Patient not customer! Why it's better to embrace the role of patient

Love him or hate him, there was something very telling about watching our COVID- 19 positive president, a few months ago, be chauffeured around in his limousine to greet his fans for a pre-election political stunt. He did this while being treated in an inpatient setting with a diagnosis of a highly contagious, potentially lethal virus. This act potentially jeopardized the health all those sealed inside the airtight presidential limousine with him.
 
I know that he’s the president and all, so surely he can get away with things that most of us can’t. But there’s more to it than that. Beyond this isolated event that we witnessed a few months ago, there is a damaging “patient first” mentality that is fast becoming the real beast behind the mask in our healthcare system. And this mentality isn’t just limited to catering to the president’s wishes.
 
This mentality to permit patients to do things that may not necessarily be good for them or for those around them isn’t a new phenomenon. And it sure isn’t unique to the president of the United States.
 
Customer or Patient?
Somewhere along the way, our healthcare system became a system that prioritizes customer service over patient care. The clinical needs of the patient come secondary to the patient’s immediate wants. Being a customer and being a patient are not at all the same. A customer is a consumer; a person who has purchasing power and therefore can exert some influence over another party. A patient, on the other hand, is the recipient of medical treatment and care. They are not at all two sides of the same coin and shouldn’t be treated as such.
 
Why is this even an issue?
Being a customer and a patient at once can often be a conflict of interest. We all know that the things we want in life are not always good for us. We are human after all. There is no shame in admitting that we have a strong preference for immediate gratification. The concept of delayed gratification is not innate. It’s a learned skill that at times we can implement rather effortlessly and at other times we cannot.
 
Think about the last time you were sick. Unless your appetite was lost as a result of your illness, my guess is you probably found yourself craving certain comfort foods. Chances are, you weren’t thinking much about getting your workout in for the day or making the healthiest food decisions. Many of us seek comfort and indulgence when we are vulnerable and there’s nothing inherently wrong with this.
 
It’s also very natural for us to want to exercise autonomy and free will. We don’t like being told we can’t do something regardless of who’s imposing the restrictions. Yes, we trust our healthcare providers for the most part. But we still don’t want to be told “No”.
 
My experiences as a nurse
I can’t tell you how many times I’ve found myself in situations when I knew that caving to a patient’s immediate desire might harm them. Despite this, we were given clear directions from both the attending physicians and from upper management that our priority was to keep the patient happy. What was actually good for their health seemed to be more of an afterthought.
 
The man who loved sugar
Let me share an example here to help demonstrate what I’m talking about.  A patient was admitted for uncontrolled blood sugar levels. His blood sugar was consistently between 300-400. To give you an idea of how high this is, an optimal blood sugar level should be less than 140. He was in the midst of a health crisis and it was critical that we bring his blood sugars down before further damage was done to his body. He’d already had one foot amputated from diabetes complications.
 
Logically, he knew how important it was for him to limit his sugar consumption. And I’m sure his sugar cravings were intense. But this was a serious matter and his desires had to be put on hold for his own good. Or so I thought. Being a newbie nurse, I assumed we’d take all measures to protect him from himself, to help him pull through this health crisis. I couldn’t have been more wrong.
 
While technically on a hospital’s “diabetic diet” (a diet where each meal might have more sugar than I consume in an entire day), his whims and cravings overrode any efforts at keeping his blood sugar under control. He ate whenever he desired, never waited for the requisite insulin injections at mealtimes and ate as much sugar as his weakening heart desired.

We were simply advised to keep him happy in an effort to prevent him from complaining about us on his patient satisfaction survey once discharged. We were aiming for high satisfaction scores and we weren’t going to let a person’s health get in the way of achieving this goal!
 
“Did you ring, Sir?”
Ahhhh that good ole ubiquitous call bell….I’m sorry... but there is no other way for me to view this horrible addition to the bedside other than comparing it to a servant’s bell. Don’t get me wrong. It’s absolutely vital that your patient be able to reach you in case their safety or health is in jeopardy. The use of bells to request assistance from others is nothing new and I am all for it. It’s the abuse of bells in the hospital setting that irks me most.
 
In a hospital setting, it’s important that urgent request for assistance are differentiated between non-urgent requests for assistance. Yes, there are emergency bells that sound different than the standard call bell. But for all other requests under the sun, the patient is told to ring that darn bell. They are told to never hesitate to ring that bell, no matter how seemingly trivial their request might be.
 
The end result is dangerously understaffed nurses and aides running all over the place like chickens with their heads cut off, trying to keep up with this incessant cacophony assaulting our ears for 12+ hours and wearing on our very last nerves. After all, our ultimate goal for the shift is to make people happy. Our next goal (if we have any time left) is to save lives.
 
One time I was actually reamed out by a patient’s family member who was tired of waiting for a new pair of socks for her father. What was the cause of the delay, you may ask? My patient in the room next door to her father was coding. He was in cardiac arrest. Later on when I tried my best to calmly explain the reason that no one could answer her call bell, she only became more agitated. I then listened with a dumbfounded look on my face as she actually uttered the words, “that is not our problem”. 
 
Catering to every patient whim is not only unrealistic on understaffed units, and is not only harmful to patients sometimes, but it also promotes the total loss of human decency and compassion. It only serves to endorse this “me-first” mentality that already runs rampant in individualistic societies.
 
What can we do?
Medical care as a for-profit business model isn’t going anywhere anytime soon. It looks like it’s here to stay. It’s not all bad though. Some healthy competition between facilities might be necessary. It might help to improve standards of care across the board.
 
But fortunately there are a few things that patients can do to try to lessen the negative impact of the patient as customer model:
 

• Educate and advocate for yourself

Believe me when I say, I’m a bit anti-authority myself. I am not suggesting that we blindly follow all healthcare advice dispensed to us and become yes-men while receiving medical care. A balance of power between patient and provider is ideal. Gone are the days when we are helpless, passive recipients of care without voices.
 
Instead, I suggest that you educate yourself on your condition as much as possible. Become a collaborator and share decision-making with your provider. Respect their knowledge and expertise but also share with them your values and your body’s unique needs. Really try to understand why certain restrictions may be in place. You will often see that restrictions are only in place to help keep you on your track to recovery. Having said this, if you still do disagree with a certain treatment plan, also understand that as a patient, you have rights. And this is when it’s time to speak up for yourself.

• Be patient (no pun intended)

It’s easy to understand why people want to get all they can out of their healthcare experience, given the outrageous costs of our healthcare system. A hospital stay can sometimes feel more like a hotel stay. But it is not a hotel.  And you are not a patron. Understand that healthcare providers are there to give you medical care. We are trained to provide treatment as needed. Unfortunately we do not have the time to be at everyone’s beck and call all the time. For us to deliver the absolute safest, highest quality care, we need to be able to direct our efforts where they are most needed, when they are most needed.

• Don’t demand meds and/or treatments you don’t know enough about

The U.S. is one of the few countries in the world that allows direct advertising of medication to consumers. A quick 20-second commercial is not long enough to determine if that medicine would work for you. You don’t know that you need an antibiotic unless it’s determined that you have an infection that a specific antibiotic would be able to treat.

Demanding antibiotic treatment when you don’t actually need it can cause more harm than good. It can create superbugs and cause antibiotic resistance. Some of these medications, while often seen as quick fixes, can actually have a lot of nasty side effects. You can only make an informed decision once all the risks and benefits of taking a particular medication have been measured.

• It’s okay to view yourself as a patient

We are all vulnerable at times. It’s okay to need guidance, support and treatment. When we are seen as customers, we are simply seen as a person that is participating in a transaction. Services are rendered and money is paid out. It’s actually kinda cold and heartless.

But when we are seen as patients, we are instead subtly communicating our need for compassion from our fellow human beings. We are not mere money bags. We are people in need of care and there is nothing wrong with this. In fact for this reason alone, the care that we receive as patients trumps the kind of care we could ever receive as customers. Embrace this relationship between caregiver and patient because in reality, it’s far more healing and therapeutic than the customer/server relationship could ever be.
 
A Nurse’s Pledge
As a nurse, I took a pledge to Do No Harm. Finding myself in the conflicting roles of customer service rep and healthcare provider has not been easy. A piece of your nurse spirit dies every time you reluctantly cave in to a patient’s self-harming desire. Another piece dies every time you’re forced to tend to that pesky call bell patient rather than spend some time with that quieter, immensely lonely patient that is terminally ill and on his last leg.  
 
By just a slight shift in perspective, each of us can do our part to try to create a more compassionate, safer healthcare system for all.
 
What are your thoughts on this? Does this resonate at all with your experiences in our healthcare system? We’re always open to new perspectives so please feel free to leave a comment below to share what you think!