My post last week discussed part of my experience being a patient.  This post follows on from that one.  I’ve had a few emails asking if I’m OK.  Yes thank you, I am 100% fine and appreciate the concern.  Last week, my post ended with an observation about how my nurse was worried the she would be chastised by the doctor if she stopped my drugs.  This was certainly a manifestation of what we call the healthcare hierarchy.

The healthcare hierarchy

Quite a lot of my research has had to be particularly sensitive to the hierarchy that exists in hospitals, with doctors at the top of the pinnacle and nurses considered to be on the lower rungs.  The moral implications of this ingrained structure are for another post, but I certainly saw the hierarchy in action.  Most especially when it came to my request for fewer drugs (detailed in the previous post).  The reason there was so much resistance was that “the doctor said I needed to take all the drugs he had prescribed for me”, and the nurses feared that if I wasn’t a good patient, they would get into trouble.

The hierarchy also has an unfortunate effect of making nurses feel disempowered, and seems to give them a sense that they have to defer to the doctor in the majority of medical decisions related to the patient.  I don’t think it should be like this, nursing sisters spend the most time with patients, and they are trained in their craft.  I believe we need to give nurses much more capacity for critical engagement in patient management and a level of trust and responsibility in a supportive, rather than hierarchical and retributive environment.

The need to be in control

A number of patients have told me that whilst in hospital, they felt as though they weren’t in control of things.  Patients felt out of control when they couldn’t ascertain what was planned for their day – making it difficult to get a coffee or arrange for friends to visit, or they didn’t know what time they were going for a scan or to theatre.  For me, the lack of control was manifest through much smaller incidents, only one of which I am going to briefly mention here.  At one stage I was too nauseous to walk, and I couldn’t reach my bell to call the nursing sister because it was housed on the counsel behind me – my arms just aren’t long enough.  Getting out of bed to get the bell was out of the question because of my nausea.  Eventually, I had to phone the ward from my bed to ask for the nurse to come and see me.

Being a patient, as it turns out, is about much more than a medical intervention.  It’s probably easy to forget that patients have insecurities and expectations, and that these need to managed as sensitively as possible.  In today’s era of shared decision making, patients do need to be a bit more empowered, and so do nurses.

The views published in this blog are entirely my own (informed) opinions.  They are open to debate, discussion and disagreement.