Thread by @innodim

#AIMART storytime 🧵
This just in: Boom💥
So, I’m getting ready for work today, tying up the ol’ scrubs and peek at my phone - I see a message, sent last night from the ER doc stating that one of my patients, a young Black man admitted for Sickle cell pain crisis...

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..., wanted to leave and the doc was okay with discharging because the patient’s pain seemed to have resolved. Ok, I get to the 🏥and my team informs me the patient is still in-house (in the ED – No beds on the floors.

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The ED is overflowing, so we have patients admitted and waiting in the ED for a bed for daaaays on end. Coupled with the ED being short-staffed - yeah…not good) and didn’t leave, after my wonderful senior resident convinced him to stay and receive more analgesia (pain meds)

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for his, it turns out, un-resolved pain crisis.

We go see him and a conversation ensures:

Me: Hey there, my dear Mr. X, what’s happening? I heard you wanted to leave last night? Is that correct?

Him: *Sigh*despondent affect* Yes, I did want to leave.

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Me: Ok. Is your pain at goal?
Him: No.
Me: Oh? So, why did you want to leave, sir?
Him: *Sigh* Every single doc come in here telling me that the hospital was full and they needed space and after a while I just felt like, okay, let me let them have their space...

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...and I can go home and treat myself the best I can.
Me: Ok, let me repeat back to you what I understand from what you’re saying. It sounds like a number of docs and other healthcare folks came by informing you that there was not enough beds in the hospital...

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...and that’s why you are still in the ED. But, because of the number of times this happened, you began to perceive that you were not wanted here and that there was an implied message of a desire to discharge you in order to make room for others. Do I have that correct?

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Him: *Perking up* Yes. And I told them each time that I understood the situation and I was going to be patient. I didn’t cause any trouble.
Me: Ok. So, this behavior continued even though you reassured the messengers each time that you understood the situation.
Him: Nods.

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Me: *Takes a deep breath*On behalf of the entire team, but us your primary and ED – because we are all representing this institution, I am so sorry, Mr. X, that behaviors by our staff were done in such a way as to make you feel like you are not wanted here.

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Me: You and your health are very important to us and we want to help you and for you to be here to help you. Thank you so much for your patience with us and this challenging situation we find ourselves in, it must not be easy.
Him: *Nods* Thank you.

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Me: My feeling is that the team likely wanted you help set your expectations & reduce the likelihood of you being frustrated. However, they should have listened to you when you told them you understood the situation and was willing to exercise patience with the situation.

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Him: *Nods again.*
Me: May I ask you how we work together to move forward? Here are some options: 1. We continue your treatment here as is until you get to your goal and discharge at that time. Praying and hoping a bed opens up as soon as possible. Or...

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2. You can go home if you prefer & we’ll figure out an outpatient regimen adjustment to tide you over till you follow up with your hematologist this week. Which one works for you?
Him: *pauses* You know what, now that I’m getting my medications at a regular frequency...

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...I can feel it working. So, I’d like to stay and continue the treatment plan until I get to goal and then follow up outpatient. That’s my choice.
Me: *shakes his hand* Sounds like a plan. Again, my deepest apologies and thank you again for your patience with us.

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Him: it’s ok. Thank you. Have a good day.
Me: Thank YOU!

After the encounter, I debrief with my team. I get their feedback of the encounter and asked what they took away so they can apply in future challenging encounters.

Our discussion broke down to 4 tips:

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1⃣Get the patient’s story/perspective: Ask open-ended questions and do not interrupt. Listen actively with nods and “mmm, hmm”s to show engagement.
2⃣Summarize what you heard to ensure you understand the situation/problem: Repeat back in your words the crux of the issue...

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...Try to tap into the emotional core that was expressed. Use feeling words & tie it into an inciting behavior. People mostly want to feel heard. & seen. Sometimes, it’s not about fixing/doing anything. It's about acknowledgement, affirmation, validation, & expressing value.

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3⃣Make amends: Apologize for the action (not how they feel) and express a commitment to behaving differently.
4⃣Respect their autonomy: Offer choice for how to move forward so that they have a sense of control in what is always a difficult situation – being a patient...

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...(a situation further compounded by this COVID Pantiti). Often, the loss of control is what gets us in the dumps. So, whenever possible offer reasonable safe options as part of respecting the patient’s humanity and mental health.

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It is important to contextualize that this patient is a young Black man. With a chronic painful illness. He is multiply stigmatized and as I’ve mentioned before Black men (and many women) in healthcare settings are unduly stressed...

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...becos of concern of being labeled as ‘aggressive’ if they insist on their patient rights, which will cause them to be policed & not receive the care they need. For many Black & other minoritized people, healthcare settings are a site of intersectional structural violence.
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This is another arm of medical racism, again rooted in white supremacist logic that espouses the sub-humanness of Black bodies. Thus, we have to be intentional how we engage with them & ensure that our communication – both verbal and non-verbal...

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...explicitly and implicitly conveys the message that they are seen, heard, and valued.

Regardless of the hospital/clinic/other healthcare setting state of affairs.

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Have you had an experience like this?
How did you handle it?
What would you have done differently in this case?

#MedTwitter
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#healthcare
#BlackLivesMatter
#Doctor
#PatientCare
#patients
#MedEd
#AIMART

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