[00:00:00] Hey, all welcome back to another episode of the pulse check podcast. I’m hehe and I’m 

[00:00:06] Mandy. 

[00:00:07] And today we are diving into when medical staff weaponizes patient autonomy. And if you’re out there being like, what the heck does this mean? Let me explain it to you. So over on my TikTok, I had a nurse comment on a video that I had put up explaining patient rights and their right to informed refusal and discussing the rights that patient have when it comes to declining certain care aspects, procedures, really anything. And this nurse dropped into the comment saying, “that’s fine. I will just document in your chart that you refused care and we’ll see how things happen from there.”

[00:00:51] And the comment just struck me. So terribly, honestly, it just activated me to such a point. I took a couple days to respond because I wanted to truly think about like, where was this nurse coming from? And I really wanted to deconstruct the comments so that patients, you listeners, people on my tiktok, people on my Instagram could really understand where to take this comment if they encountered it in the patient room. And here’s where I settled A: providers and nurses should be documenting everything anyway. Whether a patient declines or accepts your clinical suggestion shouldn’t dictate whether you document that it should not impact that at all. Actually it should be more like counseled patient, patient accepted, and here are the things that we did. Or counseled patient patient declined, spoke with patients about alternatives, and here is what we did. For this nurse to literally weaponize a piece of her job. I mean, it’s a job requirement to make notes and document inpatient medical records. What is happening? The patient care room for them to weaponize that against patients in order to almost control them or in an attempt to bully them into submission is what it felt like is so inappropriate. And it also felt like she was weaponizing this patient’s autonomy because patients do have the right to decline

[00:02:35] And the fact that she said refused care. Also, I mean, I just got full body chills saying that out loud, refusing care and declining certain aspects of care or certain procedures are two totally different things and I just thought we could talk about it today. 

[00:02:55] Yeah. So it sounds like refusing care to you is kind of a step toward abandonment.

[00:03:01] Totally. 

[00:03:01] Okay. So like someone then saying, oh, well that person refused care means. She doesn’t want my care. They don’t want any part of this, but that’s not actually probably what the example was. The example probably wasn’t the patient was leaving AMA.

[00:03:20] Exactly 

[00:03:21] and refusing all kinds of care. So they were just declining an aspect. Yeah. I, I mean, do you have a lot of angry nurses in your comments? 

[00:03:30] It depends on what the video is. When I talk about declining IVs, it gets nurses up in arms, man. I mean, they just come for my breakfast, lunch and dinner and then dessert too. 

[00:03:42] Really? Okay. So that’s a great. That that’s a great example. That popped up for me this week as well. My, one of my one-on-one clients, it was like birth planning strategy session. And her pronouns were she her. And she was like, I just need to know. And I was like, Hey, let’s talk about some themes. And I was going through all this, like, thanks for sharing your story with me.

[00:04:03] And she was like, no, no, no meat and potatoes. I need to know about this IV. And I was like, oh shit. And I said, well, what information did you get? And do you know, she only got we’ll just make, we’ll just like come to an agreement, make an exception you can have a saline block. In labor, like uncomplicated, she’s not going in for surgery.

[00:04:25] She’s not going in for like an trauma ,or colonoscopy or anything like that. So like, Okay, well, we have this procedure and you need to have the medicine and it doesn’t make sense that you wouldn’t be able to have the medicine without the IV. And so maybe there’s like a gap in education. She’s like, as far as I know, no need for IV and no desire for IV. I’ve posted about IVs before, because there’s a lot that comes up with IVs. And I know for certain that medical professionals are not trained on the nuances around what IVs represent and what they mean for folks for patients and for the community. And they can be really, really triggering and activating. And 

[00:05:08] I mean to be on the care side and to know that this person may be making a decision that A: you don’t agree with B: that you feel is dangerous and C: that you maybe in your career have seen this choice lead to things that were in emergency or were dangerous or did result in bad outcomes certainly is activating.

[00:05:32] And it definitely is going to make you feel big feels, but what you cannot do as a provider or a nurse or anyone in any sort of authoritative role, you cannot weaponize that against these patients. You cannot say, well, because you have declined something that I personally as your nurse don’t, don’t agree with I’m now going to document it in your chart that you were combative. I’m now going to paint you in a light in your chart, that you were, you know, a hard patient that you were a difficult patient. And I just think that in her commenting. Well fine. I will just document it that you refused care. That’s exactly what this person was doing.

[00:06:14] Mm-hmm yeah. So she’s telling on herself, she’s kind of telling on the system that she’s definitely aware that folks that are labeled difficult for whatever reason is often due to bias or discrimination or both. If they’re labeled difficult, then they get treated differently and they get treated worse. So they wouldn’t label them VIP. They wouldn’t label them sweet and compliant, because that’s associated with blind compliance or like people are told what to do and they’re just like, do what they say they know best. If they’re labeled the opposite of that, then they are treated differently. And that’s what it sounds like. She knows very much ,she knows that much is true.

[00:06:55] And so she wants to label that person as difficult as like that’s their negative consequence to declining something is now they’re gonna be difficult. And, and that’s done in OB and like saying late prenatal care is another way of saying like, this person is non compliant. Language is super powerful and those little, little phrases can mean and change a lot about your care.

[00:07:20] And, and my client was very worried about being labeled and treated differently, treated poorly. She was like, “I am a grown ass woman.” She like named these privileges that she had. And she’s like, I am not treated like I know anything. I’m not treated like a whole human in medicine, in my prenatal visits, in the hospital. Anytime I go there, I am labeled as blankety blank, blank,” whatever is in her chart as a label and treated very differently. And that that’s what that comment says that that nurse made on your video is like, oh yeah, you want me to make their time bad? Let me just write a note in the chart about how they’re, you know, difficult.

[00:08:06] And, and that’s kind of like using the system against someone. Who knows what that nurse was going through. I can imagine that she’s seen pain around someone doing something that she didn’t agree with still doesn’t matter like that can’t change how we care for someone, but it, it does because it’s kind of unresolved and there’s no real processing around that for nurses and healthcare professionals.

[00:08:32] That’s what I was actually just about to say is, you know, you just said a sentence that she wanted to label this person as that, so that they got treated different. It’s that want. It’s that desire that you want there to be repercussions or consequences for patients if they don’t do what they say. For me, A: just how fucking rude, like how terrible of you as a care provider to want ill intent on your patients. And number two: my heart shatters for this nurse, because I can feel the unresolved trauma that she carries around, whether she has ever even seen an emergency happen or bad outcomes happen from low risk births declined in an IV or not. Likely she has not seen something go bad.

[00:09:23] Right. We just hear the stories over and over. 

[00:09:25] Exactly. Like how do we even know if these stories are true? What if they’re just passed down through the lineage and they’re just like, you know, stories.

[00:09:33] Yeah, because in another light a nurse who’s like really good at IVs and really quick come in, someone needs an IV real quick. Maybe they come right off the street and they’re like, oh my gosh, I’m bleeding. I have this emergency going on. That nurse goes right to the arm and she’s like, or they’re like, Hey, can I start this IV? We wanna give you this, this, this, and this. This is what we think’s going on. Can I put this IV? I’m gonna put it right here. Da, da, da, da, da. And they look, the patient looks at her like, well, I can’t do it. And you know what that nurse is gonna say, I got you. I can put an IV in. I’m not scared. I’m calm. I’m okay. I can do this. I can help you. I’m your person for this. And like they asked me to come in. I’m great at IVs. I actually love IVs.

[00:10:12] I don’t want it to hurt you. They’re going to talk themselves up about how good they are about IVs. And they probably are really good at IVs. And then we have this whole story that we tell people that’s like, well, you know, if you need one in emergency, who knows how long it’s gonna take 

[00:10:26] well, I would hope not long because you have a whole college degree in nursing.

[00:10:29] There’s so many things that can affect how an IV goes in that’s not about someone declines it when they don’t need it and then wants it when they need it. Like, there’s not a problem with that. There there’s a lot of other things going on and maybe our eating, drinking policy is F’d like put someone in a disadvantage for getting an IV quickly because we tell ’em, we can only have ice chips and they throw up every time they have ice chips. There’s other problems, but that story changes quickly depending on what we want out of the situation.

[00:10:57] So it feels like this nurse, hopefully she’s just calling their bluff. Not hopefully, Jesus. Maybe she didn’t want ill will, maybe she’s just calling their bluff and being like, you know, this is the coercion tactic that they’ve seen used time, time again, that’s what’s been taught. And so this nurse is gonna use coercion tactic to get the patient to get the IV at the time that benefits everybody else.

[00:11:22] So for listeners out there who have been taught this Mandy and, and maybe even regularly use this and they don’t know how else to communicate with patients on not calling their bluff, but maybe not even trying to convince them. Cause you never want a provider to try and convince the patient to do something that they don’t want to do.

[00:11:42] But maybe just meeting them halfway and helping the patient understand the importance of what you are trying to do. How would you suggest providers, nurses, anyone in medicine, communicate with the patient in a respectful way to just say, all right, I’m just gonna note this in your chart that you declined this and we can revisit it later. Is that something that you would say, how would you say it at the bedside? 

[00:12:06] Hmm, I don’t yeah, it depends on the person and kind of what state they’re in. I wouldn’t wanna talk to them and not be on their level at that point. So if they’re really disgruntled, I wouldn’t wanna be like, okay. So cuz that that’s not really me. I would just be like, Hey, I, I would sit down and I would just like define the power dynamics physically. I would sit. And I would just be like, I think what you’re saying is that you’re absolutely. And this is what I’m trying to do in parenting. I’m trying to do this in parenting because I was also parented in this very authoritarian authoritarian way. Like spanked, told no, told shut up. So I, I am doing this in parenting and where I have to sit down and it’s much easier with patients to be able to regulate my nervous system, but it wasn’t for a long, long time. And I would get really like, and then they would go and we weren’t really able to co-regulate.

[00:13:02] So I would sit down and just take a breath and be like, It sounds like you really, really don’t want this IV. Because also not even in parenting, like I have to be this kid’s parent forever. I have to be this person’s nurse, right? For an extended amount of time or could possibly come back in the room if I’m not their nurse and be of help because of my specialty, my unique, you know, things that I can offer.

[00:13:26] So I don’t want to sever this relationship because this person doesn’t have a lot of options. And also they don’t have a lot of perceived power by anyone right now in this space. So I would wanna sit down and be like, Hey, this is what I hear is going on. Is this what’s going on? And they might hear it and be like, no, I never said I don’t ever want an IV. And then that’s information gathering for me. I don’t wanna put something in the chart that’s not true, because then the next nurse, potentially the next provider, or the next person could just be like, oh, so you don’t want an IV. And now I look like an ass because I just wrote a story that’s not true. I undermined our trust. I just wrote a story that’s not true, cuz I didn’t gather the information. I just assumed that this person was difficult. They don’t want an IV. Fine. You don’t want an IV? Fine. Put it in the chart. Fine. Take it off my shoulders. No, no, no, no, no, no, no. Get information. This person has a very good reason for saying what they’re saying and doing what they’re doing.

[00:14:20] Whether you feel like it’s good or not, doesn’t matter either, right? Like it’s not your job to pass judgment on how valid someone’s reason for declining or accepting or requesting something in their medical care is it’s just not part of your job. 

[00:14:37] Right. And that takes a lot of pressure off of me and a lot of responsibility. I don’t need to know all the details you wanna tell me why you don’t want an IV because it’s invasive. And because you don’t like things sticking inside your body and because you can’t pull it out and because it keeps you trapped and because of the line. You can tell me all that, but I don’t actually need all of that to hear you say, you don’t want an IV right now. You don’t want it by me. You don’t want it before X, Y, Z, or maybe some like misunderstanding comes out and then I’m like, oh, I hear you. Can I clarify? And they’re like, no, I told you I’m going to the bathroom right now. Like, okay, can’t clarify. I’m gonna make a note to bring that up later and be like, Hey, just wanted you to know.

[00:15:18] I don’t know where you heard that, but the needle doesn’t stay in. That’s all I wanted to say. It’s just plastic. I’ve also made a note that at this time you don’t want one, but you can always ask me. Always ask me questions and I’m here. And so then the trust has to be continuously built, being transparent.

[00:15:33] The information that I had is have is their information to have to help them make their own decisions. So I’m like kind of talking quickly with them because I don’t wanna like make it sound like I’m talking them into something. I wanna be very like, Hey, I just wanna give you information if you want it.

[00:15:50] I want you to know, I have a little bit more information. I want you to have it when you’re ready to have it when you can hear it. Also it is, I have to say, when I think an IV would be helpful, beneficial, necessary, blah, blah, blah, blah, blah. So it might come up if you ask for a certain medication and it’s only given by IV, I’ll totally tell you that.

[00:16:10] Yep. And that helps me too. Not be like, oh no, you you’re not, you can’t have that cuz you didn’t want an IV. No, no, no, no different scenario. They make their decision based on the information they have at that time. When the thing changes, when the situation changes, their decision might be different. I can like, whew, take the pressure off.

[00:16:29] I don’t have a horse in the race. It’s not me getting the IV so I can take a breath and be calm because they’re obviously not calm. You know, they could be agitated. They could be confused. They could be scared. They could be a lot of things if they’re like, hell no, I don’t want that. Or they just could be in a challenging position because they’re saying no to someone in a position of authority inside of the hospital.

[00:16:54] So honoring that and just being like, Ooh, thanks for telling me. It’s practice advocating for themselves. So if I’m easy to practice and that’s very similar to parenting, like my kid comes home and they just like fall apart. That means they trust that they can fall apart with us and will still love them, hug them, you know, believe in them, accept them. Same, not, not like parenting with nursing, but same with like establishing trust.

[00:17:23] And practicing it in safe ways. So like, if I’m not threatening, when they say no about an IV, they might be able to say no about other things that they feel are hard to do. Or imagine in the future they’re advocating for their parent, they’re advocating for their own kid, they’re advocating for someone in a marginalized group that they don’t even know they’re going to be practiced at saying at standing up and being like, “no, my gut says, my gut says, I need more information. My gut says, I need to wait. My gut says, I need to pee before I make this choice. My gut says, I need to call somebody”. You could be like, awesome, good job using using your tools. 

[00:18:01] And let me tell you this if you are a nurse or a provider Who can show them what good medicine is like, what consensual care is like set that bar for them about what are we actually trying to achieve here? What does good compassionate, consensual care look like? You have now set that patient up for all their future encounters with other professionals, because when it doesn’t look like what you just gave them, they’re gonna be like, whoa, this is not how Mandy treated me. You’re a bad provider. Whoa, Mandy, didn’t give me this much trouble.

[00:18:39] I feel like you’re trying to coerce me into something. If you can show these patients what good care is like you’re giving them a solid foundation to advocate for themselves in every single future interaction doesn’t mean that they’ll be able to do it. Some providers are harder than others. Obviously we all know this, but you don’t wanna be the provider in their brain, in their memories that fought them on everything that bullied them, that coerced them. Because I tell you what they remember your names and they remember your face. I promise you that. 

[00:19:13] Yeah, for sure. I saw that a lot today when I was recording some TikTok videos earlier this morning and the stuff that people remember these little, like someone told them to be quiet. Someone didn’t help them to the bathroom. And they remember that for so, so, so, so long. It’s a great exercise for us nurses. It’s gonna be uncomfortable when we’re first realizing that we’ve been taught coercive tactics. And, and we’ve been taught harmful tactics and harmful communication around this power dynamic and the power dynamics in the hospital.

[00:19:46] And having these conversations, it’s gonna look different every single time. And the first few times that you’re doing it, I mean, I have like, I talk really slow and I’m like, okay. So let me think through this. But this is, you know, it’s like exercising our muscles at getting better at this. So someone declines, one thing and it’s no big deal or someone, you know, Says I totally understand. Or I’ve gotten enough information that I need. I don’t wanna do that. And you’re like, okay, cool. It’s no big deal when they decline something that is a big deal. And you do have to make sure that you have given information that can get really sticky. And it can really feel like the old times when it was coercion and you were like, they don’t know, they just don’t know what’s best for them.

[00:20:35] And thats probably not it, but there could be a gap in understanding. And so you have to have the easy ones, you have to have those easier conversations kind of in number. And then if that big one comes up, then you’re like, Hey, you know, I tell it straight. I love that. That’s how that’s the kind of nurse.

[00:20:55] I am. Not everyone’s, you know, talks like talks like me. We all do different things, but I am like, I gotta tell it to you straight. Can I give you a little more information? again, I don’t care what, like you have to be in charge of your own body. Yep. And I’ve seen, you know, what you’ve seen. Can, can change what you talk about, but it can’t be the only thing that you talk about because every everyone’s situation is different and we actually don’t know what’s gonna happen when someone chooses something. We just think we might know. And that’s a thing we gotta go deal with with our therapist. 

[00:21:31] yeah. Outside of the patient care room, it just can’t be dealt in the patient care room and it cannot in any way run into the way that you paint this patient. It just can’t. It can’t come across in the way that you speak to them.

[00:21:46] It can’t come across in the things that you share and laugh about at the nurse’s station. And it can’t come across across in the things that you note in their medical records, like it has to stay neutral. It has to stay unemotional, emotionless, and it needs to just be fact based. It cannot be based on your opinion or your past experience because this patient deserves a clean slate. They deserve a nurse that is looking at them as an individual through clean lenses, not painted by past trauma in their career. 

[00:22:21] Yeah, for sure. That’s hard to do when to get started, but if and when our listeners are doing it, I’m excited.

[00:22:28] Me too. 

[00:22:29] Guys. It’s uncomfortable. It’s really hard. It activates you. You’re gonna be super sweaty. So pack some deodorant. I mean, I’m sweating right now having this conversation. Like you can do it though. And, and I love, love, love how you made us think about it being a muscle that you continue to build and flex.

[00:22:52] It is right. Every time you start to have these conversations, every time you have a patient decline, something that you disagree with, it just builds that muscle and strengthens that muscle of, okay, I’m gonna trust this patient to know what is best for their body. And if we get into a situation where things change, I’ll have that conversation with them.

[00:23:15] Yeah, for sure. We have this like community private nurse labor and delivery nurse community called the nurse circle. And one of the examples that a nurse gave was that the patient and the family asked to be left alone. And the nurse was like commenting that as a win because English wasn’t their first language. And the family was just like, yes, do whatever, do whatever do whatever. And she was, the nurse was having a really hard time with. Or challenge with translation and making sure that everyone really understood, like, don’t just let me do whatever.

[00:23:47] Like, I really need you to understand what’s going on. And she had been doing this trauma-informed care course and doing this work. And so she was like, I really need you to understand. And then by the end of the shift, they were like, yeah, could you just leave? could we just have privacy? And she was like, I’m so excited.

[00:24:06] yes, you can. 

[00:24:08] Right. She was like, they said, no, they said no. And so we all were cheering for her and she said, I’m gonna take that as I wasn’t over could have been that. They were just like, she’s just over, explains it. Like we get it.

[00:24:21] Gotta leave us alone cause 

[00:24:22] we are tired of hearing you talk.

[00:24:25] This is exhausting. Translation is tiring. Like you have someone in the middle. Double the amount of time to like talk. So they’re probably like, yeah, we just wanna talk without, without you. But she was so excited. And I think that that is kind of what it is. It’s kind of like when someone tells you no, you’re like, Hey, wow.

[00:24:42] That used to make me like pretty have a lot of feels about that. Pretty sweat. Yeah. But then, then the next thing which we won’t go into today is like interpersonal fallout from that when someone’s like, She said kind of like you let you let them say no. You’re like, whoa, whoa, whoa, whoa, whoa, whoa.

[00:25:02] We got a whole culture to be shifting around. But with the patient, like you said showing your true colors when you write on social publicly, like I’m gonna write then their chart, that they’re difficult. Red flag. And can you tell us where you work? Because we don’t want you. No, we want you to learn to not do that.

[00:25:24] this was a good example he he. All right. Well, we definitely wanna hear your examples of being told no and loving it. Your examples of consensual care. So let us know on our Instagram pulse check dot podcast and if you’ve tried to be on the show to tell us your story anonymously or non anonymously link was down, but it’s up. So find us at, pulse check dot podcast.

[00:25:49] We’d love to hear your story on the podcast with us. And until then, we’ll see you next time. Bye. Bye,