WORLD GO ROUND

December, 2007 Volume 34, Number 5

Letter from the President

By Helen Bakker, ISPA President

In early October, I was all packed and ready to leave for France, to attend the national conference of the Psychologues Scolaires (AFPS), our long term affiliate. I had the honor of being invited to speak, in my role as ISPA President, and was all set to go. AFPS is a well respected affiliate of ISPA, and the organization had put forth a lot of effort to make this happen. In particular, Rosene de Saint Hilaire worked hard to get everything organized.

Before leaving, I went for a tennis lesson and in the last five minutes I tore my Achilles tendon! So instead of flying to Bordeaux for the conference, I found myself in the hospital, waiting for surgery.

As I am writing this, 6 weeks have passed, and so have the casts and tape, and I am pretty much back on my feet. But most of all, I have experienced being ‘on-the-other-side,’ being the patient instead of the health provider! And what important lessons I have learned!

My first lesson as a patient was about the importance of communication and information. I think it is safe to say that usually I am not afraid to ask questions and to stand up for myself. I also consider myself a reasonably informed patient. However, despite all that, I found myself time and time again not knowing—not having enough information.

I was told that I needed surgery early in the afternoon. It took until about dinnertime before someone showed up again and told me (again) that indeed I needed surgery, and ‘would be put on the list.’ Fortunately, it did not take much longer after that, but it becomes a long wait when you are not informed about what is happening.

My boyfriend, who had been waiting throughout the operation, was informed when I got out of surgery, and was told I would be back in my room in about an hour. However, because I was experiencing pain after waking up, they had given me painkillers and I had fallen back asleep. As a result, I stayed in the recovery room for an extra two hours, none of which was communicated to my friend. A simple phone call would have sufficed, but now, of course, he was wondering why I did not return as he was told. It was unnecessary worry, because I was okay; nothing was wrong; I was just sleeping my pain off.

Communication stayed an issue throughout my recovery. I learned about the use of files containing confidential information about my case. Every doctor or nurse that passed by (not many, by the way!), asked questions and took notes. None of them ever referred to the ones from my file. It truly seemed the reporting was an activity of its own, but of no use. Reading the file certainly did not seem to be their habit. Later, when I was in the stage where my cast was being changed, it even turned out that there were no notes at all of one of my visits to the casting room. My ‘file’ there consisted of a single sheet of paper, with two sentences about my first visit to the room – and since the electronic file could not be opened (?!), the doctor actually asked me why I was there and what step he had to take. They had a protocol for treatment of an Achilles tendon, but the fact that I had made an extra visit to the room that had not been noted made him wonder if the protocol should be followed. Was that not his responsibility and role, and is that not the reason for keeping a file to begin with?

These events made me think about current changes – at least in my country – in the (mental) health system. Regulations about reporting and transparency follow each other, and most health professionals spend an extraordinary part of their time writing reports, and filling out forms. Inasmuch as this is needed to help patients or clients understand what is being done, why it is done, and what the conclusions are, I believe this is essential and important. However, where it is primarily to satisfy insurance companies or financial departments, I believe the time should be spent on the core activity and focus: i.e., helping patients. My experiences with the hospital made me wonder how the professionals view the files. It seemed they did not even use it any more for one of its core purposes: a document for transferring information between the various professionals involved.

Even though, again, I consider myself reasonably assertive, every time I returned from a visit to the casting room, I realized there were questions I forgot to ask! I still wonder what it is that happens that makes you forget your plans once in this environment. It made me all the more aware of the importance for a health provider to stand next to the patient and put one’s self in his place. Too often, I am afraid, professionals spend too little time sharing their findings or discussing what to do next. Clients are expected to ask questions, but in the circumstances, they may be too overwhelmed and not ask much. As a result, the effect of the contacts may be limited, and clients may feel unsatisfied because some of their questions – or expectations – were not answered.

Fortunately, I also got to experience good practice! One of the most impressive moments was when I woke up in the recovery room. Even though I just had surgery and was pretty groggy, I very intensely noticed the efficiency, smoothness, and friendly atmosphere of this room. There were as many medical personnel as patients, some with serious operations behind them, and everything went smooth and fast. The medical personnel did not miss a thing. Even though I think I was only there (while awake) for about 15 minutes, the atmosphere and client-centeredness of the whole room made a lasting impression! In addition, the communication was good: I was well informed about everything they did and they never failed to explain why they did it. This certainly was an example of ‘good practice’ and it really made me feel like I was in good hands!

Another lesson I learned as a patient was that of the importance of voicing expectations, and informing about prognosis. Never in the whole process did anyone take the time to sit down and explain what steps were going to be taken and what I could expect. My main source of information was the internet! However, of course there are many ways leading to Rome, and being a novice, the internet does not really provide enough information. I found myself living from one visit to the casting room to the next, and not knowing more than what was going to be happening within that short time. The only thing that was told to me right away, as I was still in the hospital, was that I would need physical therapy at the end. Of course, there was not much they could do while my leg was still in a cast. So the one thing I was expecting was physical therapy. Well, when the final tape was off, the doctor told me ‘that was it’! So I carefully asked ‘and what about physical therapy now?’ Guess what—none! Of course, as in every profession, there are different theories and practices, and this doctor did not really favor physical therapy. His explanation seemed reasonable, but so did that of the previous doctor.

So what lessons did I learn in my experience with the different health professionals? I learned how important it is to communicate clearly, and to be clear about expectations, both from the patient’s point of view and from that of the professional. I also learned how important it is for a professional to recognize the knowledge base of the patient and be aware that patients have different amounts of information available to them. I learned that it is important to tune in to the information level of the patient.

I learned as well about the importance of informing the patient, of explaining what you are doing and why you are doing it. Things that seem very logical to the professional may not be logical and ‘automatic’ to the patient.

Interestingly enough, the week I was writing this letter, my university organized a debate about the ‘doctor-patient communication.’ The keynote speaker–a well-renowned researcher on Healthcare—argued that research shows that good communication is not only important for a good relationship between doctor and patient, but also for good assessment and diagnosis, and for the progress of the therapeutic process.

Doesn’t this all sound familiar? Is this not what we–as school psychologists are, or should be, doing all the time? But aren’t we also at times falling in the pitfall of the hurried pace, the bureaucracy, the automatism? Next time, when I am seeing a client, I will try to think of myself as being in their shoes. Maybe we all should!