In a message dated 3/1/2006 10:16:53 AM Eastern Standard Time,  
[log in to unmask] writes:

Betsy  writes: "Around here, if a patient is non-compliant, a physician has 
the right  to terminate care."


Dear Friends:
   In my nursing education "non-compliance" was a nursing  diagnosis and all 
the interventions I was trained to do involved some form of  manipulation and 
use of authority. A non-compliant patient was one who didn't do  what they 
were told to do. The problem was that the patient wasn't doing  something, never 
that the healthcare professional was asking for things that  weren't 
understood, or weren't acceptable culturally, or weren't acceptable  personally. I was 
trained to find ways to get the patient to accept the medical  care, and never 
once was I taught to any counseling techniques or any techniques  to 
investigate the reason an autonomous person would reject any  suggestion.
    I remember as a beginning student nurse working  with a demented tiny old 
lady. This lady refused her bath. As I was young and  strong and bigger, I 
basically picked her up and put her in the tub and washed  her. I earned a "A" 
for that clinical day, and got lots of strokes from my  instructor for taking 
charge, and accomplishing the necessary task.
    The little old lady struggled, and tried to bite  me. She must have felt 
that I was going to kill her. I was never given any  guidance about how to 
work with the patient to meet mutually acceptable goals,  never any reminders 
about maintaining respect and dignity of personhood, and  never any encouragement 
about cooperation.
    I will never forget that day...............as a  young nurse, I was so 
proud to have earned a commendation from my teacher. And I  am horrifed and 
ashamed today, and also aware of the power struggle between  patients and the  
healthcare system.
    The head neonatologist in a NICU said at a meeting,  in front of staff 
nurses and me, that human milk is insufficient nutrition for  the first few days 
of life. That belief is underneath her clinical practice to  supplement with 
human milk substitutes for premature or sick babies. 
    One on hand I am glad that she was honest; on the  other hand I am 
horrifed. Because this physician has all the power in the NICU,  I am fighting an 
uphill battle. And I am supposed to support this practice, so  that parents in 
the NICU won't be upset with physician recommendations.
    Such a complex situation, and NOT about health.  This time it is about 
power and control. 
    How many hospitals have a 'patient bill of rights'  posted on the wall? 
And how many hospitals will actually support those  rights?
    warmly,

Nikki Lee RN, MS, Mother of 2, IBCLC, CCE
Maternal-Child Adjunct  Faculty Union Institute and University
Film Reviews Editor, Journal of Human  Lactation
www.breastfeedingalwaysbest.com

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