Pushing Back Against Fear

I am not very good about guarding what I say. I am awkward and often say the wrong thing. If an act, statement, or policy is harmful, unproductive, or meant to limit my ability to improve, I tend to speak before my passion can be tamped. I have gotten in trouble for making a “thing” out of a moment and bringing a concern to light. Unfortunately, there have been plenty of inopportune misunderstandings, and my actions negatively hurt myself or others, creating fear instead of change.

We encounter fear in many forms; fear of loss, fear of harm, fear of the unknown, fear of physical, psychological, and emotional pain, fear of inadequacy, fear of punishment and repercussions for ourselves and those we love, and more.

The use of fear to align others with a specific ideology, behavior, or action is written throughout history. Fear motivates positive and negative responses and can create those responses en masse if utilized correctly. Fear can motivate a kind of peer pressure so intense that those who do not conform encounter danger to themselves and their family simply by choosing not to follow and not to be afraid. Fear shut down the world and had neighbors calling authorities on neighbors for simply being outside their front door.

I understand that fear is an amazing change agent! Targeting one person on a team, when that person is leading a policy change or encouraging transparency and a better environment for the team can quash all momentum and stop any movement toward change. Using fear to set an example works.

This is especially true in the patient care setting, where the use of coercion, threats, gaslighting, narcissistic behavior, deflection, and fallacy is used to gain patient compliance. It can happen to anyone, even the most seasoned patient advocate I know.

I encountered the use of peer pressure and fear of failure in a recent conversation with an MD influencer. This MD used her platform and personal success with an elective 39-week induction to encourage her followers to comply with her preferences. I spoke up, but the replies were invalidating, and some were downright mean because I was not a doctor. It did not matter what ACOG statement I shared (the doctor’s governing body) supporting informed choice or the research indicating the benefits of spontaneous labor in low-risk pregnancies and the risks of elective induction…I was told my experience did not count because I didn’t have the ‘right’ credentials and did not know what I was talking about.

As a nurse, I have stood at a patient’s bedside listening to their provider use these tactics to gain consent or listened as the patient is told that they do not have the experience to make medical decisions regarding healthcare interventions.

Fear is used to create doubt and compliance en masse, because if the system can make you feel like an outsider, it is easier for it to control you.

So....what is the answer?

In my experience, finding those who think and believe like you. Want a homebirth? Find others who have birthed at home. Want to give birth in a birth center, extended breastfeeding (breastfeeding > 2 years old), not circumcise your son, or make other care decisions considered not mainstream? Find those who have made those choices, and the fear is melted away with support and knowledge.

This is a special note to those we turn to for support in our choices. To those who help us navigate informed choices and our options, please remember yours is not to convince but to guide, support, and ease the fear that comes when we venture away from the influencers and followers. It is easy to become the fearmonger when you have convinced yourself that your choices are right for everyone or that you know best because of your training and credentials. We need you to push that aside and support informed choice so that every voice can be heard.

Fear...it has had enough control!  It is time to be brave!

Everything Has Risks

I am a fierce supporter of informed choice and autonomy in healthcare. I have worked for 23 years to give my clients and patients the freedom to choose what they feel is best for them. That means carefully educating to avoid bias, coercion, intimidation, or the appearance of authority.

“Every choice we have made leading up to that moment has created outcomes that pertain only to us and only to that moment.“

Informed choice involves the review of the risks and benefits of options and is not solely a medical treatment issue. It often impacts the choices we make in our daily lives that have little to do with healthcare. Additionally, the choices we have made before this point, especially the choices we have made with our bodies, and our lifestyle, impact our options and the risks of those options.

This is the risk-benefit ratio. These are the options and choices where you have to consider the risks versus the benefits and is highly individualized. My risks and benefits pertain to my circumstances and center around previous choices and outcomes. This is the reason why routine care policies and standard practices can be harmful. Every choice we have made leading up to that moment has created outcomes that pertain only to us and only to that moment. It is our risk-benefit ratio, and no one has the right to tell us what risks are too much, and what benefits are too few or vice versa.

I have had clients/patients who want their nurse or provider to make their care decisions. In those cases I take that responsibility very seriously and try to consider the risks and benefits within their treatment. I then introduce options with the least risk first, ask their preference, and continue to involve them in their care as much as they desire. I never want to be responsible for making decisions for a human who can choose for themselves. Even as a parent, the “because I said so” was very rare, and there were almost always two choices and an explanation of why. I’m not going to let you run into the street and get hit by a car or grab a hot pan, but if you try to do those things, we will talk about the risks.

“We don’t get to choose the risks or consequences, as they are a part of the natural order of humanity.“

The fact is, everything has risks, even those choices that do the most good or have the highest reward, we perceived the benefit so greatly outweighs the risks that we do not consider there to be negatives. We don’t get to choose the risks or consequences, as they are a part of the natural order of humanity, and even when we only see the benefits or positives of our choice, there will be a negative aspect.

“My risks and benefits pertain to my circumstances and center around previous choices and outcomes. “

For those that do not want children, either temporarily or permanently, the risk of pregnancy is so high that they will do everything to prevent it. They accept the risk of their decisions, namely birth control or surgery, because the risk of a pregnancy is much higher. For those who want children, they view pregnancy as a positive without risk, or the benefits so greatly overshadow the risks they are minimized to the point of null. However, the risks still exist, and usually show up to be dealt with; such nausea and vomiting, fatigue, stretch marks, bone and joint aches, and ultimately birth.

“However, the choice is ultimately ours, and no one has the right to remove our ability to choose which risks and benefits are acceptable to the individual.“

When we generalize healthcare and create an environment where everyone has the same interventions, we take away informed choice and force negative impacts creating a high risk, low benefit care environment. This is especially true with “you will” interventions – and often these are presented as you will have or we will be doing this intervention, and the options are often timed. For example: at 20 weeks you will have an ultrasound – at 37 weeks you will have a GBS (beta-strep) swab – we will break your water at 3 pm. These are suggested as interventions without risk, or where the benefit is assumed and the risk minimized, yet no one but us can assess the risks and benefits, and there lies the problem. For me, the option presented may carry acceptable risks, but for you the risks may outweigh the benefits and carry more harm.

“Additionally, the choices we have made before this point, especially the choices we have made with our bodies, and our lifestyle, impact our options and the risks of those options.“

I live the consequences of my choices. Yes, some of those choices impact others around me, and that should be considered in the assessment of risks and benefits. However, the choice is ultimately ours, and no one has the right to remove our ability to choose which risks and benefits are acceptable to the individual. As patients we have the right and responsibility to question, investigate, research, and expect feedback regarding our options. As providers we have to acknowledge that we do not fully know the risks or benefits for our patients, and since we do not live their life, we have to defer to their personal assessment. This means taking the time to listen and educate without the bias or our belief system or personal experiences.

*Sometime the options available are outside of the providers skills or ethical beliefs. The solution is referring or deferring to a different provider that can meet your patient’s needs.*

Remember That Catastrophe…

Plainly said, hospitals as they are currently run are unsafe for patients.

You feel a twinge of pain in your back on the right side, and you wonder should I go see the provider, but you talk yourself out of going.

Three days later you feel sick, have a fever, and you have pain when you urinate. Now you have to go see the provider, who promptly sends you to the emergency room to rule out a kidney infection (pylonephritis).

You are triaged at the emergency room and then asked to take a seat. You wait 1….2…..3 hours. People rush past you, bleeding, unconscious, screaming children, trauma patients, and you wait. At 3 hours you ask how much longer, as your pain is worse and you feel dizzy. You are told they only have enough staff to use 3 out of 8 patient rooms, and you will be brought back when they have an open room. So you wait, 4…. 5…. 6 hours.

In a place you are supposed to get better, you are getting worse.

Finally, they call your name. You are assessed by a nurse, labs are taken, an IV is started and you are given IV fluids while you wait to see the ER provider. After 2 more hours in walks a provider who says they are admitting you for a kidney infection.

45 minutes later you are wheeled into a Med-Surg room, helped onto a bed and you wait… A nurse comes in, takes your vitals, says they will be right back. An hour later you push your call light because the pain is getting worse. Unbearable pain along with fear that you will be left helpless takes hold. In a place you are supposed to get better, you are getting worse. Staff flutter by with barely a moment to spare.

Billable patient care not the patient is the priority for the system.

– Speaking of staff: hospital staff, especially nurses, work in such a toxic environment that every moment is under intense pressure to get done what can’t be done. There is little time to care for their patients needs, and no time to care for their own needs. It is common for a nurse to not have meal or bathroom breaks through a 12-14 hour shift. For many sitting, hydration and snacks occur while charting the mandatory documentation. Up to 60% of new nurses leave the nursing profession within 1 year. Hospital administrators and the systems they work in focus so completely on their income they have cut support staff, increased nurse to patient ratios, shorted patient care supplies, and refused adequate pay; yet their salary has continued to increase, sometimes drastically, while they decry lack of funding. To that fact, it should be stated clearly that nurses are NOT a chargeable cost. At no time have insurance companies or administrators suggested billing for hospital nursing care. Your nursing care is wrapped up in your room cost. Nurses are not a credit to the hospital monetary system, they are a cost, and are treated as such. Yet, hospitals cannot function without nursing care for patients. Billable patient care not the patient is the priority for the system.

As a patient, you lay in your hospital bed, alone with only the call light as your connection to your helpers. That call light often gets answered remotely, or not at all. In some facilities a telenurse on a screen asks you what your need is. Your medications will be late, your mobility will be limited, and your pain uncontrolled, because there are too many patients and not enough staff. The most critical patients will get what little time the staff has. This is the experience that many hospital patients are having. This environment is harming our patients, and causing unnecessary injuries and deaths. Plainly said, hospitals as they are currently run are unsafe for patients.