{"id":16885,"date":"2014-12-12T11:29:52","date_gmt":"2014-12-12T16:29:52","guid":{"rendered":"http:\/\/pmedicine.org\/epatients\/?p=16885"},"modified":"2014-12-12T16:59:23","modified_gmt":"2014-12-12T21:59:23","slug":"naughty-or-nice","status":"publish","type":"post","link":"https:\/\/participatorymedicine.org\/epatients\/2014\/12\/naughty-or-nice.html","title":{"rendered":"Engaging Patients in Safety: Naughty or Nice?"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" class=\"size-full alignright wp-image-16886\" src=\"https:\/\/participatorymedicine.org\/epatients\/wp-content\/uploads\/sites\/3\/2014\/12\/Naughty-or-Nice-300x200.jpg\" alt=\"naughty or nice image\" width=\"300\" height=\"200\" srcset=\"https:\/\/participatorymedicine.org\/epatients\/wp-content\/uploads\/sites\/3\/2014\/12\/Naughty-or-Nice-300x200.jpg 300w, https:\/\/participatorymedicine.org\/epatients\/wp-content\/uploads\/sites\/3\/2014\/12\/Naughty-or-Nice.jpg 407w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><i style=\"color: #222222\">This post by long-time SPM member\u00a0<a style=\"color: #1155cc\" href=\"http:\/\/millenson.com\/\" target=\"_blank\">Michael Millenson<\/a>\u00a0first appeared on the\u00a0<a style=\"color: #1155cc\" href=\"http:\/\/www.engagingpatients.org\/patient-and-family-engagement-2\/engaging-patients-safety-naughty-nice\/\" target=\"_blank\">EngagingPatients.org blog<\/a>. We&#8217;re re-posting it here to both put it on the membership&#8217;s radar, and to invite comments on Michael&#8217;s POV that &#8220;As much as we can argue that patient engagement with their own healthcare decisions is progress, asking patients to keep doctors honest about the most basic medical practices is less a form of patient-centered medicine than a tacit failure of physician professionalism &#8211; and to an even greater degree a failure of medical management.&#8221;<\/i><\/p>\n<p style=\"color: #555555\">The process of engaging patients in making care safer should be seen through a Santa Claus lens. It can be\u00a0<a style=\"color: #00b5cc\" href=\"http:\/\/www.claus.com\/naughtyornice\/nn_hmpg2.php\" target=\"_blank\">naughty or nice<\/a>, depending not on good intentions but on the specifics of the intervention.<\/p>\n<p><!--more--><\/p>\n<p style=\"color: #555555\"><strong>Seeking True Empowerment<\/strong><\/p>\n<p style=\"color: #555555\">The key question is whether patients are being truly empowered or whether providers are passing the buck, placing on patients\u2019 shoulders responsibilities that rightfully should reside elsewhere. It\u2019s like those old Westerns where the sheriff hands rifles to a bunch of ranchers and tells them to\u00a0<a style=\"color: #00b5cc\" href=\"https:\/\/www.youtube.com\/watch?v=FLAVOttONmc\" target=\"_blank\">form up a posse<\/a>\u00a0and ride with him after the bad guy. While it\u2019s nice to be a valued part of the justice system, there\u2019s a reason the local citizenry finally coughed up enough cash to pay for a real police force.<\/p>\n<p style=\"color: #555555\">When providers ask patients to help them prevent the routine\u00a0<a style=\"color: #00b5cc\" href=\"http:\/\/qualitysafety.bmj.com\/content\/12\/1\/58.abstract\" target=\"_blank\">hazards of hospitalization<\/a>, it\u2019s an implicit admission of professional failure dressed up in empowerment clothing. It\u2019s not my job as a patient or family member to make sure doctors and nurses wash their hands. It\u2019s not my job to make sure I get the right medication. It\u2019s \u00a0not my job to make sure the room is clean.<\/p>\n<p style=\"color: #555555\"><strong>Patients as \u2018Safety Buffers\u2019<\/strong><\/p>\n<p style=\"color: #555555\">As a 2007\u00a0<a style=\"color: #00b5cc\" href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1369-7625.2007.00450.x\/abstract?deniedAccessCustomisedMessage=&amp;userIsAuthenticated=false\" target=\"_blank\">article<\/a>\u00a0in the journal\u00a0<em>Health Expectations<\/em>\u00a0on patient involvement in patient safety put it: \u201cPatients can act as \u2018safety buffers\u2019 during their care, but the responsibility for their safety must remain with the health care professionals.\u201d<\/p>\n<p style=\"color: #555555\">A\u00a0<a style=\"color: #00b5cc\" href=\"http:\/\/mdmunk.com\/2014\/08\/27\/asking-patients-to-advocate-for-their-own-safety-is-not-patient-centered-care\/#more-528\" target=\"_blank\">blog post<\/a>\u00a0in mid-2014 from Dr. Marc-David Munk put it even more bluntly:<\/p>\n<p style=\"color: #555555\">As much as we can argue that patient engagement with their own healthcare decisions is progress, asking patients to keep doctors honest about the most basic medical practices is\u00a0less a form of patient-centered medicine than a tacit failure of physician professionalism\u00a0(and to an even greater degree\u00a0a failure of medical management).<\/p>\n<p style=\"color: #555555\">I accept that being a \u201csafety buffer\u201d is, for now, a necessary role, but it should be a source of professional embarrassment rather than pride. Imagine your family went to a restaurant that promised a \u201cpatron-centered\u201d dining experience. After being carefully consulted on the ingredients for each individual\u2019s appetizer, main dish and dessert, the chef adds one last request. Could you please smell the fish, chicken and meat and take a close look at the vegetables to make sure nothing is rotten? Of course, the restaurant tries its best, but buying and preparing food is an inherently unpredictable process.<\/p>\n<p style=\"color: #555555\">When,\u00a0<a style=\"color: #00b5cc\" href=\"http:\/\/www.jstor.org\/stable\/10.1086\/677145\" target=\"_blank\">after 150 years to get it right<\/a>, hospitals boost their hand-washing rate to 90 percent or more, patients will be a buffer. At 50 percent hand hygiene compliance, you\u2019re asking us to put our finger in the dike while you ignore the raging ocean on the other side. Again, it may be necessary for safety, but it shouldn\u2019t be.<\/p>\n<p style=\"color: #555555\"><strong>Consider the Implications<\/strong><\/p>\n<p style=\"color: #555555\">In early 2014, the Centers for Disease Control and Prevention issued an<a href=\"http:\/\/www.cdc.gov\/HAI\/patientSafety\/patient-safety.html\" target=\"_blank\">\u00a0infographic for patients<\/a>\u00a0on healthcare-associated infections. \u201cBe informed. Be Empowered. Be Prepared,\u201d it proclaims. Some of the advice is legitimately empowering, some isn\u2019t. \u201cAsk your doctor how he\/she prevents surgical site infections,\u201d followed by \u201cAlso ask how you can prepare for surgery to reduce your infection risk\u201d gets the roles right. But, \u201cIf you have a catheter, ask each day if it is necessary\u201d is advice that sounds reasonable until you play out the implications a little further.<\/p>\n<p style=\"color: #555555\">Imagine this dialogue one morning in the intensive care unit:<\/p>\n<p style=\"color: #555555\">\u201cDoctor, based on my 15 years as a real estate agent, I wonder whether that central line catheter providing me with nutrition and medications really needs to be in my chest today.\u201d<\/p>\n<p style=\"color: #555555\">\u201cBased on my 15 years working with desperately ill patients, I thought so, but now that you mention it, let\u2019s remove it right now.\u201d<\/p>\n<p style=\"color: #555555\">I feel more empowered already.<\/p>\n<p style=\"color: #555555\"><strong>A Matter of Professional Responsibility<\/strong><\/p>\n<p style=\"color: #555555\">There are guidelines to ensure that central lines are used appropriately. When they are followed, along with other \u201cchecklist\u201d items related to monitoring use of those lines, bloodstream infections related to central lines\u00a0<a style=\"color: #00b5cc\" href=\"http:\/\/www.ahrq.gov\/professionals\/quality-patient-safety\/cusp\/clabsi-final\/index.html\" target=\"_blank\">drop dramatically<\/a>. Fewer patients are hurt and fewer die. It is a professional responsibility of the highest order to ensure that systems and a culture are place to ensure those guidelines are followed. The same holds true for dispensing medications and hand hygiene.<\/p>\n<p style=\"color: #555555\">By contrast, providing patients and family members the means to protect themselves in case of rare events that could seriously harm them is truly empowering. So, for instance, enabling a family member to \u201ccall a code\u201d for a rapid response team acknowledges that even the best systems can break down and that patients can be trusted as partners in care to react appropriately. It also acknowledges that a hospital\u2019s workplace hierarchies may cause a nurse or junior physician to hesitate where the patient\u2019s family will not.<\/p>\n<p style=\"color: #555555\"><strong>True Engagement is Collaboration<\/strong><\/p>\n<p style=\"color: #555555\">Enabling patients to report adverse events is engagement that\u2019s empowering. So is having the staff seek real-time feedback from patients on possible safety issues. Establishing patient and family advisory councils to examine hospital processes through the patient\u2019s eyes for ways to make care better is enormously empowering. True engagement is collaboration; the rest deserves a lump of coal in the stocking.<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>This post by long-time SPM member\u00a0Michael Millenson\u00a0first appeared on the\u00a0EngagingPatients.org blog. We&#8217;re re-posting it here to both put it on the membership&#8217;s radar, and to invite comments on Michael&#8217;s POV [&hellip;]<\/p>\n","protected":false},"author":57,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"give_campaign_id":0,"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","_price":"","_stock":"","_tribe_ticket_header":"","_tribe_default_ticket_provider":"","_tribe_ticket_capacity":"0","_ticket_start_date":"","_ticket_end_date":"","_tribe_ticket_show_description":"","_tribe_ticket_show_not_going":false,"_tribe_ticket_use_global_stock":"","_tribe_ticket_global_stock_level":"","_global_stock_mode":"","_global_stock_cap":"","_tribe_rsvp_for_event":"","_tribe_ticket_going_count":"","_tribe_ticket_not_going_count":"","_tribe_tickets_list":"[]","_tribe_ticket_has_attendee_info_fields":false,"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[1,5,59,62,2],"tags":[72,76,82,8,165,307,1063,312,413,169,3680,4616,1867,7710,3592],"coauthors":[],"class_list":["post-16885","post","type-post","status-publish","format-standard","hentry","category-general","category-ptdoc-co-care","category-policy-issues","category-reforming-healthcare","category-trendsprinciples","tag-blog","tag-doctors","tag-e-patient","tag-e-patients","tag-health-care","tag-health-care-reform","tag-health-care-system","tag-healthcare-system","tag-medicine","tag-participatory-medicine","tag-patient-centered-care","tag-patient-engagement","tag-patient-safety","tag-shared-decision-making","tag-spm"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Engaging Patients in Safety: Naughty or Nice?  - SPM Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/participatorymedicine.org\/epatients\/2014\/12\/naughty-or-nice.html\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Engaging Patients in Safety: Naughty or Nice?  - SPM Blog\" \/>\n<meta property=\"og:description\" content=\"This post by long-time SPM member\u00a0Michael Millenson\u00a0first appeared on the\u00a0EngagingPatients.org blog. We&#8217;re re-posting it here to both put it on the membership&#8217;s radar, and to invite comments on Michael&#8217;s POV [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/participatorymedicine.org\/epatients\/2014\/12\/naughty-or-nice.html\" \/>\n<meta property=\"og:site_name\" content=\"SPM Blog\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/participatorymedicine\" \/>\n<meta property=\"article:published_time\" content=\"2014-12-12T16:29:52+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2014-12-12T21:59:23+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/participatorymedicine.org\/epatients\/wp-content\/uploads\/sites\/3\/2014\/12\/Naughty-or-Nice.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"407\" \/>\n\t<meta property=\"og:image:height\" content=\"272\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Casey Quinlan\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@s4pm\" \/>\n<meta name=\"twitter:site\" content=\"@s4pm\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Casey Quinlan\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/participatorymedicine.org\\\/epatients\\\/2014\\\/12\\\/naughty-or-nice.html#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/participatorymedicine.org\\\/epatients\\\/2014\\\/12\\\/naughty-or-nice.html\"},\"author\":{\"name\":\"Casey Quinlan\",\"@id\":\"https:\\\/\\\/participatorymedicine.org\\\/epatients\\\/#\\\/schema\\\/person\\\/6e341f8175db79341ddc513cee260c5b\"},\"headline\":\"Engaging Patients in Safety: Naughty or Nice?\",\"datePublished\":\"2014-12-12T16:29:52+00:00\",\"dateModified\":\"2014-12-12T21:59:23+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/participatorymedicine.org\\\/epatients\\\/2014\\\/12\\\/naughty-or-nice.html\"},\"wordCount\":975,\"commentCount\":8,\"publisher\":{\"@id\":\"https:\\\/\\\/participatorymedicine.org\\\/epatients\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/participatorymedicine.org\\\/epatients\\\/2014\\\/12\\\/naughty-or-nice.html#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/participatorymedicine.org\\\/epatients\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2014\\\/12\\\/Naughty-or-Nice-300x200.jpg\",\"keywords\":[\"blog\",\"doctors\",\"e-patient\",\"e-patients\",\"health care\",\"Health Care Reform\",\"Health Care System\",\"Healthcare System\",\"Medicine\",\"participatory medicine\",\"Patient Centered Care\",\"patient engagement\",\"Patient Safety\",\"shared decision making\",\"Spm\"],\"articleSection\":[\"General\",\"Patient\\\/Doctor Co-Care\",\"Policy Issues\",\"Reforming Healthcare\",\"Trends &amp; Principles\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/participatorymedicine.org\\\/epatients\\\/2014\\\/12\\\/naughty-or-nice.html#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/participatorymedicine.org\\\/epatients\\\/2014\\\/12\\\/naughty-or-nice.html\",\"url\":\"https:\\\/\\\/participatorymedicine.org\\\/epatients\\\/2014\\\/12\\\/naughty-or-nice.html\",\"name\":\"Engaging Patients in Safety: Naughty or Nice? 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