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January 9, 2013 By Brenda

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Samantha says:

January 10, 2013 at 11:52 pm

Daer Brenda,
I’m a Nurse Practitioner with experience in trauma and orthopaedics as well as internal medicine, psychiatry and pulmonary mdicine and nursing and I want to say I am appalled at that PA’s response to you. DON’T EVER ACCEPT A STEREOTYPED NON-RESPONSE LIKE THAT! 55 is middle age – you are not in an advanced geriatric situation with fragile bones which are prone to break due to years of osteoporosis. It’s YOUR body and you have the right ethically and under the law to DEMAND a much better answer than that. In our health care, er… illness care system, it’s a sad but true fact each of us must be proactive for ourselves. More and more, I see what has happened to you occurring in health care, and it simply infuriates me for the pateints’ sakes, because everyone is entitled to respect and proper information.

I love to advocate for my patients’ needs and so do most of my colleagues, but not every professional knows the real meaning of that verb. Apparently the PA you encountered falls into that fortunately small category of those who need to be educated about this.
When dealing with the “system” I find it helps my patients to do the following, so I pass this on to you in hopes that it may be of help in some way:

#1. When you get a blow-off or dismissive response such as you did, always say “I don’t understand what you are telling me. Explain that in more detail, please.” If they try to duck a better response say “I still don’t get it. Again, please.” Do the broken wing act… keep them at it until you hear something substantial or something that rings true. Remember – it’s your right!

#2. Another useful phrase to pin down a glib reply or insufficient explanation is “Please write that down for me, so I can remember. There’s a lot going on for me just now that I must focus on, and I don’t want to forget this.” If the person tries to diminish the importance of his or her remark, say “NO, I’m serious… I need you to write this for me” or ask for a piece of paper and say “Never mind, I will write it myself.” I bought my 91 year old mother-in-law a small notebook to take to medical appointments with her, and she uses it. Professionals who should have known better than to “give Granny a few little words” instead of a proper response, rapidly begin to give better information when she dictates out loud to herself the idiotic replies she sometimes gets from them, all the while writing them in her book.

#3. “What is the particular reason you say that?” Put the ball back in their court. It’s easy to brush off or give an insufficient answer to someone who appears willing to accept it, and staff who are very tired, not really knowledgeable, or uncertain of what to say to a patient will do that. A real professional will not. NEVER accept a ‘half reason’ or ‘no reason’ as a reason for what is happening to you. It’s not adequate and you deserve better as an intelligent human being who is capable of understanding your own medical issues. Remember, it’s your right to be fully informed by someone who is able to discuss and explain your condition fully and offer and discuss treatment options.

#4. If all else fails, “I wish to speak with your supervisor. NOW.” works absolute wonders.
It’s always preferable not to have to be confrontive, but some people earn it by their refusal to speak to their patients as fellow humans who are entitled to be fully informed of what is going on. I tell all my nursing students, both graduate and undergraduate, that patietnts do not need attitudes from us; they need help, honest and appropriate answers, respect and kindness. They come to us with enough of their own problems and do not wish or need to be saddled with ours. It’s OK to say “I’m not sure I know that answer. But I will find someone who can give it to you.” We can’t know everything. The day any RNs, NPs, PAs or MDs think they do, they need to hang up their stethoscopes.

To give this overly glib PA the benefit of the doubt, perhaps she was very tired, or had another crisis going on and was distracted. Personally, I still feel that is no reason to have given the answer she did. I do encourage you, Brenda, not to accept such replies. They are harmful, lead to a lack of trust so necessary between health care provider and patient, and they leave you in a one-down position when just the opposite should be true. It’s always difficult to stand up to someone with authority (and all medical/nursing personnel have some) when one is feeling ill, discouraged, in pain and lacking good information. The prospect of yet another stressful conversation is never appealing – but it has been my professional experience of over 36 years, that when a patient states clearly, simply, assertively and without anger that more is necessary – more knowledge, more treatment, more respect – it is usually forthcoming. And if, having been firm, pleasant and unwavering in your requests, the response is still nil or completely inadequate, it’s time for the ultimatum which always gets a proper response:
#5: “When you bill my insurance provider, I’m actually paying your salary. I’m paying for adequate information which is part of my medical care, and since I can’t seem to get it from you, I need to speak with someone else immediately! And I cannot permit you to treat me again.” Don’t take any guff. don’t accept platitudes or equivalent pats on the head with a placating “There, there…” If polite and pleasant fails, play hardball. It’s your body and your legal and ethical right to get informed, compassionate care. Illigitimus non carborundum!

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