Some Tired Kristen miscellany
In the last six days, I've worked almost 50 hours at the hospital, so the current version of me is a little on the tired side. I am very happy to have some days off now!
I was planning to do another edition of our Tightwad Gazette book tour, but that can wait until next Wednesday. 🙂
For now, a few miscellaneous things to tide you over for today.
A poem for me
In a recent issue of James Clear's newsletter, he shared this Emily Dickinson poem:
"If I can stop one heart from breaking,
I shall not live in vain;
If I can ease one life the aching,
Or cool one pain,
Or help one fainting robin
Unto his nest again,
I shall not live in vain."
And I immediately thought of how this applies to nursing. I've written before about how sometimes the problems of the world feel overwhelming because I cannot possibly help to fix even a tiny fraction of them.
But what helps is remembering that I cannot change the world, but I can change the world of the person in front of me.
I am such a tiny cog even in the machine of my hospital, but for the 6-7 people assigned to me each day, I am a main character. I can ease the aching for those people, that day, and that is enough. 🙂
Patients vs. Clients
In my nursing school curriculum, efforts are being made to phase out the word "patient" in favor of the word "client".
This strikes me as weird when we are talking about something like a person getting cancer treatment. "Oncology client" feels almost disrespectful because "client" to me has connotations of choice, like when you have an elective nose job.
Cancer treatment is quite a different animal.
Anyway, in my real-world hospital experience so far, I have noticed that exactly zero of my co-workers have referred to people as clients. Everyone still calls them patients and they just laugh when I tell them my textbooks seriously do say "client". Ha.
I dunno. Maybe down the road "client" will happen, but right now, it seems to be a thing limited to textbooks and classrooms.
(I sort of want to quote Mean Girls and say, "Stop trying to make client happen. It's not gonna happen!")
Deep, but short
I have been thinking about how interesting hospital health care is because it is both deep and time-limited.
A perfect stranger gets wheeled up to my floor, and in a matter of hours, I'm getting very up close and personal with my patient. There's the physical part of really getting up in someone's business, but it usually doesn't take too long until the patient gives me a peek into the rest of their world too.
We spend a couple of days together, I cheer them on, empathize with them, feed them, ambulate them, and take a bazillion vital signs, among other things.
Then we say goodbye, and off they go to live a life that probably will never cross paths with mine again.
It's sort of a unique experience, for a relationship to be so deep and also so short. But even though it's brief, it feels rewarding to me to be able to make a little difference in people's time on our floor.
A plot trope that gives me anxiety
Sometimes when I am in patient (err, client?) rooms, I catch snippets of the TV shows that they are watching. Last week, one of them was an episode where a character was expecting a huge windfall of money, so he was spending money lavishly in anticipation of the payday.
I didn't see the whole episode, but I am absolutely sure that it ended with him not receiving the expected money.
And oof, that common storyline makes me feel so nervous when I watch it. I see the writing on the wall and I want to scream, "NO NO NO DON'T DO THIS!!"
My risk tolerance when it comes to money is very low, so if I was expecting a windfall, I would never, never, never spend a penny of it until the money had hit my account and the hold had been released.
My reaction made me wonder if other fellow frugal people have the same sort of discomfort as they watch characaters count their chickens before they're hatched!
It does, a lot!
I love your knit TV 🙂
I do actually appreciate the word client. To me, it implies a partnership relationship where some might interpret patient as a passive recipient of Care. I agree that someone doesn’t choose cancer or any other illness, but we all do choose whether to treat our illnesses or not, and many times often choose the doctor, the clinic or hospital where we seek treatment, so I believe that it’s important to consider that part of the word client as well. Regardless of all that, I certainly have no problem with referring to me or any others as patients.
@J, I like your line of reasoning about "client." And "client" is certainly now the term of choice in my former area of copyediting expertise (mental health treatment of all sorts), though I didn't realize there is now a push for it in the more strictly medical health professions. At DH's nursing home, the preferred term was "residents." But, like Kristen, I've observed that in all settings, most of us go right on referring to a "patient." It may take a long time before "client" seems natural.
@A. Marie, @J, I'd probably accidentally refer to patients as "customers"!
Both of my older sons had to be in the hospital for five days because of jaundice when they were born. A few weeks after my second son was released from the hospital, I was at the mall in the small city the hospital was in, and saw one of the nurses that took care of us. She was there with her family. It took me a second to place her, because it was so strange seeing her out of context. Like kids seeing their teachers out in public. Or the time I ran into our priest at the grocery store. 🙂
I can't stand calling patients or students clients. To me it just shows how everything has to be given a corporate spin!
@Sophie in Denmark, I came here to say this. I’m in education and the changing of students to clients alters the perceived relationship. Education (and healthcare) is more than the transaction implied by employee-client titles. It seems to depersonalize the relationship.
@Sophie in Denmark, On one hand, I appreciate how it helps to balance power in relationships like therapy. But in a more clinical setting, "client" makes me think of a business transaction. And I really don't love to be reminded how much I have to pay for dentists and doctors LOL
@Sophie in Denmark, Same. “Client” reduces a person to someone simply paying you for a service.
@JenRR, That's why I like it. Hey doctor, I'm paying you for a service, just like my plumber.
@JenRR, I agree. That’s the connotation I take away from this use.
@JenRR,
Same here. You put into words what makes me uncomfortable with calling patients "clients". Thank you.
@Sophie in Denmark, I agree!
@Sophie in Denmark, as I said above but not quite so specifically, "client" sounds like a fancy word for "customer".
@JenRR, that is exactly what too many doctors think. In addition to being stupid. The US medical system runs in spite of itself but there will be a breaking point.
@Selena, Agreed. "Client" describes a commercial relationship. The bean counters love that, keeping everyone thinking about money. Reducing relationships to money is a sad direction that ignores the special relationships that happen between people of particular connections: teacher/student, nurse/patient, parent/child, architect/builder. Maybe it is also a failure of vocabulary? Tho I think the intent of the "client" change is to help the medical staff beware of the "us v. them" attitude that can ignore the needs of individuals to be recognized as themselves, not as numbers on a roster, or diagnoses in an exam room.
One of my friends who had an array of lingering health problems after cancer surgery used to argue against the use of the term "provider" in medical settings. He would tartly say, "I was treated by a doctor, not a 'provider."'
Several times in the course of DH's career he has worked for companies that gave out a profit-based annual bonus, and twice had co-workers who got into some serious financial difficulties when they spent the bonus before receiving it in a year when it was greatly reduced.
@Ruby, I can see "provider." So many kinds of people treat patients now: PAs, nurse-practitioners, etc, not just clients.
@Rose, "not just doctors."
@Rose,
I totally agree. if you tell people in general to "check with your doctor about [x]", and they see a PA, CNP, etc. instead of a doctor, the person may or may not follow through on what you've suggested they do.
I could maybe see the word “client” for routine follow-up visits, but when I got very suddenly and unexpectedly extremely ill and ended up in the hospital for five days, I was in no sense of the word a “client.” (I’m fine now, that was decades ago.)
I can’t watch shows where part of the plot line is people being really stupid, which definitely includes spending a windfall before receiving it. I don’t even think you have to be especially frugal for that to bother you. It just requires a little common sense.
I think the plot trope that bothers me the most is when character A talks about character B behind their back, but character B overhears. So cringe!!
One time in high school I had a moment like that, where I spoke about someone behind their back and they discovered it. I learned a very important lesson.
We just rewatched the episode of Friends where Ross makes a pro-con list for dating Rachel, and she ends up FINDING it! ARGH IT'S SO BAD.
What portion of the Tightwad Gazette will we be discussing next? I like to look over my book ahead of time, but I’ve lost track!
Summer, from book one!
Our children have sung a choral arrangement of the Dickinson poem that is very beautiful, I Shall Not Live in Vain, by Ruth Morris Gray, in case you want to give it a listen. Apparently there are quite a few other choral settings of this poem.
https://www.youtube.com/watch?v=PBf2m1ypjFM
@Jan G, Beautiful!!!
@Jan G, That was lovely, thank you for sharing it.
There's another way to look at the use of "client" versus "patient" and I speak from experience of 10 plus years dealing with the medical community for diagnosis, treatment, post-cancer issues.
I also speak as someone who spent over four decades as a creative services provider to clients of all kinds. When you provide a service, of any kind, you, in fact, whether you choose or not, you have clients for whom you provide a service. This is a totally different headset for many people, one that they do not get.
I went from being a creative (writer, editor) for various media, a majority of which were publications (print, online) to the head of a small marketing services company with Fortune 500 clients.
I thought I understood the shift required in terms of interacting with clients. But in the first month or so, my boss, the owner of the agency took me aside and explained a few things. First of all, she emphasized, you never, ever say NO to a client. (When asked for things to be done that were not in budget or not something we as an agency could do, I had simply said: "I'm sorry but no we can't do that.") I didn't get it until she explained that we always, always emphasize what we can do first and foremost. That we generate more conversation around the request, that we offer alternatives or other ideas and suggestions when clients put forth unfeasible requests (demands in some cases). But there is no, NO.
Once I understood what she was talking about, it literally shifted how I interacted with clients. I wasn't just providing a service, I was putting the client at the center of what I did and not just the service. I was there to reassure them, to assist them, to make it easier and better for them to get what they needed. I was to BE. THERE. FOR. THEM. To put their needs (spoken and unspoken) first and foremost and then best meet them.
The issue in healthcare is that doctors, nurses and other medical staff all too frequently, especially in the last decade or so as the demands on them have increased to the point that many have left medicine because they feel they cannot provide the care their patients deserve, they don't act as if they are there to be of service ---AS WE, THE PATIENTS DEFINE IT---but only as they choose to provide it. For every individual who provides truly patient-centric care (based on that patient's needs and not a textbook or a system or a process) in a way that we, as a patient, feel seen and heard, there are many who treat us rather badly in terms of communication, response time, recognition of needs and help in real time, etc. They make ER and hospital visits a living hell, far more than they inherently are due to a medical problem. (I'm in a wheelchair. I have an overactive bladder and need to get to a bathroom sometimes multiple times in an hour. It's tough enough at home when I can wheel into my bathroom within seconds of knowing I have to go, which, I emphasize is needed quickly. No time to wait for someone to unhook my IV bag(s). So I try to prevent this problem by asking to have my IV put on a pole, so I can wheel it and me to the bathroom. Almost every time, I get told: "Oh, we don't have one, you don't need it. " Well, yes, I do and it's not for YOU to decide. How many times I have had "accidents" because of this because no one is available. Because I cannot move my legs and walk and get off those high ER beds, for example, I asked to be left in my wheelchair. WHY? So I don't have to seek help that isn't available and allow nurses, etc. more time to care for others in greater need. I'm told: We can't do that. (List of why not is long but not valid.)
I have been in the hospital numerous times where, even after being told, made aware,
that I need the wheelchair RIGHT IN FRONT OF THE SIDE OF THE BED, so I can get in/out of the bed for multiple bathroom trips on my own without ringing for help, they LEAVE IT ACROSS THE ROOM. So, what part of "I cannot walk and barely stand on my own without something to lean on" Do they NOT get?
Now, if you had hired an aide to assist you in these circumstances, it's their job to do these things, as you ask. Why? Because you pay them. But here's the thing...I AM PAYING the medical staff via either insurance or my taxes. But I don't get the services I need for the most part, which in most cases simply requires them to meet some very doable requests, which they would, if they truly viewed me as the client, whose needs have to be met.
It's all on the medical staff terms...not on ours. From the minute you enter the "system" whether a doctor practice, hospital, ER (especially) or another venue where medical care is provided. It's as if medical staff have totally forgotten that we are (in one way or another, even if someone is without insurance) PAYING for services, SERVICES THAT WE DEFINE. Too often it's all about the providers and their issues or limitations, etc.
In many cases, you are treated as if you are a burden with your needs/requests (No matter how small, reasonable or actually needed. We're not talking diva behavior here on the part of the sick person.) and not only a burden, but you have no right to ask! You are dismissed, sometimes verbally (After waiting almost three hours to get discharge papers, with a service I had called to pick me up and which would leave if I was not outfront of the hospital, the nurse who was responsible yelled at me that she was "Busy with other patients, didn't I know that?" Well, fine. But you had three hours to get to the paperwork and you did not. Did you not understand that I had to get out of there by a certain time (established upfront by the hospital! Not me. "You have to leave by X hour." I agreed and arranged accordingly, not easy, as you sometimes have to wait hours for a service to pick you up. Again, I question whether it is a service at all, if you pay but then you don't make yourself available as I need and request. )
Other times requests were either ignored or dismissed outright with no attempt to fulfill them. Now, someone who is truly patient centric doesn't need to think "client" or "patient" (as you are Kristen) but for those who don't put the patient first...they do need to be told: You provide a service. I am your client. You are here to provide assistance as I define it and need it at times.)
It's a headset change. I went from someone in the marketing services agency who thought her job was just to provide the physical products of the service to a client based on how I thought they should be provided to someone who started with the client and how they wanted to work and how I could meet their needs. It's hard to write about it here but anyone who is truly a service provider gets what I'm talking about.
So the long way to make my point: A word choice is not a random thing. It has meaning and purpose.
Hospitals have been changing the names of the various departments and individuals who are specifically charged with meeting the sick person's needs as they are defined by the sick person, not the service providers. Sometimes it's all just a game because there is no real shift in terms of the interaction and attitude.
Doctors in particular often misunderstand their role. As a "consultant" for many years, the hardest thing to deal with was that clients could accept or reject, my advice with no reason or rhyme. I mean, hey, you're paying for my expertise but you reject it? If you are to be successful as a consultant, you change your attitude and realize that you are here to OFFER your best advice not MANDATE IT. And to not criticize, argue with or subtly or not so subtly try to mandate compliance.
Think about how your doctors react when they tell you to have a certain procedure, take a certain drug, undertake a certain course of action that you, hopefully with enough information to make a truly informed decision (rarely enough time or info) will then follow as they have stated. A good, patient-centric doctor will deride you or your choice if you disagree or don't want to opt for the recommendation. They will start by asking if you have other questions or need more information. They won't give attitude or get huffy when you decide NOT to take your advice. Because, hey, they ALWAYS KNOW BETTER than you about your own body (How many times have we had our health jeopardized and worse because doctors think they know it all, for everyone. One size patient does not fit all, especially as you age.)
I didn't plan to write all this but I was happy to hear that wherever Kristen is enrolled is taking this approach. I was concerned by her and fellow classmates negative take on all of this and their belief that it is semantics. IT IS NOT. There IS a reason and though it's clear Kristen provides good patient centric care no matter what a sick person is called, as she goes through years of working in a system, her ability to deliver the care she knows a patient needs, may be compromised. (I have had countless conversations with fabulous nurses and doctors and NPs and PAs about how the system works against them delivering needed care. How they feel as if they may have to leave because they cannot help their patients.)
Client: Requires care defined in part by the sick person
Patient: The sick person whose care is defined almost exclusively by the health care provider.
@Irena, I'm not sure I like either word, but your explanation makes me like 'client' better. I absolutely agree with your take and think you would make a great teacher for medical personnel on this issue.
I'm old enough to remember when doctors were considered gods and their words were never questioned, just followed. I sometimes have difficulty dealing with the new 'partnership' concept in medicine. As much as I feel I know what's right for me and my body, I still have a very hard time saying no to treatment a doctor insists (or commands) that I need.
@Irena,
This is such a good point, and I agree. I think this is the rationale behind the shift. There is often a serious knowledge imbalance between a service provider and a client whether you are a brain surgeon or a plumber.
I am an attorney. I used to work for the public defender. Even though my clients absolutely did not choose to hire me, it was important to refer to them as “clients” as an expression of respect. In that job, the knowledge imbalance was usually extreme as my clients often lacked formal education. It was important to speak to them as people worthy of respect and capable of making decisions in their own best interest.
My clients have often been wrong, often frustratingly so. They are often wrong about facts and usually wrong about the law. Assisting them in making legally and factually correct decisions is both complicated and humbling. I imagine this is similar in health care.
I recently accompanied my close friend to the hospital when she had surgery. She has class III obesity and it was eye opening to see the difference in the way she was treated by health care professionals vs the way I am usually treated as a generally physically healthy person. Following the surgery, one of her arms was all red and her fingers had swollen up like sausages. This was alarming and I pointed it out to the nurse. She said dismissively, “Oh, don’t they always look like that?” I said, “No, they do not, please compare this arm to her other arm.” It was ridiculous. Nurses also kept making comments about “lifestyle choices.” I can definitely see the need to educate medical professionals about respecting those in their care.
@Irena, I know how you feel. When I was in the hospital for a week or so in January 2023, I could not walk because of electrolyte imbalances and I also had uncontrollable diarrhea. All due to campylobacter infection. I could not get my nurses, aides, etc to understand I needed a bedpan on the bed because I could literally not wait for them to get one. AND I needed a large one because the smaller ones they kept bringing me overflowed. You know what's a great feeling? Not that.
And then when I'd been there for a few days and decided I'd had enough of not being able to hold it while they found a bedpan, I'd use a walker to get to the bathroom, I wasn't allowed and finally a nurse shoved a walker at me and snarled, "You wanna go? Let's see you walk!" I said thanks, unhooked the IV, walked over and then used the toilet. Good times.
@Tarynkay, Reminds me a bit of how ER doctors treated my father in the ER when he got so dehydrated he had hallucinations. My blood boiled and I privately yelled told them that my dad was a former marine, a highly decorated NYPD officer and an artist, and he needed to be treated with respect. Ever notice how to doctors, they're Doctor Smith but we're just "Rose"? annoying. I didn't say not to call my dad "Bill," but I thought it.
Nurses and techs are first-name basis with patients, interestingly. In fact, for safety purposes, we usually only have our first names printed on our badges.
How I address patients varies; I guess I kind of play it by ear, and I am not super consistent with whether I use first names or last names. But regardless, my tone and behavior is kind, warm, and respectful, and I think that is probably what matters most.
(You can use "Mr. SoandSo" in a very unkind and disrespectful way, you know?)
@Rose, funnily enough, in Denmark, EVERYONE is referred to by their first name regardless of what their status is. Even the prime minister is referred to by her first name. It's seen as being more rude to call someone Mr/Ms Last Name as that is perceived as creating distance.
@Kristen, it wasn't so much the first name part, but their treating him like an old drunk wreck. Yes, Dad had been drinking too much. So? He was 74 years old and alone for the first time in his life. He'd barely ever been apart from my mom for 51 years and now she was in rehab for her stroke. I have always loved and respected my dad and to see him treated like that was heartbreaking.
(To be honest, I had a lot of heartbreaking those years, from divorce, jail, death, disability, my mom's suicide attempt, you name it, it went wrong.)
That’s what I’m saying; the attitude and treatment is the main issue no matter what words are sued. And I’m sorry your dad was struggling so much. That must have been very hard to watch. ♥️
@Irena, I do understand your frustration with small medical related requests being forgotten about, although I'm sure it is not on purpose. Perhaps you could watch them closer until the request is fulfilled correctly.
But personally, I take GREAT exception to people who will not take NO for an answer. I believe they are called entitled and they make life so difficult for others who are in their lives. Just my opinion.
@Tarynkay, I am a believer that no one should go to the hospital alone. One should always have an advocate present. It is not only a help to the patient, but it can be a help to the providers.
When my MIL was in the hospital, she could be quite combative. She suffered from dementia and hospital visits really agitated her. She would call the nurses names and yell at them. I could calm her down and explain to her what was happening. She would listen to me. I also made sure that the nurses administered Ativan - which she was taking on an as needed basis - before attempting any type of procedure like blood work. It made life easier for everyone.
@Kristen, it wasn't so much my dad struggling as the ER people treating him with such disrespect. My dad was a Marine who helped save Vice President Nixon's life when his car was attacked by a mob in Caracas in 1958. When Nixon was president and Dad ran into him as a police officer, he mentioned he had been in Venezuela with him and Nixon shook his hand and thanked him personally. Apparently that incident shook Nixon badly as he might easily have been killed. Everyone dislikes Nixon today for obvious reasons but at the time, a mob coming attacking the Vice President's car was deeply shocking.
Dad loved children and animals and was a brave, intelligent, talented and funny guy and he didn't deserve to be treated like a derelict.
Sorry. Loved my dad. I get choked up about him. And his last words to me in the hospital were asking how my mother was.
I am also sorry he was being treated poorly; I try to always remember that I am seeing a small snapshot of a patient, on what is one of the worst times in their lives. So, it's not fair to make a judgment based on that, and besides, no matter the circumstances, that person is a human being who deserves care.
I had a patient chained to the bed recently, with police officers standing guard 24/7, and when he asked, I went on the hunt for coffee for him, asking him if he wanted cream and sugar, just like I would with a non-arrested person.
@Rose, I had a similar experience. My MIL was hospitalized for a severe infection and being dosed with morphine. She was constantly complaining about kids running around the room and jumping on the bed. The nurses and even my SIL dismissed her complaints as hallucinations and not always nicely. Little did they know, the grandchildren of the woman in the other bed were being sneaked up the steps down the hall and were running around, yelling and jumping on the bed. I caught them in the act one day and set the record straight.
@Irena, everything you say is valid. I say this as a healthcare provider who has totally seen this shift over the past 25 years.
I have always tried to do right by my patients, regardless of how much energy, effort, and time it takes me. As a result, I’m pressured by administration to see more patients, to rush my visits, to keep squeezing more patients into my schedule.
I left my job of 25 years in June. As much as healthcare has always been a calling for me, I’m just not sure if I’m going back.
Some less than stellar hospital systems, as well as bad leadership at our hospital (administrators and my section manager) for lack of a better term…suck.
@Tarynkay,
The way overweight and obese people (patients/clients) are treated by health care professionals of all kinds is appalling. There is an alarming amount of negative bias towards overweight and obese folks in the health care world - I watched and listened to a webinar last year on just this topic. As a hospital dietitian, I have received consults to educate obese ICU patients on a weight reduction diet....guess what.....when you're in the ICU is NOT the time to learn about how to lose weight. (Insert major eyeball roll).
Everyone who enters the hospital anywhere - not just where I work - deserves to be treated respectfully and with compassion. I am not perfect by any means, but I really try to do just that, even if the person I'm taking to doesn't agree with me, or has no intention of doing what I suggest.
@Rose,
I usually say "hi, Mr. SoAndSo", and if they then say "oh, call me Bill", then I call them Bill. I will say, everyone's electronic medical record where I work includes their full name as well as what they generally wish to be called ("Betty" instead of Elizabeth, for example, or a nickname, etc).
@Irena, Your comments are a perfect example of how a well thought out and rationally presented explanation can change people's minds. I had not considered many points you made, and I have had an intimate involvement with the health care system almost since birth due to a cardiac defect. Thank you for taking the time to give another viewpoint.
@Liz B., OMG, the discrimination against the overweight is utterly shameful.
My sibs and I laughed, when Dad was admitted after the dehydration thing, they gave Dad nicotine patches etc. He's been smoking 4 packs a day for 60 years folks: goooooooooood luck with that. I once promised to buy him a new Corvette (his dream car) if he quit. Needless to say, I never had to shell out. (And he didn't die of smoking related disease either.)
@Rose,
Your dad sounds like a wonderful man and it’s tragic that the hospital was treating him so poorly.
Treating everyone like they saved the President’s life is a good default setting.
Firstly bc you just really never know, secondly bc everyone is precious, and thirdly, bc people do tend to rise to expectations.
@Liz B.,
It was appalling to witness, especially the part where the nurse was just brushing off serious symptoms bc of her bias.
@Rose, I think it is a loss in my life to never have known your father. It would have been amazing to have conversations with him. You were a blessing to him! Your love made his passing blessed. From one loving daughter to another, Frances
@Irena, what a thorough and excellent explanation! If only the people required to make the switch from "patient" to "client" understood the approach, all would be clear and simple and understood. It is very hard to be told to do something that makes no sense—when stuff comes as a mandate or a command without explanation, it feels so irritating and unnecessary. The words are just symbols; it is the understanding makes the difference.
@Tarynkay, Thanks for being a PD. You do really important work for very little pay. During my son's legal travails, I got to know several PDs and felt very humbled by them.
The first time was literally the day after my husband left. (Yes. He left knowing his son had a date in court the next day.) I found the courtroom where the hearing was supposed to be and a man came over and said he was my son's public defender. To this day, I have no idea why someone decided he/we needed one, except that maybe he was listed as not having an attorney (I didn't know he needed one; I thought it was a formality) and decided we were indigent? I still don't know. And I was so shocked and upset about my husband I literally couldn't take anything the lawyer said in. I had to ask him to repeat it at least twice or three times. I didn't know anything at all about criminal court and I'm still shocked at how inefficient and illogical the system is. (Eventually I decided my son needed more aggressive representation and I hired Long Island's favored Mafia lawyer, not even joking. He was expensive but he was great.)
@Bee, my mom had dementia. Sibling and I took her to a doctor visit. We went into the exam room and she saw the speculum, stopped dead in her tracks. I asked the nurse to remove the cart. If the nurse didn't, I would have. Her doctor didn't push it but if she had, I'd have been mom's ally, if sibling didn't beat me to it.
@Liz B., I also find it hypocritical when a medical professional lectures about weight and the pot is calling the kettle black.
@Rose,
I’m not currently working as a PD, but thank you! My brother spent a lot of time in the criminal justice system which definitely affected my career choice.
If your son was a minor at the time, he was technically indigent. They don’t count the parents resources for the minor at least in my state, though they do bill the parents for any jail time the minor serves. When parents are involved, they usually do hire a private attorney when they are able.
If he was an adult at the time, they would have counted only his resources and not yours. Many people are assigned a PD and then find the resources to pay an attorney, which is honestly a really good idea if you find a good criminal attorney and don’t just assume that any attorney you pay for is going to be better. But generally the PD is going to be very overworked and sadly, may also be just over it. For example, I know a PD who closed his private practice and got a PD job bc he is going through chemo. I just don’t think that’s right by his clients, but I get that he needs the health insurance.
It’s also smart depending on the sentence range to wait and see for a little bit bc the PD often has a close relationship with the DA and can get a better plea deal than an outside attorney.
I do not like the term "client" at all - it makes it feel very transactional and related to profits. I think the word patient conveys more compassion/caretaking. I much prefer doctor/patient to doctor/client. Client just feels cold to me! And I say that as someone who works in a corporate role with clients.
A favorite quote of mine, somewhat similar to the Dickinson poem, comes from 19th-century orator Edward Everett Hale: “I am only one, but still I am one. I cannot do everything, but still I can do something. And because I cannot do everything, I will not refuse to do the something that I can do.”
And re: spending an expected windfall before it actually arrives, I'm with Kristen: I am WAY too risk-averse for that. (Even my standing instructions to my financial advisor reflect my risk aversion: "Don't f*** up or down and lose this s***.")
@A. Marie, I love this quote as well as the poem Kristen posted. Both of these are reminders that even the smallest kindness, a thoughtful word, or a friendly smile has the potential to create a small, positive change. I like to think that these kindness may have a ripple effect.
Oh, I hate when I type fast and a key word is left out.
I meant to say that a good doctor will not give you attitude or criticize you or dismiss you as a patient if you do not choose to go along with their recommendation (not a mandate as most doctors treat these things.). They will not write you up in their notes in a way that signals other doctors to treat you and not negatively comment (Example in difference in word choice. One doctor wrote that I "REFUSED" a particular treatment. Well, no, you offered and I DECLINED. There is a difference. And yes, I'm very word sensitive. It's been my professional life for decades. I need to know the differences.)
I have one doctor who is so incredible in how she works with you after you decline a specific recommendation. She asks you to share your thoughts and when available, will provide additional information. But she does not give attitude (verbally or otherwise) and she works with you on alternatives. She doesn't debate you when you say: Please, I am not comfortable taking this drug knowing its side effects. She doesn't diminish my concerns but treats them as legitimate.
Contrast this with a doctor or two that I've had who basically said: Why are you here if you will not follow my advice? Well, because you know what, I ended up in a wheelchair because you never, ever told me that one of the side effects of treatment would lead to permanent nerve damage and inability to walk. That you pooh poohed my post treatment concerns and told me, that "I was alive, wasn't I? What more did you want?
Well, as I had told the one doctor, "Quality of life" Going from being independent to life in a wheelchair? Hello? Losing your total independence. That's a big change. And if I had known, maybe I would NOT have undertaken your treatment plan.
It's like my issue with drugs. I am highly drug sensitive. I explained this to an anesthesiologist (the only one who actually met with me before a procedure, though I had always requested they do so) and told him: I have woken up twice after surgery and been violently ill with severe nausea, vomiting and pain. TOO MUCH medication. PLEASE be careful with type and dosage.
Sure enough, I woke up again and had to be admitted for severe nausea and vomiting and pain after the surgery. I actually got the anesthesiologist to explain to me what happened (Rare to get access. He was a new doctor. He didn't know enough to NOT respond to a patient request. Bless him.) Oh, there was a problem and we needed more time. So we gave you a third drug and increased the dosage on the other two. WTF?
So they knew they put me at risk and that was not a factor. (The reason why they needed more time? The person doing the procedure couldn't complete and had to call in someone else to help. I only found this out by digging, they never admitted it.)
So we know our bodies; we're open to reasoned recommendations that take into account our individual situations. But DOCTORS ARE CONSULTANTS. Not dictators or the final word.
Consultants have clients. Patients are considered passive by most medical professionals. As if we have to be dictated to as if we were children. You wonder why we are not compliant? Because we have issues with your instructions (Could give you dozens of examples of how/why something could not be followed based on patient's overall situation.)
@Irena, Thank you for such a thorough explanation of your thoughts. I am currently on the fence about a drug recommendation because the previous two I tried had unacceptable side effects to me but the doctor seems to feel I should be willing to accept the side effects for a possible prevention of a cardiac event. I need to be more upfront with my request for additional options. Thank you for the boost!
@Irena, You should write a book. Seriously. I've actually considered writing one about the psychological damage doctors did to me (and countless others) from a young age because of just the things you are pointing out. Previously, they always issued mandates and I come from a generation that was taught that everything a doctor said was correct and challenging a doctor about anything was verboten. I'm glad that is changing but there are still doctors out there who don't like to be challenged by anyone.
@Irena, My newest doctor is quite a bit younger and always looks startled if I say no to him. My cholesterol is slightly too high? I'm not taking a statin because they make my chronic fatigue/fibro worse. He actually had the gall to suggest that patients who experience that had a "nocebo" effect. I said tartly that I hadn't learned that about statins until after I refused to take them any more.
He also suggested I go to the closest long Covid clinic, just 2.5 hours away. Hm, you don't quite "get" long Covid, do you? Heh. I do like him, though.
@Irena @Stacey W @Bobi - I am so sorry to hear of your overwhelming negative experiences with doctors and health care professionals. This really saddens me. I also have been in situations when the care that was being given to me or a loved one was marginal. As a result, I encourage everyone to ask questions and speak candidly with your physicians, physical therapist, and pharmacist. You must advocate for yourself and the ones you love. Push when you have to and do not be afraid to divorce your doctor. Irena, you are 100% correct in saying a good doctor listens to you and addresses your concerns.
@Irena, Thank you for strengthening our backbones. Many of us have been taught a passive role with our medical encounters, but new times call for new roles. You have paid a terrible price for this knowledge and have every right to be angry. I hope you can find an effective way to work towards better medical systems nationwide. While I am tempted to blame insurance interferences, I think the patchwork of private businesses is to blame, along with the problem that no one in the U.S. has focused on ALL of us. Excepting maybe public health departments and epidemiologists. If we had a better large system planned to serve everyone, we could agree on many aspects of good service and also on enforcing patient/client rights. We might even influence the profiles of trained doctors. Admission to medical schools is artificially restricted by the AMA, which wants the business to pay doctors very well. If we trained more doctors, the ones who would rather not treat real people could hide in their research labs, or do something else, but we could encourage empathy, good listening, and better communicating along with the study of anatomy, physiology, biology, etc. It is not easy for a person who loves to study science, who is often an introvert, to develop good interpersonal communication skills.
I don't much care for using the word client for patient, at least in a hospital setting. What is the reason they are giving for changing it to client? Were there people complaining at being referred to as a patient?
Sometimes nurses do re-enter patients' lives again, especially in small rural hospitals. When I was entering our little hospital to deliver kid #1, a nurse in the labor & delivery hallway studied DH a second and said "I remember you! You were here with your dad." He had spent the nights with his dad in the hospital for months as his dad slowly died, 10 years before this meeting, and she somehow remembered him. It made him immediately feel better because he remembered that she had been great with his dad and it made him feel good to know she was assisting with deliveries now. You may be someone's welcome and remembered face some day, Kristen.
That trope - it makes me cringe, too. I also have to see the money in my account or my hand first. I had a real-life view of that at the mill where I used to work as a contractor for an outside employer. The mill gave its own employees a hefty - but optional! - bonus each fall for many years, and a large majority of them used it for Christmas. Some put gifts on credit cards or layaway and paid them off with the bonus. Some waited to get the bonus and then shopped, but still, probably 99% never saved up any money from their paychecks for Christmas gifts and holiday vacations, because they counted on that optional bonus. And then one year, things hadn't been great for the mill and that fall it was announced that no bonus would be given. In fact, after that, the bonuses were ended permanently, but boy, that first year, there was utter panic.
So your job title would change to CCT, eh?
The only movie/TV trope that really bothers me is something totally unrealistic. Like in the new M. Night Shamalamadingdong movie (or all his movies, really). The setup is that the "Feds" staged a concert in a huge arena with a pop star and young teenage girls to catch a serial killer. Yes, that's exactly how the world works. Law enforcement puts thousands of children's lives at risk to catch the murderer.
Or just silly sentimental nonsense, like when Spielberg made Kubrick's "AI" movie and I could tell the exact moment when Kubrick would have ended the movie and of course, Spielberg changed it.
Or when there's a really obvious Chekhov's Gun, like the whistle in the movie Prisoners. Yup, all kids love to have whistles around their necks! Rest assured that won't be a tiresome plot point later on!
Just a quick note to say thank you for bringing your whole-hearted self to your work with patients (I too will always say patients! RN for almost 20 years, FNP over 10). I love hearing how you are so intentional in your relationships and I know that you are making a difficult situation just a little easier for those in the hospital. What a gift you give!
Oh, I just don't like the idea of calling a patient a "client". Your take on it is right on....it implies choice. "I'm choosing to have this physical ailment, I'm choosing to spend thousands of dollars here." Someone here in the comments said the word makes it so corporate and that sounds right to me. Like it's a business deal. Patient care shouldn't be "corporate".
I wanted to add that you not only make a difference in the lives of your patients but you've made a big difference in the lives of the people who follow your blog by being relatively transparent with your life. Your divorce, starting over in a rental and all the emotions that go with that, going back to school as an adult. Many people can glean wisdom and get comfort from the things you've shared. For some, that may mean stepping into your blog to read about your trials, getting some comfort from knowing they aren't alone and then, *poof*, they may be gone again having gained the strength to go on themselves. You are helping many....
My risk level is very similar to yours. I do not count my chickens before they are hatched. I am even nervous about a predator getting the chickens after they are hatched.
Also I am glad there are people who can do nursing because I have never ever had that desire. I would be so exhausted at the end of the day beening that close to people all day. Give me my safe little computer bubble in my safe little cubicle. People wear me out.
I agree with your interpretation of client. It does make it sound like that cancer patient or accident victim had a choice.
Haha, and for me, being in a little cubicle sounds terrible! I like being around people.
I watch or listen to Caleb Hammer on youtube and it gives me such anxiety...they usually make decent money, but it is allll spent usually on high interest rate credit cards. It kills me to the point that sometimes I just can't listen to it. And sometimes, he is so unkind to them that I can't take that either.
"Client" is too impersonal. Maybe it is a word if they don't want the medical caretakers to be too emotionally involved.
“If I can stop one heart from breaking,
I shall not live in vain;
If I can ease one life the aching,
Or cool one pain,
Or help one fainting robin
Unto his nest again,
I shall not live in vain.”
If we could talk one to one, and listen, share. Maybe then we could understand each other. People who end up in the hospital are from all walks of life.
@JEG, I have always understood that doctors, at least, are taught not to get too emotionally involved with their patients, because otherwise it will break them.
@Rose, I agree but I also think they've been taught to talk with a great deal of reticence in case of a lawsuit.
The shift to different words has a very Orwellian feel to it. Think "birthing parent" or "partner" (in a relationship sense, not a business sense.) It's all so tiresome at times.
I for one would never want to be referred to as a client because that just confirms that the medical industry just wants my money (not saying all doctors and nurses want sick people they can charge money to but the term client does imply that.)
@Battra92, Touché!
@Battra92,
Very Orwellian. I read 1984 again a few years ago. Terrifying really.
@Battra92, AMEN!! As usual, you write just what I am thinking.
In our area nursing homes/residential care facilities, we refer to the people we care for as residents. However, I find that in documentation/progress notes we use the term interchangeably with patients. It's not always d/t semantics but time. I appreciated Irena's in depth explanation and her first hand experience from both sides of the table and am sorry she has had such difficult experiences. Her insight is an invaluable resource to those of us in the "caring" profession. I fight the selfishness of the staff and myself a lot. Dealing with residents who feel and act entitled is my greatest issue in the nursing field. On the flip side, I have had some residents become part of my heart. And in those cases it is difficult to refer to them as clients because the term lacks the intimacy.
Where has this word "trope" been? I did not have it in my vocabulary and I thought I was fairly learned. That said, the closest in feeling the "Accckkk" to me has been current. I am reaping the harvest of spending money I did not have and working diligently on rectifying the situation. I have one reduced payment left this month on one of my credit cards and can hardly wait to split what I payed on that to add to payment on the other credit card and my car payment. I'm paying down on my hearing aides more quickly than expected. This is with my SS and my 3 day work week salary. The wrench in the situation was unexpected car repair of $500plus, a prescription that costs almost $400 every three months and (6 month) car insurance premium due nearly all at the same time. I had become accustomed to x amount of dollars in my bank account and while I have enough, I have to laugh at the fact that the amount of cash in my account is still more than it was ten to fifteen years ago when I was just above living paycheck to paycheck. And I have two modest savings accounts and a modest Roth IRA to boot!
That is my absolute favorite poem! I've always felt like it's perfect for animal rescue. Unfortunately, I can't save them all, but it makes a huge difference for the ones I can help. I think it applies SO WELL to pretty much anything any of us do that feels like it's not enough to make a difference.
Don't underestimate the difference you make to patients and their families. I hate all things medical, but thanks to some incredibly kind hospice workers, my grandmother's death and my husband's grandmother's death were so much more peaceful and dignified than they might have been otherwise. We take Thanksgiving dinner to the hospice house every year now, which absolutely doesn't feel like enough, but it's what I can do to let them know how thankful we were/are for them. They don't seem to think they did anything special, but it meant the world to us.
I worked for a company publishing medical research journals for many years (including the nursing educational textbook everyone uses, but I was not in that department).
The AMA guidance was to avoid identifying people with a disease, so instead of "diabetics", you should say "people with diabetes".
Of course, this is easier to do in a clinical research text, but I can see how instructional text would also guide you to use something else than patients as it's a more passive term, and client is a more active term. But in real life it would definitely feel odd and weirdly corporative, I agree.
When I look at the bills, I feel more like a "customer" (a/k/a "sucker") than a "client", much less a "patient". A "cash transfer" conduit from my insurer through me to the "provider". Such a good idea to let private equity acquire our entire "healthcare" system, including the doctors.
Maybe some time a favorite poem post. Mine is "Burnt Norton" by TS Eliot.
@Rose, Interesting idea! I like "Richard Cory" by Edwin Arlington Robinson.
@Bobi, it's very long (a play more than a poem), but I love Auden's "For the Time Being." I like to read it aloud with my seniors before Christmas break.
@Bobi, E.A. Robinson is one of my favorite poets!
As an OR nurse I had limited time while my patient (client ugh) was awake. One night my patient was rushed to the OR in shock with post-partum bleeding. Just before she went to sleep I whispered a quick prayer in her ear. Many months later I was crossing the street in front of the hospital chatting with a coworker. At the sidewalk another walker asked me if I worked in the OR. She said she recognized my voice and remembered my prayer the night she had emergency surgery. So you never know when you will encounter a patient in the outside world. But always remember that you are giving patients your best when they need it most. And you will get better at the long shifts as you get more used to them. Enjoy your days off.
@Nancy, I remember one horrid night (well, remember portions) when I was in recovery and not recovering. My heart kept stopping and in between I was sort of hallucinating. But I remember one nurse who held my hand the entire time, whispering encouragement and reminding me that I needed to fight to stay alive. I never knew her name, but later I wrote a letter to the hospital administrator with times and the date and hope that he passed on to her how thankful I was for her calm presence. I have never forgotten her even though this happened over a decade ago.
@Lindsey, @Nancy
These are both beautiful sentiments. In an angry world, it is wonderful to stories of kindness.
One of the hills I will die on is the "customer service"-ization of nursing. Using phrasing like "client" implies a transactional relationship that compromises patient-nurse interactions. I am totally aware that there are healthcare providers that treat patients abominably and everyone has a crappy nurse story, but allowing the "customer is always right" when it comes to patient care has become a detriment to healthcare. When a patient is in the hospital, it is because they need immediate intervention of some kind and not all of those interventions are going to be painless or noninvasive. I am the biggest patient advocate for autonomy and I will do my best to keep you pain-free and dignity intact, but at the end of the day my job is to keep you alive. And I refuse to comprise my patient care standards (or to be honest the safety of myself and my coworkers) just so some end of stay survey is 5/5.
There is SO much more I could say but I will get off my soapbox. Sorry.
@Heather, this is kind of a segue but 'the customer is always right' expression really pisses me off because the original meaning has been twisted. It was initially about how if a customer requests a product, they are 'always right' in wanting it, not this concept that the customer knows more than the manager and can occasionally abuse retail workers!
@Sophie in Denmark, I agree, I've never liked that phrase or concept. Sometimes the customer is wrong. Period. And, true confession, I have occasionally been that customer who was indeed wrong.
@Heather, I do respect nurses. I couldn't do what they do in a million years.
Me personally, because I'm an autistic weirdo and also much more sensitive than most, I'd prefer less personal interactions. Like when I didn't know my exact weight when I first arrived in the ER 18 months ago. They asked me and then snorted with annoyance when one of them read the weight off my gurney. If my gurney weighs me, why do you need to ask? And I could have done without the eyerolls when my legs apparently had some dried diarrhea on them. I did my best to keep clean, I didn't know about it and guess what, when you can't even walk and you have uncontrollable diarrhea and have to crawl to the toilet it's not easy. 100% gimme a patient washing robot so I don't have to feel more damn shame in the hospital.
@Rose, Also--I need to defend the snarly nurse who shoved a walker at me. When my son came to pick me up from the hospital, I asked him to bring some clean clothes as I didn't want to put on the dirty ones I arrived in. For some reason, he brought me dirty clothes! (He said he didn't know which were dirty and which were clean. FFS.) I just lost it then and there and apparently I was loud enough that Snarly came by and asked what was wrong, and then fetched me a clean pair of sweatpants and sweatshirt from who knows where. Probably the Filthy Derelict pile. I thanked her and said I was sorry if I had been awful, etc, and we parted friends and I sent a huge plate of cookies to that nurse's station the next day.
@Rose, our hospital takes donations of clothing for folks who came in without decent clothing or had it destroyed during treatment (like had it cut off by paramedic). I know the volunteer who runs our hospital closet and the clothes are cleaned after acceptance, even if they already look clean, and they discard stuff that looks like it came from a dumpster. So, no Filthy Derelict pile here.
@Lindsey, ah, I meant "clothes for Filthy Derelicts" not anything else. The sweatshirt/pants were clean and looked new and I still have them. I think it's one of my snarky jokes that make sense only to me.
I will never refer to a patient as a client!
Sadly with the way medicine has become a big business, some executive/hospital administrators are probably not far from referring to them as “customers” or “consumers of healthcare”
Blech!
I’ll add I spend this past weekend with a childhood friend who lives out of state. She and her husband are in a precarious financial place, and are utilizing debt consolidation because they cannot pay their debt. Sadly this is the second time in their marriage they have had to do this.
It was VERY difficult for me to keep my mouth shut when she was telling me how she replaced their 5 year old washer “because I just feel like the clothes don’t get clean” and replaced their ride on lawnmower because one footrest was broken/ unstable.
Then she told me the things she spends money on “because she needs to treat herself”
In my head I’m thinking the biggest “treat” would be to totally climb out of this mountain of debt.
It actually made me anxious hearing about her purchases!!
@Kim from Philadelphia, I would have to distance myself from such a friend in order not to continually lecture her. Good Grief Charlie Brown, WHATSAMATTAH with her 5th grade math education??
That plot trope makes me very nervous. It is an enhanced version of how many people live, expecting that they will always be employed and make at least a certain amount of money. I truly dislike how people are exploited for "reality" shows.
I have 4 nurses in my immediate family. 2 of us work in huge hospital systems and 1 works at a community hospital and 1 works in a medical wing of a residential "village" that has acute patients. "Client" has been phased in for awhile now in patient paperwork and to me it feels litigious. Taking the human out of the patient care. My other cousin who is a BSN-DNP, Nurse Anesthetist, she said that it was legaleze that brought about "client" and it has morphed into all the paperwork in the hospitals. I noticed this change about 20 years ago. We use "patient" when performing rounds. When in the patient's room discussing cares we use their preferred title. I had a former dr. as my patient last weekend and I asked him what he preferred and he said "I am no longer in practice, my name is P_____, please" what a sweet guy.
I was trained to use 'client' in the midwifery setting, as the recipients of such care are not sick, they are experiencing a normal event in the development of their family. If clients in maternity complicated, they became patients. In med/surg we always referred to 'patients'.
Client will never happen. Can you imagine the h&p’s? Client is a 60 year old female who suffered a r hip dx due to a mechanical fall. Nope. Doesn’t sound right.
I have a friend who is a financial risk taker and I have to have a glass of wine after a conversation with her. It’s all I can do to not shout Vacation? Eating out? Shopping at Pottery Bsrn? What are you thinking?
Oh boy, does it!
Another thing that makes me uncomfortable is the phrase, "Buy now! Pay later!" Yes, you'll pay through the nose later.
Ditto "Low Monthly Payments!" -- that seeks to disguise how much the actual cost (price of the item + interest you pay) will be. Bottom line: you can go "upside down" in your car purchase or other major purchase real fast if you don't add up the cost.
Many a consumer has been tripped up by such things!
Even worse is the "No Interest if paid within X months!" Per Dave Ramsey, those furniture stores know that something like 80 or 90 percent of the customers will forget and have a late payment within the 12, 18, 24 or 36-month term.
When that happens, the fine print (they didn't read) kicks in: they'll be charged the full amount of interest, which is very, very high, from Day One (the day they bought it) until the term is up. That'll happen even if you're only a day late or even if you had a good excuse ("But I tied up in traffic and by the time I got there, your store was closed!"; "I was unconscious in the hospital following a car wreck!"; "I was at the bank getting the money when it got robbed and I was held at gunpoint"; "I was kidnapped and held hostage!") The store/finance co. does not care. You were late, period. Pay the accrued interest.
So you think you're going to buy that mattress or TV or living room suite for a low price with no interest -- but in most cases, you're going to end up paying something like 28% or 29.9 % more for it. Ouch!
I think the worst thing, however, is to co-sign a loan or loan money to anyone. If you get a modern translation of the Bible and look in the Old Testament book of Proverbs, it says several times to NOT be a co-signer of a loan. (Ya think God is trying to tell you something? Yep!)
In co-signing or loaning money, the person you help is more than likely going to "forget" they owe you, and you'll be left holding the bag. (One Bible verse even warns you'll lose everything if you do this....pretty scary stuff!)
@Fru-gal Lisa, I hate the ads that say, "You deserve" X, Y or Z, like affording them has nothing to do with it.
@Fru-gal Lisa, Luckily I don't look to the Bible for financial advice. Frankly--so what if people pay more in interest for certain important things? If someone has crappy credit and no money, it's better to pay out the nose for a car they need to get to work than not be able to get to work. Yes yes, we can all feel good about ourselves for not being in the position but many people are through no fault of their own.
FWIW, in veterinary medicine the clients are human, and the patients are the animals.
Your comments about seeing care providers out of context reminded me of a time when my husband and I were in Safeway. This young girl came up to my husband and quietly said she wanted to say thank you again. Then she turned to me and said, he was so kind for my first trip to a gynecologist. My husband is not a gyno, nor does he play one on TV. I had a moment where I honestly thought I was going to pass out---I have worked with women who did not see that their husbands abused children and I had this horrible sudden feeling that I had missed something in my own marriage. My husband started stammering and looking from the kid to me, when (fortunately) her mother walked up. The girl said she was just talking to Dr. X and thanking him for his kindness. The mother looked at her and said, "What are you talking about? He is not your doctor." The mom did say my husband did look a lot like Dr. X, though, and they walked off. We later looked up Dr. X and, honestly, he and my husband could easily pass for each other. Same build, same hair, same beard, even the same glasses! My husband did say that at that moment he thought he was going to pass out, too, because he was so blind-sided and so scared that he was about to be accused of something that could ruin his life.
Hahaha, I'm chuckling at your husband's sudden attack of nerves!
My brother has just had some hard news regarding his health and will be spending a lot of time in hospital for the foreseeable. I pray he meets many nurses and healthcare workers with your compassion and care to make his struggle a little easier.
I hope that he receives kind and competent care the whole way through!
A good nurse (or, unfortunately, a bad nurse) can really make all of the difference in someone's hospital experience.
I agree that they should stop trying to make "client" happen. I don't think there's a move yet in schools to call students "clients," but certainly at the university level, students have been seen as "customers" for a few decades now, and I think it's only been bad for education. Of course there is a financial component to both medical care and education, but using "client"/"customer" seems to be reducing what should ideally be relational to something that is purely transactional.
One of my doctors is very up in arms about the client/provider switch from patient/doctor. She says it focuses every part of heath care on the business instead of the care and I think she is right. It isn't a good sign that textbooks are teaching this change.
The veil between the physical and spiritual/eternal is very thin in hospitals. Your work is certainly very impactful for your patients (as a common visitor to hospitals and clinics, I will never choose the word client!)
Scary trope: marrying a guy after knowing them for 3 minutes. Don’t do it!
It absolutely makes me nervous! I hate to spend money after it has landed in my savings. I put off buying things until it can be put off no longer! My refrigerator is 22 years old, and I know it isn’t energy efficient but I keep postponing the inevitable as it still works just fine! And I feel you, Kristen about patients, we are so privileged as nurses to be part of peoples lives and healing process. Even though I am retired, I will never call patients clients, and if I am ever a patient, I don’t want to be a client, either. We had this same client/patient thing in the 1980’s, and it never changed a thing!
I get more unglued when I see people i know do it. They get any amount chunk of money thats "extra" - casino/lottery, insurance settlements, inheritance, back pay, tax refund, gift, retirement account AND they spend it all. On entertainment, a car, new clothes, traveling, shopping shopping shopping. My mom called it "Quick rich" "a fool and their money." Most have ended up broke and complaing and asking for financial help. I saved 1 from ruin by almost forcing to keep it in a safe money account where's she has earned thousands in the principle. But most don't want to listen or don't tell me what's happening. I shake my head everyday. (My 6 siblings have all this at least once)
@Connie,
Maybe when you have more time we could have quick rich as a topic. ?
@Connie, As long as we perhaps don't have the judgment and scolding? Maybe try to understand the mindset of people who don't feel in charge of their finances, who feel perpetually deprived, who feel that they might as well enjoy a windfall because it won't last (it never does; something bad happens to spoil it), and so on.
Not to mention--plenty of rich people blow their money on "stupid" things too. It's just that since they always have more, most people don't judge them the way they do non-rich people.
There is just way too much self satisfied smugness here.
And to quote my boyfriend Eric Blair, referenced above, "Hats off to the factory lad who with fourpence in his pocket puts his girl in the family way! At least he's got blood and not money in his veins.”
@Rose, Just clarifying; these people are in every social economic level. No one I'm talking about lives in poverty.
I am also talking about windfalls of $5,000- $400,000. Spend some? Sure. But all? Over and over? And end up in a mess? Judging? More like observing and suggesting asked for advice or reminding what happened last time. This IS a good discussion to have. About frugal or long term t all things.
From another woman in healthcare- I am never going to say "client". It's weird. Especially like you say for certain specialties (oncology clients, addiction clients, palliative medicine clients, etc)
I absolutely, positively, do not want to be called a client. Now if the medical profession could get rid of terms such as "patient complains" and derogatory condition names such as "incompetent cervix", I would be much happier.
@WilliamB, In my son's medical charts there are references to "patient denies chest pain" and while I know it means they asked him, "Are you having chest pain?" and he said "No," meaning he was not in pain, it sure sounds like they were accusing him of lying about it!
It is funny phrasing, isn't it? When I have a spare moment at work, I try to read through the patients' history to get a better idea of what's going on with them, so I come across this phrase a lot. I'm getting used to it, but it did hit me weird at first!
@WilliamB,
A friend of mine who had her first child after the age of 32 objected (rightfully so) to being referred to (in her medical record) as having a "geriatric pregnancy". Whaaaaa???
PATIENT, please
and the having the money before it is spent dilemma is a no-brainer to me. The other dilemma many find themselves in is having to return a Social Security check that financed bills, food etc because the person passed before the end of the month.
@BRENDA,
That's just awful to take away a SS check like that! Yikes!
Oh, man! That makes me extremely afraid! Yikes! No, thank you! Haha!
I work in a hospital and I have patients, not clients! Clients? Mmmm....nope, that doesn't sound right
No because I was raised to not spend money I *might* get. To a certain extent, I see a similar situation in the business world when it comes to bonuses. Far too many of those eligible for a bonus plan like it is guaranteed money - it is not. I won't turn down bonus money but I certainly don't plan on it. Truth be told, I've seen evidence of business decisions being influenced in order to protect bonus.
And clients, ugh. Buzz word time has now infected the medical profession. Your "user experience" won't be far behind. Quit changing my personal display settings because someone else thinks it will "enhance my user experience". Too often it means functionality I used and found productive has been removed. Sad to say whoever is pushing "client" is getting paid to come up with this idea. My bank hyped a their new product line. I am hyping my accounts to another bank. It brings me no benefit and just sucks fees from those who can least afford them.
Bah. To me patient sounds much more human and compassionate. There is so much going on in the world of health care where in the marketing and language tries to push this idea of ‘choice consumerism’ when really they are just taking away benefits and time from people and calling it choice, and ramping up pressure for providers to see as many people as possible. But I’m a crabby social worker so what do I know.
I haven't had many hospital experiences (thankfully), but I do still think about the nurses who have touched my life. The nurse who stayed after her shift was ended, to make sure I was ok (emotionally) after my emergency C-section (15 1/2 years ago); the CNA who brought my daughter back after her hearing test to tell me she'd passed her hearing test just fine but the selective hearing would start around 2 years old (LOL); the call nurse at my doctor's office who tracked me down at the office and enveloped me in a hug when my miscarriage was confirmed (13 1/2 years ago) .
I would assume that none of those nurses would even remember me, but I do remember them. I was a very very small part of their day when cared for.
That poem! I had it up on my bedroom wall when I was a kid and I have always loved it. No matter where you are in life it fits. Keep easing those who ache! I love reading your blog. Thank you!
I work in global health in the HIV sector, and we are also shifting to client from patient. For us, the shift is driven by the fact that people living with HIV are living normal lives, and we are fighting the stigma that someone living with HIV is perceived as sick or dying. It's a chronic illness now just like managing high blood pressure, etc. Also, we are working on packages of care for our HIV clients, and the idea is that they have choices in their care, hence clients. I never thought about how it may have commercial or monetary connotations.
Late checking in here, because life has been chaotic the last 3 weeks.
I was a bedside nurse for 42 of my 45 years in nursing, and, because of my husband's extensive medical history, have experienced bias a LOT from other healthcare providers.
I am also obese, and there is a huge bias against obese caretaker wives of patients. Some examples:
My husband's doctor pooh-poohed me when hubby gained 43 lbs one summer, with his torso and legs being very swollen, and I mentioned the last time I saw that much fluid on him was when he'd had liver and kidney failure and a clot in his leg. He said, well, this wasn't the case this time, but he ordered a CT scan for my husband, and before we got home from having it done, his staff was calling us to come to the office right away. Jack was admitted to the hospital ASAP with a clot blocking his liver.
Dr. H had the grace to treat me with a little more respect after that (for a while at least), even though he didn't apologize.
During that hospital stay, one of the gastric specialists told me he had seen my husband's xrays and saw no edema (swelling) in his torso. Excuse me?? I have to assist my husband with showering and dressing and have lived with this man over 50 years and you have the nerve to tell me I don't know what I'm talking about?? I told the hospitalist I didn't want that specialist to darken our doorway again. They got another specialist in the practice to take over. Oh, and they pulled 30 lbs of fluid off him in 5 days. His shirts fit him again.
When hubby was in to see Dr. H in January, I mentioned that he seemed a little more confused lately. Doc asked Jack a few benign questions, and told me, without looking at me, that he didn't see any confusion. I was livid. He bases that on seeing my husband 10 minutes every 6 months? He should see the testing the speech therapist put my husband through during this rehab stay: critical thinking skills, memory, math skills, etc. Hubby failed miserably.
When it came time to transfer him from the hospital to the rehab nursing home (that was on the bottom of my list due to prior experiences, the nurse who came in tried to minimize my concerns with discharge orders, and medications he usually takes at home being reordered. She said, "Oh, we have them written down and the doctor will see them, and the pharmacist will fill them." I said, "Oh, is the doctor usually there at 6:30 on a Saturday night? And does this facility have an on-site pharmacy that will be able to provide the medications tonight? Doesn't the facility have to wait until Monday when the pharmacy opens to get his medications? One of his meds is a very expensive hormone suppressant that is provided to us by the manufacturer's pharmacy. I have it here and we will need an order for them to be able to administer his home medications." Her jaw dropped and she stammered that she would check on that. I didn't appreciate that she was trying to blow me off and that a less knowledgeable family member would have believed they would be seeing a doctor that night and that the patient would be receiving all their usual meds.
Current rehab facility/nursing home physician plants both feet apart, hands on hips, and tells me "THIS is what 50% weight bearing is!" when I questioned how they were going to start him on 50 % weight bearing when he is totally paralyzed on the left side, unable to use crutches or a walker, and now has a fractured leg to boot. Dude, this man is NEVER at 50% weight bearing when his leg ISN'T fractured!
Nurse brought my husband his pain meds, but had a couple more in the cup at a time of the day when he doesn't usually get medication. When hubby asked what the meds were, the nurse kind of brushed it off, saying, "well, it's your pain meds and heart pill and...". I asked what heart med. She mumbled something that ended with "olol", which usually is generic for beta blockers. I said he didn't take that. She kind of sighed and went to check the med record, and in the meantime, hubby downed the meds before I could stop him or look at them myself. She came back, and said, "Oh, that was his potassium." Now, he does take potassium, but it's scheduled for 9 am and this was almost 5 pm. He also got very sleepy later, almost too sleepy to eat supper, so I think she gave him someone else's meds, but I can't prove it.
Because he has cognitive issues from the stroke (which was 45 years ago, so we have lived with this a long time), he either cannot accurately answer some questions, or he doesn't understand the question and says what he thinks they want to hear. He is also very good at masking this condition, and can laugh and joke with people, so I get that look when I have to answer questions for him. I explain his deficits and tell them I am pretty much his walking memory bank, and always provide a copy of his current and past medical conditions, surgical history, medications, allergies, and vaccinations. I keep this on the computer, with several printed copies in a folder that I grab when he goes to the ER.
These days I have no qualms about playing the nurse card. In the past, I wouldn't mention it, because I didn't want to make his caregivers nervous, thinking I'm going to watch them like a hawk, or throw my weight around (pun intended), but I no longer care. I am not going to be dismissed as the fat, pushy, elderly wife of a nice old man. Or, in the words of Glenn Close in "Fatal Attraction": " I am not going to be ignored, Dan!"
Ah yes, the joys of nursing! We submerse ourselves in our "clients" lives for 12 hours, then walk away at the end of the day to our own lives. It is a strange life we choose. I have no doubt your are fabulous at your job, and your "clients" love you for it!