I recently started working at Collingwood General & Marine Hospital’s Community Mental Health Services. There’s no question that this clinic is making a positive difference in the lives of many residents in the area. In fact, one of our top priorities is keeping patients in the community as long as they’re safe. However, the harsh reality that faces seniors without family support who are no longer able to live independently confronted me face-to-face this afternoon during a visit to a local nursing home.
In Canada, elderly people who can’t live alone have some choices if family support isn’t available. These include retirement homes, nursing homes, also know as long-term care facilities, or hospice care for those who are very ill and nearing the end of life. There are drastic differences, however, depending on whether or not you can afford care that is privately funded. Most of my patients can’t, which means their only option is government funded care. This is the kind of place I visited today and it was heartbreaking.
During the day, there are two registered nurses and four personal support workers at this 95-bed facility, which becomes one nurse and two support workers over night. My first thoughts were, ‘What if there was a fire? How would three workers get 95 seniors, most of whom can’t get themselves out of bed, never mind walk, out safely?’
Most of the rooms are shared, which means there are two to four residents using the same bathroom. Many of these people are incontinent and most of them have walking aids.
I didn’t get the sense that anyone was really making an effort to get to know these seniors, or what they were like premorbidly, either. There were no histories or photo albums by their beds. When I asked about this the nurse said, “We don’t do that here.” She wasn’t concerned about this though and didn’t give me any indication that they might consider it in the future.
There’s also no autonomy. Routine is important, but what if getting up at 7 a.m. and eating breakfast at 8 a.m. were never part of your routine and now, at 80 or 90 years of age, they have to be, because that’s the regimented schedule?
All of this made me wonder why we’ve come to accept this and how we justify it? It seems many of our elderly citizens are falling through the cracks and we’re largely letting it happen.
I’ll do my part to keep my patients in the community as long as safely possible. However, when they have to be institutionalized there should be better public options.
I don’t have a practical answer to this problem yet. What I do know is we need to address it now, because we wouldn’t consider these circumstances acceptable for any other age group.
Although there are many exceptional physicians in the world who listen, ‘Doctor knows best, don’t challenge me’ still features prominently in medicine’s culture.
Even if patient safety is on the line, most medical students and residents won’t challenge their senior colleagues. This is because they think their opinion will be ignored, they’ve been warned by people they respect not to, they fear that doing so could damage their career, or they have friends whose jobs have been destroyed by such behaviour.
In his book, Safe Patients, Smart Hospitals: How One Doctor’s Checklist Can Help Us Change Health Care from the Inside Out, Dr. Peter Pronovost, an intensive care physician at Johns Hopkins, discovered that in 90 per cent of serious, harmful patient safety events, at least one team member knew something was wrong but either didn’t say anything, or spoke up and got ignored.
We know that groups do better than expert individuals, yet we don’t get enough training about how to work this way in medical school. We spend countless hours looking at slides under microscopes to improve our individual knowledge, but very little time learning how to work as a team or how to resolve conflict.
Medicine’s culture of intimidation is slowly changing, however, because we’re starting to talk about it. This matters since it’s the first step towards making hospitals safer for patients, as well as constructive learning environments for doctors.