Fast Food Nation: When Customer Service Competes with Patient Safety

by jparadisi

Drive-Thru Health Care by jparadisi

Calculating chemotherapy doses by surface area (m2) or kilograms was a smooth transition for me, a former pediatric intensive care nurse. In pediatrics, every medication, even acetaminophen, is dosed by weight. Tailoring chemotherapy doses to a patient’s weight was already a familiar concept; likewise dose reduction or withholding treatment altogether based on the patient’s lab values and assessment.

It’s a rare patient, however, who understands that her chemotherapy is prepared to order, not mixed ahead of time and awaiting her arrival, as if it’s fast-food made for the masses, preserved under a warming lamp.

This doesn’t matter as much if the patient receives his or her care in the hospital, but sometimes it creates unrealistic expectations in ambulatory oncology clinics. Somewhere along the line, good customer service has become confused with fast service, resulting in more and more patients with unrealistic expectations for their appointments.

It was one of those shifts when appointments backed up. Several factors contributed: Harsh weather conditions meant some patients arrived either late or too early for their appointments. The rapidly approaching holidays caused schedule changes for some patients. Of course, there were the normal, garden-variety delays: lab values requiring attention and patient veins that refused to accommodate IV catheters, etc.

Throughout the shift patients asked, “What’s the holdup?” Each time I thanked them for their patience, and validated the importance of their time. All shift long I explained, “One of the difficulties is that administering chemotherapy is not like making fast-food. Each treatment is made to order, measured against your lab values and tolerance. Our most important service is guarding your safety.” The explanation was received well, refocusing expectations on patient safety. Patients expressed appreciation for their nurses, oncologists, and pharmacists watching out for them.

The shift reminded me of a statement made by my husband, “Health care is neither inexpensive nor convenient,” and another one I heard a celebrity say on TV, “There’s never enough time to do things right the first time, but there always seems to be time to fix the mistakes later.”

Delivering prompt care is part of customer service, and as nurses, we should endeavor to keep appointments on schedule. However, our most important responsibility is patient safety.

How do you help patients keep their expectations regarding their care realistic?

No Winning for Losing

Manga (we've made all your favorite foods) photo: jparadisi

Every year, the day after Halloween marks Opening Day of Seasonal Gift-Eating. Nurses, you know what I’m talking about. All over America, nurse lounges abound with gifts of food given to us by patients and doctors offices. Huge canisters of gourmet popcorn, boxes of chocolate, and homemade delicacies arrive and cover all available counter space. Even if there’s no time for a lunch break, there’s always a few seconds to grab a piece of fudge. So it’s a little unfair, in my opinion, that health care is focusing on the issue of obesity, even though I know it’s right.

Many patients, female in particular, cringe when I ask them to step on the scale at their appointments.  I don’t say their weight out loud, but simply enter it into their chart. In the December issue of the American Journal of Nursing, Carol Potera reports on the emotional impact on patients of words used to describe their weight in Words Can Hurt. The information comes from a study led by clinical psychologist Gareth Dutton. I found the study’s contrast of words used by physicians versus words used by nurses to describe patient weight enlightening.

Medscape published an article Is “Fat Bias” Making You Ineffective? by Marilyn W. Edmunds PhD, CRNP, in which she calls upon health care providers to reflect upon our biases and how they impact our patients. She also asks us to consider cultural differences in perception of weight.

We’re not the only ones looking and judging, however. Recently at an art opening, another artist told me I am the only nurse he’s ever met who isn’t overweight, and it wasn’t the first time someone has said this to me. I find this public stereotype of nurses more troubling than Dr. Oz’s sexy nurses, who were really women who lost weight, although I agree the entire debacle was in poor taste.

I want to throw one more point into this post. A patient came in raging about fast food chains. I didn’t really get it until he explained that fast food is cheap, so for people living on the limited resources of disability, it is affordable. All the fat, all the sodium, the lack of nutrients from over-processing, is all he can afford. And then he comes in for his appointment and gets lectured on his A1C Hgb results, hypertension, and obesity. In his opinion, there’s no winning for losing.