavior of patients, but maybe it’s not simply because she doesn’t want to. Perhaps she can’t? Money and access to nurtious foods. Inability to acquire equipment to test her sugar. Disability that limits mobility. It’s never simple and it’s never going to be. 

There will be those patients who don’t care about their health no matter how much education and preventative medicine exists. We care for them still because that’s our calling. Maybe your concern will be what turns the tied for them. Who knows, right? 

We’re super nurses, preventing that next readmission and saving our non compliant patient from themselves! 

Travel on, road warrior. 


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