By Ramiro Valdez, PhD, LMSW
What kind of behavior can a patient expect from medical professionals? How are they supposed to interact with patients and just what information can they ask for? What can patients do if a staff member’s touch or their conversations feel inappropriate? While this may be rare, it is important for patients to know what they can expect of medical staff and what they can do if staff crosses the boundaries.
Professional behavior applies to all staff in a dialysis clinic, transplant center, hospital, doctor’s office, nursing home, hospice or any other medical setting. Everyone from the medical director to the part-time housekeeping workers have to follow rules of conduct. Licensed, certified, or registered medical personnel, either by the state board of examiners or a national registry must follow rules of conduct and ethics, or risk losing their job. This includes physicians, nurses, dietitians, social workers and most administrators. Those staff who are not licensed, such as patient care technicians, mechanical techs, or administrative office staff, must follow the policy of the company that employs them. The following is a summary of behavior expectations of medical professionals. It applies to everyone who works in the medical setting, no matter the job title.
No Harm. It is the foremost medical oath that doctors will knowingly do no harm to one of their patients. Although no other professions take such an oath, it applies to all staff in the medical setting. This means they will not do anything they know is going to do more harm than good. Of course, getting stuck with a needle or getting cut for surgery hurts, but the benefit is greater than the pain. Thus, physicians, and all medical staff, are not supposed to perform any procedure that will cause more harm than good.
Working Under the Influence. Medical professionals are supposed to abstain from the use of alcohol or drugs prior to work or while at work. Drugs prescribed by a doctor that will influence behavior or ability to work are included. It is also considered inappropriate for a professional to have alcohol on his/her breath so that patients can smell it.
Confidentiality. There are many federal laws that prohibit sharing information about a patient with inappropriate people. Medical professionals are not supposed to discuss anything about a patient unless the patient has given consent. Certainly, doctors can share information with other doctors or with the medical staff at the clinic so that proper care can be given, but talking about patients just to talk about them is not appropriate, no matter who is involved in the discussion.
If a patient signs a consent form releasing medical information, it should specify what information is to be shared and how long the consent is in effect. Giving open-ended consent to share all information is not proper. When patients sign consent forms for release of medical information they should take care that the form indicates specific information and the form is good for only 30 days.
Non-judgmental Attitude.
Staff members must refrain from expressing value judgments of patients, whether verbally or with their attitude. No matter what patients have done, no matter how they have harmed their bodies, staff members may not judge them. Non-judgmental attitude also applies in other areas. There is no room for racism in the dialysis clinics. Neither is there room for judging people because of their national origin, religious preference, sexual orientation, gender, color or creed.
Non-Financial Relationship.
There are certain people in the clinic, such as the social worker, who can exchange money with patients, but no one else should do so. Getting involved in patients’ finances can lead to confusion and accusations on both sides. If patients lend or borrow with staff it may be easy for one or the other to forget how much was lent or how much is still owed. This can cause patients and staff to lose faith and trust in one another.
Non-Romantic Involvement. Under no circumstances are staff members allowed to “date” patients. Certainly it is possible that some patients and staff may fall in love with each other and wish to commit to one another in marriage. If this is the case, the staff member should either request a transfer to another clinic in the same company or quit his/her job.
Romantic involvements can lead to favoritism. It would be too easy for a nurse to put her loved one in his chair before other patients because she knows that he gets tired of waiting. Other patients would see this and feel left out and rightfully complain to the clinic manager.
Active Listening. Staff members are supposed to take time and listen to patients, especially for hidden messages in discussions. Such loaded statements as “I’ve been feeling a little sad lately” should serve as a red flag to staff members. This can only happen if staff listens intently to patient discussions.
There is a difference between listening and waiting to speak. Some people will allow patients to have their say while thinking of how they are going to respond. This is not active listening. Staff members are supposed to listen and respond to what the patient has said, not what they were thinking while the patient spoke.
Educational Interactions.
Every interaction, every adjustment of the machine, every form filled in, and every injection given to a patient is an opportunity to teach. Staff members should teach patients what caused their kidney failure, what they can do to get the most out of dialysis, and how they can better adjust to all the changes that come with renal failure. Patients must also take responsibility to ask questions of staff. They should always ask what injections are and what they do. They should also ask what is being done to the machine. There is no such thing as too much information for patients.
One-Sided Discussions.
Patients need to “unload” on staff members, staff do not need to unload on patients. It is entirely inappropriate for a staff member to tell a patient that he is getting a divorce, that he does not like his supervisor, that he is unhappy with his salary, or other such personal matters. Patients do not need to know this. On the other hand, it is appropriate for patients to be able to tell staff that they do not feel well, that they are discouraged with the dialysis routine, that they are having trouble purchasing their prescriptions, or such.
Friendly, but not Familiar. Medical staff members should always be courteous and friendly in a personable, but not familiar way. They should greet patients with a smile, always stable and reliable. It is unprofessional for staff members to be pleasant one day and grumpy the next. If they are having a bad day, they do not need to give the patient a bad day by being unfriendly.
Political Correctness. There is no room in the medical setting for off-colored jokes, racial epithets or leering looks at anyone’s body. Staff should ask only for the information that is required for the medical record and no more. The social worker may ask personal questions in doing her job, but any patient may refuse to answer personal matters. There is seldom a need to remove articles of clothing in the dialysis center unless the doctor or nurse is doing a physical examination.
Courtesy at all Times. Staff members in medical settings should say “please” and “thank you” to patients just as they would each other. They should always tell a patient in a polite manner what they are going to do before they do it.
But what can patients do if they know of a staff member who has violated these or other principles of good medical professional standards? Our next issue will cover the steps a patient can take if this happens.
Ramiro Valdez, Ph.D, LMSW, has over 20 years experience in dialysis, as a renal social worker, administrator and consultant. He has been a consultant for dialysis and family medical care for over ten years.
This article originally appeared in the November 2007 issue of aakpRENALIFE.
