Weird letter

[LuvOrlando]

So recently I received a letter defining a "Code of Conduct" for patients from a hospital network I have used where they basically state that they will refuse to care for people that don't fit their format of what seems to be a mold of a "good patient." Without sharing the letter to out the facility it would seem a good patient makes no offense. This letter asserts that many healthcare systems across the US have similar in place, not sure about that so wondering how many other people have seen these in their towns? They concede they will care for such undesirables in emergency care.

At first I took this in stride, as I am not in the habit of any of the things defined, but the more I thought on it the more this notice of what a bad patient is worked itself into me like a splinter. Over time different health conditions that might alter how people think, act, speak and behave started popping into my mind. i can't help but wonder if this network saying these people are unworthy of care? It says if there is an incident they will look into it and let a person explain themselves, but what if a person can't explain for any number of reasons? So far I am thinking literally any mental health issue could trigger volatility if a person is in some sort of crisis, including pain and their caregivers could be similarly affected by worry or grief. I've seen people with cancer that went to the brain make them belligerent and say batty things, people with dementia lose all sense of constraint as do people with lots of head injuries. I've watched people with poor diabetes control say and do combative things. Thinking about the homeless who often wouldn't be homeless if they could control the things that permit social order. Then there are all the people and kids with autism spectrum who just don't see the boundaries. The more I think n this the longer the list gets of iissues that could trigger a dustup in a healthcare setting.

I get no-one on earth wants to entice combative people into their orbit, but if healthcare facilities are opting out and saying they are unworthy of care, where do these people all go?

What do you think about the idea of a hospital having a code of conduct for patients?







Personally, I think they need to suck it up and fork over the cash to maintain a squad of trained caregivers in place and on site to address such patients, a fleet of social workers and other mental health professionals who know how to manage such situations, opting out is unacceptable, but that's just me and what I think healthcare should be.

 

[DLgal]

What is the code of conduct? Private hospitals can make whatever rules they want for who they treat.

 

[lovesmurfs]

I guess I would appreciate the hospital's dedication to its employees. Most abuse against healthcare providers is from patients and patients' families.

I wouldn't deem them "unworthy" as patients, but it's fair to want to treat patients who aren't abusive to the workers.

 

[Allison]

Not enough specifics here.

 

[Wiltony]

Nurses and caregivers are abused WAY too much by patients and their families, even beyond what might be expected or anticipated in the high-stress environment of a hospital. Patients get away with way too much and it is absolutely unacceptable. Those poor nurses are abused monetarily by their hospital CEOs, abused by their managers from a time and resources perspective, and abused by their patients both verbally and physically. They need way more support from all sides to stop being exploited.

A patient code of conduct is the least of what should be done.

 

[PollyannaMom]

Without details, I expect this code of conduct (like a lot of things) takes a good idea too far.

Yes, I still want people who say mean things because of their diseases to be treated.

But, no, I don't think it's OK for doctors and nurses to be subjected to physical injury on the job.

There needs to be a line drawn that will preserve both compassion and employee safety.

 

[Wiltony]

literally any mental health issue could trigger volatility if a person is in some sort of crisis, including pain and their caregivers could be similarly affected by worry or grief. I've seen people with cancer that went to the brain make them belligerent and say batty things, people with dementia lose all sense of constraint as do people with lots of head injuries. I've watched people with poor diabetes control say and do combative things. Thinking about the homeless who often wouldn't be homeless if they could control the things that permit social order. Then there are all the people and kids with autism spectrum who just don't see the boundaries. The more I think n this the longer the list gets of iissues that could trigger a dustup in a healthcare setting.

So nurses and caregivers should just have to "take it?" I can see it now:

*Some patient hauls off and slaps their Nurse*
Nurse: "Please do not hit me, I'm trying to help you."
Patient: "I have dementia and my back hurts, you forgot my jello and that triggers me!"
Nurse: "I'm sorry but that doesn't mean you can strike me."
Patient: "You're oppressing my freedom of self-expression, I'm filing a formal grievance against you!"

Just because there may be a 'reason' for it, doesn't make it ok.

 

[RoseGold]

This is the kind of thing the board and the lawyers changed, so they are sending notice. NBD to you, I'm sure.

 

[Genie+]

I always thought w was a weird letter. Too many syllables and a misrepresentation.

 

[Mackenzie Click-Mickelson]

So nurses and caregivers should just have to "take it?" I can see it now:

*Some patient hauls off and slaps their Nurse*
Nurse: "Please do not hit me, I'm trying to help you."
Patient: "I have dementia and my back hurts, you forgot my jello and that triggers me!"
Nurse: "I'm sorry but that doesn't mean you can strike me."
Patient: "You're oppressing my freedom of self-expression, I'm filing a formal grievance against you!"

Just because there may be a 'reason' for it, doesn't make it ok.

Forgive my ignorance here but do patients with dementia often in the midst of a state of confusion burst out they have dementia? Or say things like oppressing their freedom of self expression?

 

[Mackenzie Click-Mickelson]

Safety should be of utmost importance but I more read the OP was saying sometimes there are reasons for someone's behavior that which they need the help for. A mostly harmless thing such as a UTI can bring out such personality changes it's shocking for one. And the rock and hard place people find with trying to have compassion, knowing someone needs to take care of the people but also running up against issues that make it hard, make it a workplace environment that burns people out fast in some cases.

No one thinks it's actually okay to physically harm someone else., no one. But there's a line that too many medical professionals have found themselves in in regards to their own safety but understanding the issues their patient may have. My guess is there was at least one major incident that spurned this letter.

If the OP finds the letter too restrictive it's possible that may sort itself out over time if complaints arise due to that.

 

[Mle8308]

Mass General Brigham (in Boston) recently implemented this. You can Google it, plus it was in the news last week.

 

[RogueX]

I got a message from one of the Healthcare systems in MA about a code of conduct. Some of it has to do with patient refusal of care on the basis of religion, race or gender. Verbal and physical abuse. Other stuff that I can't recall off the top of my head.

I know my father would be an extremely problematic patient, since suffering traumatic brain injury he literally has no filter and says every offensive thing that comes into his mind.

 

[VandVsmama]

I have no issue with a patient policy like this.

I'm making assumptions here since I don't know the exact specifics of what's in that particular hospital's policy, but what it essentially means is that if a patient gets unruly, abusive, physically harms hospital staff, then the hospital can and will transfer the patient to a different facility once the immediate medical emergency has been dealt with.

 

[Skywalker]

My local hospital and doctors office have this. I have no problem with them trying to protect their staff from abuse. It's sad it's even necessary to spell it out.

I am quite sure they know how to use their discretion and common sense if someone is in the middle of a mental health episode or something

 

[Praying Colonel]

Without knowing more, this sounds like an appropriate effort by the hospital to promote a safe environment for employees, patients and visitors.

 

[Pooh2]

Safety should be of utmost importance but I more read the OP was saying sometimes there are reasons for someone's behavior that which they need the help for. A mostly harmless thing such as a UTI can bring out such personality changes it's shocking for one. And the rock and hard place people find with trying to have compassion, knowing someone needs to take care of the people but also running up against issues that make it hard, make it a workplace environment that burns people out fast in some cases.

We had this experience first hand with my late father-in-law.
Overnight, it appeared that he turned into a dementia patient from a UTI.
He hit a nurse who was trying to care for him.
A simple antibiotic had him back to his gentleman self in a few days.
He would have been horrified if he remembered hitting a woman.
The nurse was so kind to us and him.
Cannot imagine if they refused him care.
A hard situation all around.

 

[Pea-n-Me]

So recently I received a letter defining a "Code of Conduct" for patients from a hospital network I have used where they basically state that they will refuse to care for people that don't fit their format of what seems to be a mold of a "good patient." Without sharing the letter to out the facility it would seem a good patient makes no offense. This letter asserts that many healthcare systems across the US have similar in place, not sure about that so wondering how many other people have seen these in their towns? They concede they will care for such undesirables in emergency care.

At first I took this in stride, as I am not in the habit of any of the things defined, but the more I thought on it the more this notice of what a bad patient is worked itself into me like a splinter. Over time different health conditions that might alter how people think, act, speak and behave started popping into my mind. i can't help but wonder if this network saying these people are unworthy of care? It says if there is an incident they will look into it and let a person explain themselves, but what if a person can't explain for any number of reasons? So far I am thinking literally any mental health issue could trigger volatility if a person is in some sort of crisis, including pain and their caregivers could be similarly affected by worry or grief. I've seen people with cancer that went to the brain make them belligerent and say batty things, people with dementia lose all sense of constraint as do people with lots of head injuries. I've watched people with poor diabetes control say and do combative things. Thinking about the homeless who often wouldn't be homeless if they could control the things that permit social order. Then there are all the people and kids with autism spectrum who just don't see the boundaries. The more I think n this the longer the list gets of iissues that could trigger a dustup in a healthcare setting.

I get no-one on earth wants to entice combative people into their orbit, but if healthcare facilities are opting out and saying they are unworthy of care, where do these people all go?

What do you think about the idea of a hospital having a code of conduct for patients?







Personally, I think they need to suck it up and fork over the cash to maintain a squad of trained caregivers in place and on site to address such patients, a fleet of social workers and other mental health professionals who know how to manage such situations, opting out is unacceptable, but that's just me and what I think healthcare should be.

It is a tough time to be a caregiver right now. I don’t think most people understand how tough.

I mean, it’s always been tough. But in the past few years, things have been explosively tough. So much so, that many healthcare providers are leaving their positions. For several reasons.

When that happens, who will be left to care for people? Seriously!

As it stands now, hospitals are bursting at the seams. The systems are so jammed up that there is little movement, so patients can’t be discharged to rehabs, or home, sometimes for weeks at a time. When that happens, beds become full, and people may have to be cared for in hallways. I think we can all appreciate that’s no way to be cared for, sometimes for days on end. And it doesn’t always help going somewhere else, because they’re probably in the same boat, too.

Besides the bed situation (or lack thereof) there have been profound staff shortages. Many have been out with Covid, now we have the flu, parents have to say home with their kids who are sick, or their families and loved ones, people have injuries when they are working short staffed, etc. And many others have simply thrown in the towel and left, or retired. (And I can’t blame them.) So that means that shift after shift, caregivers may be faced with double the amount of patients they should have, all of whom need care, with few hands available to provide it. Not easy to deal with day in and day out. It’s also not for lack of trying - as fast as positions are filled, more people leave. That‘s why travelers are so in demand now.

Add to that the stress of electronic documentation. There was a study done in 2018 of physicians who were not only leaving their positions, but some were suicidal, because of the increased demand on their time. Many were averaging two hours at home after their shifts completing documentation, and they hated it. (They had not asked the nurses yet.) This can be found if you search and want to read more.

Then, of course, we had Covid. When many people were working from home, or staying home, hospital staff continued to have to go to work and deal with some of the toughest medical circumstances of their careers, and were asked to work often beyond their capabilities, day in and day out. Everyone became burnt out. Many left. Some were fired for not wanting the vaccines.

It’s hard for me to explain how bad things have been.

Now add in patients and families acting verbally or physically abusive to staff who are left trying their best to provide good care under these difficult circumstances we’re all stuck with today. I suppose you can say it’s the icing on the cake for some people, and was the thing that finally pushed them over the edge, so they left. We aren’t talking about one or two incidents; these are in the hundreds or thousands, system wide, over time. From people who should know better. And that is how policies like that come into being. As a way of supporting hard-working staff who are trying their best to provide care to people. So we have a system left.

It’s not necessarily meant for people who are confused or cognitively impaired, though those cases are likely to be looked at, as well. This is what it said (yes, it was on the news):

”Specifically, the hospital system said it will not tolerate offensive comments about race, accent, religion, gender, sexual orientation or other personal traits; refusal to see a clinician based on personal traits; physical or verbal threats or assaults; sexual or vulgar words or actions; or disrupting another patient’s care.”

If we believe you have violated the Code with unwelcome words or actions, you will be given the chance to explain your point of view. We will always carefully consider your response before we make any decisions about future care at MGB. Some violations of this Code may lead to patients being asked to make other plans for their care and future non-emergency care at MGB may require review, though we expect this to be rare.”

There is a video here that helps explain the policy. I think, in part, it’s a show of support for staff who have seen violence toward them double since the pandemic, as well as support other patients receiving care who are also impacted with episodes of violence around them, and it’s also a way to work with events as they happen, ie “this is our policy”; don’t be surprised if you are either asked to leave or not welcomed back if the abusive behavior is found to be within a person’s control. (I doubt this will really impact the truly cognitively impaired so probably not a worry, Luv.)

Just a word about what it’s like to be the target of the type of verbal abuse that they are talking about. Some patients refuse to have a person of color care for them and tell them to leave their room calling them the N word. I have seen the tears and degradement that that causes people who are there to help them. How can that not affect people? I’ve been called every name in the book, and not always by people cognitively impaired. By regular people. And families who might be angry. And way worse than name-calling, too, like throwing heavy things, or pulling weapons, etc. Having policies like this gives hospitals recourse for dealing with it. I have the feeling that if people are given the chance to explain themselves and change their behavior, they might be ok. But if it happens again, they may then be asked to leave if they are stable. More hospitals will probably go this route now, too. It’s good to get people talking about it. Basic respect is the expectation for everyone.

 

[LuvOrlando]

To be clear, I in no way implied the Dr's or Nurses or any regular staff should be put in harms way, however, nor do I accept that this is the only solution short of denial of care. This in no way seems binary to me, the behave or get out thing is not reasonable when these institutions collect a great deal of public and tax based funds if they accept Medicare etc.

In my first post ( at the very bottom) I offered what is, to me, the simple solution of facilities hiring many more staff whose sole purpose is mental health care and evaluation and management if restraint of some kind is necessary. This may or may not be a solution but it would seem these facilities are both the best well placed and have the highest contact rate with the at risk populations, not to mention they have the countries ear more often than not.

As a society we really do need to decide what we are doing, it seems a pivot to something else is necessary. When a person is acting out, as we've even seen here on the boards, literally THE VERY FIRST THING people say is, "Please go get help and talk to your Dr." and this is also true in real life. So if that institution is not going to pick it up the line, who then? We are seeing a massive uptick in violence and stories like what happened with Adam Lanza's mom being unable to get help, which are heartbreaking to me. None of this is going to do anything but grow unless we all take the bull by the horns. There has got to be something to be done.

Not putting this on Dr's or Nurses, they are physical caregivers, this is a non physical manifestation of maybe physical things and it requires a whole different set of skills on deck.

 

[Wiltony]

the simple solution of facilities hiring many more staff

There's your problem