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At The EMT Spot, there is an excellent guest post by Sean Fontaine Objectivity and Patient Care
Steve Whitehead introduces this guest post with –
I love posting articles controversial enough to warrant a disclaimer.
We shouldn’t need a disclaimer that – This should make you think.
This is encouraging us to care for, rather than care about.
This is relevant to the discussion of nebulized naloxone, where Mike made a bunch of comments suggesting that we have to do something, or else we just don’t care. This is a dangerous idea, but not at all uncommon in medicine. This hypocritical affectation of moral superiority kills patients.
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If we don’t do something, we don’t care.
If we don’t get excited, we don’t care.
This is exemplified by –
When in danger or in doubt,
Run in circles, Scream and Shout!
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What does Sean write?
I contend that when we emotionally care about our patients we become subjective caregivers and as such render subjective care, transitioning to reactive rather than proactive medicine.
The big problem with subjective (emotional) care is that it encourages us to Just Do Something!
This is bad.
Why should we assume that something is better than nothing?
Why should we assume that nothing is bad patient care?
Because we are unrealistic optimists. This is why so many believe in spinal immobilization.
When treatment with nothing, but pretending it is something (homeopathy) was made up by Samuel Hahnemann, there was almost no evidence-based medicine, so common medical practice was often more dangerous than doing nothing. At that time, homeopathy was not a bad idea – but only because the alternative was often worse. That is not true today. Medicine has made progress. Homeopathy cannot make any progress, because there really is nothing there.
Sometimes doing nothing is the best thing we can do for the patient. This is called Benign Neglect.
Neglecting to do something bad is not bad patient care.
Doing something bad is bad patient care.
Doing something just for the sake of doing something is bad patient care.
Don’t just do something, stand there!. This is much better than doing something just for the sake of doing something.
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As you can tell by my verbiage the line as I see it is, “Caring for your patient equals proactive/objective care, whereas caring about your patient equals reactive/subjective care.
Too often we have people tell us that we just don’t care, as if becoming emotional about something is somehow a sign of moral superiority.
Apparently, these people just don’t understand.
Where is the benefit of harming patients through emotionally charged, but misguided, treatment decisions.
The idea that we should make emotional decisions would have us following the, What if . . . ? approach to patient care. Using this approach, we would give the patient every treatment we have, not because a treatment is appropriate, but because we are not thinking and we cannot be sure the patient does not have something that will get better with something we carry. We would not allow patients to refuse treatment/transport, because the patient clearly does not understand the gravity of the situation – What if there really is something wrong?
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Every patient is deserving of our best and most objective efforts.
This is the problem of bad patient care and alternative medicine. We mistake doing something because we can for doing something because we understand the potential benefits AND we understand the risks.
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To be continued in Part II.
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I think it is possible to both “care for” and “care about” patients.
Caring about the patient does not necessarily lead a provider to the “do anything, just do something” mindset.
However.
Being able to keep a balance takes a lot of training, a lot of practice in dealing with staying focused while under extreme stress. It is a learned behavior.
There is a big difference between “emotionally connected” and “overly emotionally involved.”
Not everyone is able to keep that balance, which is why many providers burn out early.
I think if doctors were able to actually give people the straight truth about their problems, they would care more. Most people want you to give them a pill, tell them it’s fixed, and send them on their way. Why would you want to care about them?
Example: I am the only person my doctor sees who manages their ulcer/stomach issues with diet. My doctor knows I hate pills. She also knows me and cares about me so we tried the diet. Not only did it work, I dropped 15 lbs. and am in the best shape of my life – all because my doctor knew me and cared. Sometime it is the patient, not the doctor. If more doctors could tell the straight truth to their patients, we’d see a lot less problems today.
I think it’s important to remember that “objective” does not mean “uncaring”. IMHO, it is important for us to care about our patients as people, so as to have some compassion if not empathy. Objectivity simply means not letting our caring or feelings interfere with our professional judgement.
Mr. Fontaine says it very well here:
> During those instances, I stated with no intended malice, that a sick, dying or dead pediatric patient
> demands the same mental cognizance as a sick, dying or dead adult patient. As such, I see no
> reason to change my treatment or mindset because the pediatric patient is viewed as “innocent” or
> deemed “more worthy” of our efforts by some caregivers who then become emotionally involved with
> the patient. All patients are “worthy” of our full and complete efforts and treatment. That’s our job.
Don’t change treatment because of how you feel about the patient; the correct treatment doesn’t change whether you like or hate the patient. True objectivitity is a difficult goal in any profession; it just gets harder when the outcome stakes are higher.