Sunday, November 16, 2008

person or product?

Throughout this whole mum's-having-brain-surgery adventure, I think one of the hardest things for me has been dealing with the humanity/objectivity balancing act of modern medicine. It's something I'm still struggling with, both emotionally and intellectually.

When things got difficult, I coped by observing, analyzing and trying to understand, and for the most part, thinking about things in that way helped me feel better about the situation. But there was one thing that consistently elicited a visceral, almost overwhelmingly negative reaction: my mum's bar code bracelet.

Now, intellectually I understand that it is critical for hospital staff to correctly identify patients, especially when the patient will be, say, having brain surgery, and thus be unable to communicate. I understand that having a rapid and accurate way to do this (like a bar code) is important. Also, I think it's great that before administering any medication, they would enter the patient and drug information into the computer to verify that it was all correct. I'm sure this system has prevented many medical errors, and I'm all for that; I just hate how they do it.

It really bothered me that every time a nurse came in to do something to my mother (not interact with her, do something to her), the first step was to scan her bar code, which was on a bracelet on her right wrist. It made me feel like my mum was just a hunk of meat, some sort of product the medical system was processing.

And, in a way, she was: during that portion of the interaction, the nurse's attention was focused on the bar code, the scanner, and the computer receiving the data. Now, to me, one of the most important aspects of nursing is observing the patient to figure out how she is doing. For the less engaged, less wonderful nurses, this aspect was essentially absent; even for the completely over-the-top fantastic nurses, checking on the patient was an entirely separate process from scanning in the patient to administer drugs and check the chart. And the scanning business always came first.

During one particularly memorable incident, a nurse strode in and practically rolled her eyes with impatience as my mum struggled to get her bad right arm over to the left side of the bed to be scanned. I got the impression that she would have been happier with five pounds of saran-wrapped ground chuck on a styrofoam tray. You don't have to wait around for packaged meat to move itself.

It just seemed wrong to me that the emphasis is now on "the computer says that patient X needs Y," rather than observing that patient X exhibits symptom Z, suggesting that treatment Y would be a good idea, or even "after prescribed treatment Y, patient X exhibited response Z."

So, can anyone devise a system that combines the speed, accuracy and convenience of scanning a bar code with some level of human interaction?

The next time I see a nurse walk into a hospital room, I want her eyes to go first to the face of the patient, not the bar code bracelet.


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