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Judgmental versus Objectivity: A healthcare provider’s tightrope.

Posted Dec 23 2008 9:14pm
W eaved into the fabric of healthcare education are numerous lectures by mentors and professors of medicine and nursing about maintaining one’s objectivity when caring for people in the acute care setting. To let go of one’s objectivity and become swept up by the emotional, political, moral, religious, or value aspect of what illness or injury a patient has is considered counterproductive and irrelevant to the care of a patient by most. It would be so noble to have such an individual that could turn off the judgmental switch and focus on the task at hand. Reality however dictates otherwise for many healthcare professionals.

Emergency departments (ED) are where much of the battle between judgment and objectivity wage on a daily basis. The drunk driver that comes to the ED either mildly or critically injured that is abusive, combative and fighting with hospital staff. The frequent flyer as they are often called that present to EDs with fictitious complaints of pain looking to score pharmaceutical grade narcotics. Or the IV drug abuser who presents with a huge abscess on their arm days after injecting themselves using a dirty needle with cocaine, or heroin. All these patients are regularly seen by every ED in the country and there are several other patients that frequent EDs across the land that consume precious resources that could be utilized more efficiently for those who are in better need – a judgment statement for sure.

Incorporating judgments about people and their behaviors is purely a human instinct. We make judgments all the time, and that’s OK, but how do healthcare providers rationalize withholding pain medicine, or other treatments to alleviate patient’s woes when the provider feels that they want to teach the patient a lesson because they have engaged in an illegal, immoral, or high risk behavior? The other day I heard a physician provider who was “caring” for one of the aforementioned patients say “I’m not giving them anything, they can suffer.” Other phrases like” just ignore them and eventually they will sign out AMA”(Against Medical Advise).

At what point do other providers either nurses or physicians blow the whistle on their colleagues for clearly not maintaining their objectivity in providing care? Is it OK to let a drunk driver who gets into a car accident and hits another sober person lie on an ED stretcher in pain to teach them a lesson? Some would say yes. Should healthcare providers commit finite and precious resources to heroin addicts that overdose and stop breathing? Why should healthcare save these people? Clearly some very difficult questions that are hugely contentious for many of us. Can healthcare providers maintain their objectivity long term or should they let their plan of care be influenced by personal values as a way of mitigating high risk or dangerous acts of others that cause them to be taken to an emergency department that is already busy and crowded? What are your thoughts?
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