Doctor or nurse? The hospital assumptions that put patients at risk [PODCAST]

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes

Snap judgments happen all the time in medicine. Sometimes they are funny, and sometimes they put patients at risk. Christine King, a certified registered nurse anesthetist, has seen it from inside the operating room and from her sister’s first oncology appointment. This episode is based on her article “The assumptions in medicine that put patients at risk,” published on KevinMD. You will hear why she mistook a hospitalist for a nurse, and why asking “Who did you bring with you today?” beats guessing at family ties. She describes how a new hospital team of skilled clinicians took time to gel because they came from different systems. She walks you through the many people a patient meets before surgery, including a patient whose sedation erased the memory of the surgeon’s visit. She also explains why you should feel free to ask each person’s role and whether they washed their hands. Press play to hear the questions clinicians and patients can ask, and why she says relationships still matter in the age of AI.

This episode is brought to you by Froedtert & the Medical College of Wisconsin.

As a physician, you give everything to your patients. At Froedtert & the Medical College of Wisconsin health network, our focus is on giving that same care back to you. When you join, you practice at the top of your license, backed by a care team built to handle the routine so you can be fully present with your patients. Experience the best of both worlds: access to academic medicine with the Medical College of Wisconsin and a health system that empowers you to thrive: both grounded in deep community roots.

So whether you’re exploring a role in Family Medicine, Internal Medicine, or Med-Peds, you’ll have the team and the technology behind you. Reinvent health care in Wisconsin. Be here. Visit FroedtertCareers.com to learn more.

VISIT SPONSOR → https://froedtertcareers.com

EXPLORE PHYSICIAN ROLES → https://kevinmd.com/froedtert

SUBSCRIBE TO THE PODCAST → https://www.kevinmd.com/podcast

Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome back Christine King. She’s a nurse anesthetist, and today’s KevinMD article is “The assumptions in medicine that put patients at risk.” Christine, welcome back to the show.

Christine King: Thank you. I’m glad to be here.

Kevin Pho: All right. Before talking about the article, tell us why you decided to share it in the first place.

Christine King: Just because I think medicine and health care is such a complicated system. I think we have to make snap judgments all the time, and sometimes those judgments are just incorrect. Sometimes the outcomes are humorous, but they can also be dangerous too.

Kevin Pho: Right. In your article, you give us a couple of stories and examples of these snap judgments. Tell us about the article.

Christine King: Yes. There’s something I actually didn’t put in there. I worked in an OR, where most people wear scrubs, so it’s very hard to distinguish what position everybody has. It happens that people will come in and assume you’re a doctor, and you have to say, “No, I’m a nurse.” Or they assume a female doctor is a nurse.

I’ve done that myself. That was one of the stories I put in the article, about how I went onto the intensive care unit and mistook a hospitalist for a nurse just because she happened to be outside the patient’s room. She took it very, very well. I was embarrassed.

I know that when my sister had breast cancer, she went to her initial oncology appointment and brought my brother and sister-in-law and my mother, also her mother. The oncologist assumed that my brother and sister-in-law were her parents and that my mother was her grandmother, and everybody laughed about it. No harm, no foul; nobody said anything or corrected her.

But I think it’s easy. I’m sure everybody has had the experience of walking into the room and saying, “Oh, is this your wife, or is this your mother?” It’s much, much better to walk into a room and say, “Oh, who did you bring with you today?” [laughter]

Kevin Pho: I think we as health care providers have probably all learned that the hard way. Sometimes, with these snap judgments and these assumptions we’re talking about, how can they impact patient care?

Christine King: Well, I think you have to take every patient who comes in as an individual. When a patient comes into the hospital, they assume they’re going to get the best care you can provide, and that should be an assumption they absolutely can make. That’s why they’re there: to get the best care that can be provided.

As health care providers, we have to set aside our assumptions. Not everybody has the same background, and you have to accept people for who they are. I think that’s really, really important to do, because assumptions can lead to making judgments that may or may not be true.

Kevin Pho: You’ve been on both sides of that debate, both as a clinician and as a patient. What are some things we in health care can do? I like that example you alluded to, when you go into the exam room and ask, “Who did you bring with you today?” Any other tips and tricks you could share with us from the clinician side to avoid some of these misperceptions?

Christine King: Yes. Like I said, when you go in, make sure you look at the patient and ask who they brought with them. Make everything patient-focused, and ask if it’s OK to speak in front of the person they brought, because sometimes it’s just a neighbor or a ride who happens to be sitting there. I think those are important things to explore.

Another story I didn’t put in the article, but that kind of applies, is from when I first started working at the hospital I just stopped working at. It was a brand-new hospital, and everybody was brought in. They all had solid backgrounds and were all very, very competent providers, so we assumed that everybody would do everything the same way. But we were coming from different places that had different systems in place, different charting systems, and different ways of communicating.

So it took a while to gel as a department. Yes, you could assume that everybody had the skills they needed to have, but you can’t assume that everybody was doing it exactly the same way, and it took a while to gel as a team because of that.

Kevin Pho: I can only imagine. When you go to a new place, you have people from a variety of backgrounds, and culture takes a little bit of time to build. You have to build that individual culture, and it’s only going to take some time for that to happen.

Christine King: Exactly. We eventually all got on the same page, but I think that’s an important thing too. I just think relationships matter in health care. The relationships you develop with your patients are important, and the relationships you develop with other staff members are also very important.

Kevin Pho: Now, how about from the other side? Sometimes patients mistake a physician for a nurse. They make the same misperception you did when you were in the intensive care unit. I know there are some hospitals with name tags that clearly define each person’s degree. How can we get past some of those misperceptions? These are stories I hear a lot on my podcast, and they still happen despite everything hospitals are doing. What are some ways you can think of that we can get past some of these stereotypes and misperceptions?

Christine King: I just think it’s very difficult. I think they should have your position very, very clearly marked. But especially in an OR setting, you have patients who are coming in so nervous because they have a surgery ahead of them. Even if it’s a minor surgery, it’s not minor to them. And you have so many different departments approaching them all at once. I think they get very confused and very overwhelmed.

In an OR, at the first start of the day, everything is extremely chaotic. There are a lot of people around and a lot of noise. I think it’s easy to get very lost in that. So I think the best thing you can do is just take your time with each person, as much time as you can, and really focus on them while you’re at the bedside. Introduce yourself by what your position is, and then focus on them directly.

I think it’s really important as another provider too, because everybody wants to get to the patient before surgery to get consent, to do exams, and that kind of thing. I think it’s important that we do it one at a time. I know time is of the essence, and I do understand that, but I think the patient is getting lost in all the production pressure we have.

Kevin Pho: Give us a sense of what goes on in a typical surgery. You obviously have the surgeon, and you’re a nurse anesthetist. How many people have to interact with that patient? Just to give us a sense of how many people there are, or how overwhelming it is for patients who have to go to a hospital for a procedure.

Christine King: Sure. Usually, the patient is brought back by the pre-op nurse, who is getting them ready for their surgery, who may or may not start an IV, and who does an intake on them. That’s all the questions you encounter pretty much everywhere: allergies, that type of thing. So they’re going through all of that, and what procedure they’re there for.

You have the anesthesiologist, who has to see the patient and get consent. You have me, as a nurse anesthetist, coming to the bedside to introduce myself, because I’m going to be the one who’s in the room with them the whole entire time. Sometimes you have to explain what my role is compared to the physician’s role, because they’re like, “Well, I thought that person was going to be in the room with me the whole time.” You have to explain how that system works, because not everybody is fluent in health care, and not every system does everything the same. And then the surgeon has to come by. Usually, they know the surgeon, which is actually good, but the surgeon has to answer any last-minute questions.

I even had a patient once who was getting, I’m sorry, shoulder surgery. They had a block done, and they got Versed and fentanyl for the block. The surgeon came after the block was in, and because of the Versed, they were not able to remember that the surgeon was there. I had to call the surgeon back. They said, “I haven’t seen my surgeon. I’m not going back to the room until I see my surgeon.” They had seen the surgeon, but they just didn’t remember it. So we had to bring the surgeon back, with the family member there, so that everybody who had questions could have their questions answered.

Kevin Pho: That’s a great point, because a lot of these patients are going to be under some type of anesthesia, and sometimes you may need to reintroduce or reclarify who the members of the team are.

Christine King: Right. For sure.

Kevin Pho: Now, how about from the patient standpoint? You talked about your story when you were a patient in the intensive care unit. If the hospital or the medical team doesn’t take the steps we talked about, properly introducing themselves and making it clear who is who, what are some things patients can do to make sure we can reduce some of these assumptions?

Christine King: I think patients have become a little bit better at asking questions, and I think they need to. I think ten years ago, they used to be much more intimidated by the health care system, and now you see a little bit less of that. But I think as a patient, you have to be willing to question: “OK, now what’s your position again?” Or, “I met so many people today. I don’t remember what your position is.” Just be honest about that.

I’ve never met anybody in health care who would not tell you. We joke, “You’re going to have a quiz about this later,” which of course they’re not. But you have to speak up. And I think it’s OK, because you can’t assume that everybody has washed their hands. I think it’s OK as a patient to say, “Hey, I saw you at that bedside. Did you wash your hands in between?” I think that’s OK too, because any health care provider knows you have to wash your hands between patients. But there’s so much production pressure that sometimes it’s OK to have a little reminder, and you can do it in a nice way.

Kevin Pho: And for the patients who are listening to us now, I do want to emphasize that it’s OK to ask us who we are and what we do.

Christine King: Absolutely.

Kevin Pho: I would say there are very, very few clinicians who would take offense at that at all, right?

Christine King: Absolutely.

Kevin Pho: We’re talking to Christine King. She’s a nurse anesthetist, and today’s KevinMD article is “The assumptions in medicine that put patients at risk.” Christine, as always, let’s end with your take-home messages for the KevinMD audience.

Christine King: I think it’s just the same: It’s OK to clarify what everybody’s position is. If you have questions, it’s OK to ask them. And I think it’s very important, especially in this day of AI, to remember that relationships matter. The relationship you establish with the patient matters. The relationships you establish with your co-workers matter and help you give the best patient care you can give.

Kevin Pho: Christine, thank you so much for sharing your story, time, and insight, and thanks again for coming back on the show.

Christine King: Thank you very much. Thanks for having me.

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes