Patient Safety vs Quality of Life: A Compromise
By George Barnes MS CCC-SLP
Ah, the age-old balance of safety and quality. One that comes with a whole bunch of baggage. Enough baggage that often the question isn't addressed at all. But the more we avoid it, the more it seems to flash in our faces like floodlights on a rainy night.
When we are little kids, safety is more important than quality. With that safety comes a lack of choices and a ton of rules. "Don't eat that. Don't run. Don't climb. Don't cross the street. Just sit there... quietly... and do... nothing. Please?"
But this makes sense for kids. They’re vulnerable. They're impulsive. They do things that are... questionable at best (Like my son flushing his underwear down the toilet- true story). So we monitor them closely and we make strict rules to control their behavior. And it's worth the trouble to have a safe, healthy, kid. But in the fight towards quality of life, kids push back against these rules. They whine, they hit, they throw, they curl themselves into little balls, and perform spastic movements on the floor worthy of a phone call to the local exorcist. This is because quality of life matters. It’s an innate need that we fight for before we can even talk.
As we grow up, we are slowly allowed more and more quality of life. This comes in the form of freedom of choice. This freedom expands until we are basically allowed to do whatever we want in life (within the confines of the law of course). We can cross the street now. Heck, we can even drive across the street. If we wanted to, we could cartwheel across the street while juggling and eating grapes (Yet not advised by our trusted SLP). But at a certain point in our lives, as we age or become ill and our vulnerability increases, this quality starts to decline again. We are told, "Don't eat that. Don't run. Don't climb. Don't cross the street. Just sit there... quietly... and do... nothing. Please?" But this time, we get pissed. Because we are adults now. We’ve earned the right to have quality, to have choice...to have freedom.
I think about this struggle every time I have a hard conversation with a patient. We discuss the costs and benefits of each clinical option but in the context of safety AND quality. And with these discussions, I find you can often have both in a way that fits the patient’s specific desire through a little thing called compromise. What will ultimately make the patient happy? Is it 4 oz of pudding? A few ice chips? Or does it HAVE to be an all-day, all-you-can-eat buffet line? Safety and quality are a compromise. They have always been. But after we grow up, the biggest difference is that the adult, or in this case the patient, needs to make the final decision in the negotiation.
Without this approach, you will have an unhappy patient. And an unhappy patient probably won’t listen to you. By empowering the patient with choice and control, we are giving them space to work with us. Like a tree falling in an empty forest, what is a recommendation if nobody listens to it anyway?
Thanks for reading. Liked it? Why not share it?
Comment below.
