Treat Me as a Human First

At 6:45 a.m., I began my one-week inpatient service as an attending hospitalist at an academic medical center. While reviewing the sign-out from the previous hospitalist, I was stunned to discover that a 32-year-old man with no prior medical history had had 3 cardiac arrests in the past week. Before these events, the patient had undergone tracheostomy tube placement due to complications from COVID-19 and was recommended to have regular suctioning. The patient declined to have suction, and it appeared that the reason for the multiple cardiac arrests was respiratory failure in light of mucous plugging. To prevent the possibility of another cardiac arrest, I made it a priority to begin my morning rounds with this patient.

During our conversation, I emphasized the importance of scheduled suctioning of the patient’s tracheal tube to prevent further cardiac arrests. Although he smiled, he did not address it. I then spoke with the patient’s duty nurse and the charge nurse to determine the reason for the patient’s refusal of tracheal tube suctioning. Both nurses informed me that they offer suctioning to the patient as ordered in the electronic medical record, but the patient refuses almost every shift. Further conversation with the nurses revealed that the patient’s mother is very involved in his care. I contacted the patient’s mother and requested her assistance in explaining to the patient the critical importance of regular tracheal suctioning to prevent further cardiac arrest. The patient’s mother informed me that the patient felt disrespected as nobody was addressing him as “Mr.” before his name. I asked her if this was the reason why he was refusing the tracheal suction, and she confirmed that it was. Armed with this vital information, I promptly reminded the nurse and charge nurse of the unit that the patient prefers to be addressed as “Mr.” before his name.

The following morning, I spoke with his nurse to remind them of the patient’s preference for being addressed as “Mr.” During my rounds the next day , I discovered that the patient had allowed the nurses to suction his tracheal tube. For the rest of my week in service, there were no further instances of cardiac arrest. In my sign-out to the next attending hospitalist, I emphasized the importance of the patient’s preference and how it had contributed to preventing recurrent cardiac arrest.

Although I was initially taken aback upon discovering the reason behind the patient’s refusal of tracheal tube suctioning, his perception eventually made sense to me. The patient believed that he was not being addressed with the respect and dignity that he deserved, which was of utmost importance to him despite understanding the importance of tracheal tube suctioning. This eye-opening experience reminded me of the book If Disney Ran Your Hospital: 9½ Things You Would Do Differently. The book emphasizes the importance of how our patients evaluate their hospital experience based not only on the quality of care but also on the respect and dignity with which they are treated. Kneeland and Burden recently wrote in Annals of Internal Medicine  that it is essential to recognize that our patients’ thoughts, emotions, and overall well-being are influenced by each of our words and actions (1). There is a consistent positive correlation between patient experience and both patient safety and clinical effectiveness (2). Furthermore, patient experience is positively linked to health outcomes, including medication adherence and preventative care, such as the use of immunizations. It is also associated with use of health care resources, namely hospitalization and primary care visits. Therefore, it is incumbent on us as health care professionals to provide compassionate care that is respectful and empathetic to our patient’s needs, both verbal and nonverbal. Doing so will undoubtedly empower us to achieve higher hospital ratings and, most importantly, better patient care with patient satisfaction.

References

1. Kneeland PP, Burden M. Web exclusives. Annals for Hospitalists inpatient notes - patient experience as a health care value domain in hospitals. Ann Intern Med. 2018;168:HO2-HO3. [PMID: 29554686] doi:10.7326/M18-0231
2. Doyle C, Lennox L, Bell D. A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open. 2013;3. [PMID: 23293244] doi:10.1136/bmjopen-2012-001570