When protocols replace compassion: Have we lost humanity in healthcare?

0:00Welcome to the untold, take it deep breath, take the higher road, it's what they always say, as if they know the way, they won't take it from me. Don't ever doubt yourself as wiping just a drain, you made your own so kick and scream, the people who will lock with and never end it for us, you never have the chance to watch your waiting for it. This is called my friend because this is what it's time and this is what. So I finished something yesterday that I really haven't been able to stop thinking about.

1:01And it wasn't necessarily the medical information being presented, it wasn't the discussions about medications, COVID protocols, or even the disagreements surrounding what happened during the pandemic. It was the families, the doctors, the nurses, the husbands, the wives, the sisters, the brothers, it was the families and the people that were strong enough to stand up and speak out. These were people sitting in Washington, DC, recounting some of the most devastating experiences of their lives, husbands talking about losing their wives, families, describing what happened to their parents, people who walked into the hospital, expecting their loved ones to receive care. Never imagining that they would be sitting before a room of people years later trying to explain what happened.

2:09And then you look at some of the reactions. People arguing about conspiracy theories, fighting about vaccines, turning somebody else's grief into another political argument. And I'm sitting there thinking, have we just completely lost our humanity? Seriously. Can we not sit and listen to somebody, describe losing their husband or wife without immediately turning it into an argument about who was right and who was wrong? I mean, you don't have to agree with every conclusion somebody draws from their experience to be able to recognize that their grief is real. And you certainly don't have to agree with somebody's medical decision to believe that they deserve compassionate healthcare.

3:10Somehow, during COVID, all of that became controversial. And it's stuck. It's still there today. It's been carried on since COVID and is still within our medical system this way of thinking. And I remember seeing healthcare professionals online making comments about people who chose not to receive the COVID vaccine. Things like, if you're not vaccinated, don't come to the hospital. Don't expect us to take care of you. Don't take up a bed. You don't deserve the care. And I remember thinking to myself, have we all completely gone mad? The world has literally gone mad. Since when did receiving medical care become conditional on whether your healthcare provider approves of your personal decisions?

4:16Because if we're going to apply that logic, where does it end? I mean, let's apply that logic to other scenarios. Does the patient with type 2 diabetes, who struggles with their diet, forgets to give themselves insulin? Do they no longer deserve treatment when their blood sugars elevated or in their diabetic ketoacidosis? They don't deserve care anymore? Or what about the patient with hypertension who hasn't been taking their medications or who still eats fried chicken all the time or who goes to McDonald's three days a week? Who stressed out and won't practice any stress relieving techniques? Yeah, I don't know. But what does that patient with hypertension? We shouldn't treat them either. They don't deserve treatment. What about the kidney patient who struggles to follow dietary restrictions or who skips dialysis?

5:19They don't deserve treatment anymore? What about somebody who smokes? And they develop lung cancer, infosima. Do we tell them, well, I mean, you made your decision and therefore you just, sorry, you don't deserve treatment? Of course not. Nobody, we would never do that. That's what you tell yourselves. And that's what you think. And obviously that should be the answer. We would never do those things. But we did. We did during COVID. That logic went out the door and the logic of you chose not to get vaccinated. You don't deserve care entered. And some of that's kind of stuck around. You know, our job as healthcare professionals as a nurse or as a doctor, nurse practitioner, physician assistant, whoever. Our job is to educate. We discuss risks, benefits. We work with the patient. We try to understand what is preventing you from following the treatment plan that we're recommending.

6:30And most importantly, we continue to care for them. No matter what decision they make, that is what healthcare is supposed to be. We, medical professionals, society, whatever, we don't get to decide that somebody's life is less valuable because we disagree with their decisions. And, you know, I think we need to have a serious conversation about how we got to this point. So I'm so glad you guys are joining me today for this conversation. Welcome back to the nurses report right here on America Out Loud. I'm your host, Ashley Caputo. I'm a registered nurse and I am a functional medicine practitioner with remnant healthcare. And I am a very passionate patient advocate. So if this is your first time joining me, this is where we just we have conversations about healthcare, patient advocacy, medical freedom, and the issues affecting patients and families that they just don't always receive the attention we deserve or they deserve.

7:42So we are here to provide a platform. Today, I want to talk about something that happened yesterday. If you're unaware in Washington, DC yesterday, Senator Ron Johnson hosted around table titled COVID-19 Hospital Protocols, real stories from real people. Bringing together patients, family members, physicians, and nurses to discuss their experiences during the pandemic. Our very own Gail McCray was there and was chosen to speak and she represented nurses so beautifully and we're so proud of her and so glad to have her standing up for those of us who weren't able to be there. But I want to take this conversation a little further, a little maybe different direction because I know we've talked about COVID a lot. We've talked about what's happened in the hospital. And to be honest, I will probably never stop talking about that. But I want to kind of shift gears a little bit because while these families are sharing their experiences from COVID, I see some of these same underlying problems in healthcare today.

8:56You know, we're so dependent on protocols, policies, algorithms, and standardized treatment pathways that I just I sometimes wonder whether we're losing the ability to look at the individual patient. And I'm not saying that protocols don't have their place. Of course they do. They're a guide. But what happens when a patient's condition changes and just nobody stops to reconsider the treatment plan? What happens when a nurse raises a concern and it's dismissed because the physician is following the established protocol? I heard that over and over and over again at the hospital. I would say the patients deteriorating, not getting better. Why aren't we doing X, Y, or Z? And they would say we're following the protocol.

9:57You know, what happens when a family asks for a second opinion or wants to discuss another treatment option and suddenly they're labeled difficult. It's charted that they refused. You know, and why does it feel like the patient is the last person being considered in decisions about their own healthcare? So I want to talk about all of that today. And I also want to talk about why I believe that we need to return to a more individualized approach to medicine. And I say return because it's what we used to do. There used to be a holistic approach to medicine. One that considers the whole person, not simply their diagnosis. Because when we strip away all the politics, the arguments, and the medical disagreements, we are talking about human beings. And that should never get lost in healthcare.

11:03So I want to start with a few of the stories that came out of yesterday's round table. And I encourage you to go watch the testimonies for yourself. Don't just watch a 30 second clip on social media or just listen to a couple of my examples. I think the best place to find it is either the children's health defense or go to rumble and look for Ron Senator Ron Johnson. And you can find the whole recording on his page. So one of the people that spoke was Brad Siler. And I hope I'm saying his last name wrong. And I do apologize if I'm not. Or if I am saying it wrong. So Brad described what happened to his wife, Gail, when she was hospitalized with COVID. And according to his testimony, he was told that his wife was beyond saving that she wasn't going to make it.

12:12And so he decided he wanted to take her home. And he talked about the struggle of just getting her discharged and the extraordinary circumstances surrounding getting her out of the hospital. He even said they weren't permitted to leave through the main entrance. Think about this as a patient. Gail was taken down a freight elevator through an area that was used for transporting deceased patients. How would that make you feel? Well, you put up a fight to get out of the hospital. And then you can't even just leave the hospital. You have to go down this freight elevator the way they take patients to the morgue. And Brad recalled being told that his wife wouldn't survive the trip home and definitely wouldn't survive the night.

13:12But guess what? Gail did survive. And she's alive today. She's spending time with her grandchildren and her children. Now, you know, I wasn't there at the hospital with Gail, of course. And I haven't looked at her complete medical record. I can't tell you everything that happened behind the scenes. But what I can tell you is that her medical freedoms, her personal rights were taken away. And her experience raises some very important questions. I mean, what happens when a medical team reaches a conclusion about a patient? What happens when a family wants to explore another option? Are we creating an environment where physicians can reconsider a prognosis? Where patients can seek another option? Where families can have, you know, meaningful conversations about the care being provided. And I mean a conversation, not just being told, but actually being allowed to ask questions and discuss the care plan.

14:24Or have we just become so accustomed to the standardized pathways that were, you know, uncomfortable when someone asked to deviate from them, when doctors aren't used to being challenged. Nurses aren't used to being challenged. And this isn't pretending, you know, every patient can be saved. People have very poor prognoses, and we still treat them, right? You don't give up on someone. I've seen people turn the corner. I've seen miracles happen. And if everybody on their care team had given up on them, that wouldn't have been possible. You know, I think we all understand medicine does have its limitations. That doesn't mean that miracles don't happen and that the body doesn't do miraculous things.

15:25But it's about all of this is just about making sure that those difficult conversations happen with compassion, transparency, and respect that true informed consent is given. You don't, you should never be told what you're going to do. You know, the doctor shouldn't walk in and say, we're sending you to dialysis today. The doctor should come in and say, hey, we reviewed your labs. This is what's going on. This is the treatment plan that I think would be most beneficial to you. This is why. Here are the alternatives. This is why I would prefer you not. Turn to these alternatives and proceed with my plan of care. Do you have any questions? And then you have a conversation, a full on conversation.

16:25You want understanding the patient and the family, the need to understand and feel comfortable with what's being recommended to them. Now, I am not blind to emergency situations, right? If someone comes in the hospital and they're coding and we decide to give them epi or atropine or, you know, shock their heart or whatever, we're not talking to the family and say, okay, we'll listen. We're going to give this epi. This is what it's going to do. These are some of the side effects. I mean, obviously there's no time for that. I get emergency situations or emergency situations. But once, you know, you are in the hospital and your plan of care is being discussed, it is worthy of a discussion. It is worthy of questioning it. You have the right to ask those questions and get a respectful answer.

17:26And we've lost sight of that. And it's really unfortunate. And so people are losing trust in the medical field and their caregivers and their doctors and their nurses. We used to be one of the most trusted professions out there. And now no one trusts anyone when you go to the hospital. Everybody's questioning everything. And there was another family member who testified. Her name was Stephanie Williamson and absolutely heartbreaking. And she described losing her husband Dave. And she raised concerns about treatment decisions that she said occurred without adequate informed consent or family involvement. Just imagine yourself being in that position. Someone you love is critically ill. And you're trying to understand what's happening.

18:33You're depending on people that you've never met to make decisions that could affect whether that person comes home or not. And you feel like you don't have a voice. I mean, I don't know if people fully appreciate how traumatic that experience can be. And when these families come forward years later, we, society, we should be willing to listen. Someone should be examining these records, investigate concerns where appropriate. And we all need to learn from what happened. We shouldn't be treating someone's grief as an inconvenience. You should see some of the disgusting comments during the, during the roundtable. Where are the Epstein files? Who cares? All these people are conspiracy theorists. They shouldn't have gone to the hospital anyway. And just, I mean, it was just, it was absolutely disgusting. Humanity was, was lost in a lot of the, the comments. And I know there's keyboard warriors out there.

19:42And you just, you really can't pay attention to a lot of those people, but it kind of gives you an idea where the temperature is in the public, right? And there are still just so many people that can't recognize what happened. And that's scary because I mean, you could say, well, just let them think whatever they want to think, right? It's scary to me because when the situation happens again, when there's another pandemic, another crisis, they're not going to do anything different. And I don't want to see anyone get hurt or take an advantage of by the system. You know, another thing is we also need to remember that the people working inside of those hospitals, we were dealing with extraordinary circumstances. We were being lied to, we were being manipulated. Policies were changing every single day. We weren't being given the right equipment.

20:48We weren't being allowed to treat people the way that we wanted to. We weren't allowed to really ask questions. You had to really make a ruckus if you wanted your voice heard. And when I started questioning what was happening on the COVID units, when I started questioning, why aren't the doctors going in the rooms? The doctors aren't even examining the patients anymore. They sit on the outside of the room and they call the patient's room. They're not even examining. Nobody's listening to their lungs. I mean, I did as a nurse, but and I documented what the doctors were going off of my assessment, which is, I mean, I trusted my assessment. But I would never make a decision based on someone else's assessment.

21:48When I would get report from a nurse, when I was coming on to shift and they would say, oh, there were crackles in the lungs or, you know, their short of breath or this or that or whatever it might be. I would, I would not document that and just take their word for it. I would go in and do my own assessment and come to my own conclusions. So for the doctor to come on to the floor and never even go and see the patient, I threw a fit about that because they're ordering labs and they're prescribing things and they're chained, you know, they're doing this and that. But it didn't matter because no matter what they found on their assessment, nothing was going to change because they had a protocol. They had a protocol that they had to abide by and they couldn't deviate from it. And so I started questioning that as well. Why can't we give them Budesneed? Why aren't we giving them breathing treatments? Why aren't we giving them steroids?

22:53Why did we stop giving people vitamin C and zinc and hydroxychloroquine? Why can't we use Ivermectin? It was out there. The research was out there. I think there's over 100 papers talking about how Ivermectin can help with a viral respiratory infection. And yet it was so taboo to even bring it up. So when I started saying things and talking to the doctors and going to the nurse manager and going to the charge nurse and questioning what was going on, well, I stopped getting called into work for one thing. I constantly got called off. We don't need you today. That was happening to a lot of nurses because we shut down so many floors of the hospital that there was nowhere for the nurses to go. And later that came and bid us in the rear end because we had all these floors closed, a lot of the nurses left.

23:54And then the bed started to fill up and we had to reopen these floors and there was nobody to work on them. So when they said the hospital was full, it didn't always mean that the hospital was at capacity. It meant the beds that they had staffed were full. So I started getting called off and then when I would get called into work, I was getting sent to different floors that were not COVID. And so they were just kind of moving their problem around, hoping that I would just forget and stop talking about it. And eventually I left. Looking back, I wish I'd done more. You know, but I've learned from my mistakes. And that that's the whole point is that we have to learn from this. We have to know what happened and how to not let this happen again.

24:57You know, all these things can be true at once, right? It can be true that the hospitals may mistakes, but it can be true that there were decent people working at the hospital, speaking out. And there was a lot of emotional and traumatic experiences that happened in those hospital walls for doctors, for nurses, especially for patients and families. You know, and that that kind of brings me to something else. I wanted to discuss because one of the things that just really bothers me about the pandemic is kind of how quickly we were divided. We were put into these categories, right, vaccinated, unvaccinated, compliant, noncompliant, responsible, irresponsible. And somewhere along the way, those labels began affecting how people spoke about one another. I remember hearing nurses make comments about patients who hadn't received the COVID vaccine, suggesting they shouldn't expect hospital care.

26:06And I want to be very clear about something. As a nurse, I find the idea of withholding compassion because you disagree with somebody's personal medical decision, deeply troubling and extremely dangerous. Our job as a medical professional is not to determine whether a patient deserves our care. Our job is to care for the patient in front of us. We treat people with uncontrolled diabetes. We treat patients with chronic obstructive pulmonary disease. Who continue to smoke? We treat people with hypertension who don't consistently take their medications or follow any recommendations. We treat patients with kidney disease who struggle to follow their dietary recommendations, who skip dialysis. We treat people who have made decisions that may have contributed to their current medical condition.

27:12And we don't get to stand at the bedside and say, well, you should have listened. Now you're on your own, right? That's not nursing. That's not compassion. And it's certainly not the kind of healthcare system that I want my children growing up in. So we do have to take a break. We're going to dig into this more when when we get back. So I appreciate you guys sticking with us on the nurse's report on America out loud. We're going to hear from our sponsors and we will be right back successful weight loss is about changing the gut brain relationship with food. Dr. Kelly Victory with the wellness company. If you don't like needles, you'll love oral dissolving tersepatide Rx. This doctor designed solution works by targeting the GLP1 and GIP receptors that influence appetite and metabolism. Tersepatide helps with food portion reduction and satiety while changing how the brain responds to engineered sugars and unhealthy fats. And unlike injections, these are fast absorbing sublingual tablets placed under the tongue paired with an energy boost of B6 and B12.

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30:27America out loud.News is the antidote to these poise and his own. America out loud.News is that place to awaken your heart, soul and mind to the out loud truth. Welcome back to the nurses report on America out loud. I'm your host Ashley Caputo and today I am doing a solo episode. I had all this going on in my head after watching the round table in DC yesterday and just so many feelings. Sadness, compassion, empathy, anger, frustration, all the things that I just felt like, man, I really got to talk about this but talk about it in a different way. Not just talking about exactly what happened but talking about the healthcare system because this is certainly not the kind of healthcare system that I want my children growing up in.

31:32Now there's a difference right between discussing clinical risks and judging somebody's worth. Before the break we were talking about how you were judged based on your medical decisions and how inappropriate that is. There may be legitimate medical reasons to recommend a particular treatment. Take infection control precautions or explain why an intervention is or is not appropriate. But all of those things, if a patient asks me, hey, why aren't we doing this? Then I want to talk about it. I'm not just going to dismiss their question. It deserves a conversation. And those conversations should be happening. But the patient still deserves dignity. They deserve that explanation.

32:34They deserve to be cared for no matter what their decision is. I think I've talked about it before. I stood by a patient who decided he did not want dialysis. And the doctor was like, well, you're going to die if you don't get dialysis. And he said, I understand that. But I still don't want it. And the doctor was like, but you should get it because I can save your life. You're only going to live if you do dialysis. And he said, but I don't want it. And she said, well, I can't support that. You're going to do it anyway. And she did. She put the order in. She sent him down to get dialysis. And he was absolutely devastated. And I had to go to the charge nurse, the director of nursing. I had to go to the head of the hospitalist, the chief of staff. I had to cause a storm to get this patient what he wanted to be cared for the way that he wanted.

33:37Because his concerns, his wishes, they were all dismissed. It wasn't about him anymore. It was about what the doctor wanted. So we need to recognize that people's decisions are complicated. Maybe somebody's afraid of a medication because they previously experienced a serious, you know, adverse reaction. I've had that happen with a patient where they're refusing an antibiotic. And I'm like, you're septic. Why are you refusing this antibiotic? And then they tell me why? You know, their mom was in the hospital, except this and she got this antibiotic and she didn't make it. And so we talk about that and we address their concerns. You know, maybe they have a question that just hasn't been answered. Maybe they don't quite understand exactly what you're recommending.

34:38Maybe they've had just traumatic experience with healthcare. Or maybe they just simply don't agree with your recommendation and want to pursue other options. But our responsibility is to educate, explain and work with that individual. And this brings me back to the discussions surrounding COVID. You know, there were legitimate scientific questions about the origins of the virus, the effectiveness and limitations of different interventions, and how public health recommendations were communicated. Right. The lab origin hypothesis was called a conspiracy theory. Well, we now know that it was most likely a lab leak. You know, we also learned that vaccination did not prevent infection or transmission like you were told.

35:41That is not informed consent. That distinction matters. Science? Sorry, Dr. Fauci, but science should allow questions. You should question science. It should allow new evidence to change our understanding. I think the public would have had a whole different perception if they got up in front of everybody at the, you know, they had those press conferences every day. And if they said, you know what, we don't know. Or we're not sure. Or even we were wrong. I mean, could you imagine? Could you imagine Dr. Fauci standing up saying we were wrong? Oh my gosh. I really, I don't think he could ever do that. But so many people would have had a lot more respect and understanding for that, rather than getting up and telling you with certainty, you have to stay six feet away.

36:47You have to wear a mask. You have to get vaccinated. This is a pandemic of the unvaccinated. I mean, we were told so many things for certain. And they weren't. They were all lies. There wasn't transparency. There wasn't informed consent. There wasn't any kind of honesty. And people, you know, people and patients, they should be allowed to ask questions without automatically being treated as adversaries. And I deal with this a lot. And being a patient advocate. So, you know, at Remnant Healthcare, we offer advocacy services where you hire me and my other fellow nurses and healthcare professionals, you know, we have a team of people that do this.

37:48We are there to make sure that you're getting the right care to make sure that your questions are answered. We're there to question the doctor for you when you don't have a voice. I'll be your voice. And I can't tell you how many times I'm on the phone, like on speaker with the family and the doctor is there. And the family has legitimate concerns, legitimate questions. And the doctor's reaction is so. It's bizarre. It's so bizarre to me because as a nurse, I would never respond to people this way, right? It just doesn't even seem. Like, I don't know when this started to happen. Or if it's just always been this way. But you question, you know, why do you want to do this treatment or why aren't we checking these labs or is there an alternative to this, you know, treatment or this surgery or this procedure or whatever it is.

38:56And the response you get, this literally happened to me the other day, guys. I said something about the patient wanted direct donation, like a blood donation, but from someone they knew. And I totally respect that. We help do that all the time. You know, we work with the pure blood registry if needed, but we help get direct donation set up. So I am advocating for them and I was talking to the doctor about the process and about everything. And he stopped me mid sentence. And he said, I am the physician. I get to talk. And it didn't even make sense. I say it was bizarre because it was really bizarre because I was we weren't even talking about really anything medical. It was all procedural about what paperwork had to be filled out. And he just he didn't want to listen to me completely dismissed everything that I had to say. He told the family their decision was dangerous and unheard of and uncalled for.

40:10And just really belittled the patient for expressing their wishes and questioning the treatment plan. You know, why weren't certain labs being done. He was really upset about that. And it's just it's really unfortunate because you lose sight of why everybody's there. We're there for the patient. You know, my priority is not to prove you wrong or not to to make you look bad. My priority is making sure that the patient's wishes are carried out and that she's getting the proper care. And that should be the doctor's goal as well. And it wasn't his goal was about being right. And he was so upset that he was being questioned that his recommendations weren't just being taken that there was pushback.

41:13And we see that all the time across the board, whether it's from nurses, whether it's from the doctors, the case managers, it's everybody wants you to listen to what they have to say they want to tell you what you need to do into story. You don't get to question it. You don't need to understand it. I'm the physician. I know what to do. And that's scary because I'm paying you to take care of me. I'm at least paying for insurance that's paying the hospital to take care of me. Like you basically work for me. I get to decide what happens to me. And that's been lost. You know, I mean, back to this round table, you know, regardless of where somebody stands on COVID, we have to think about these families.

42:18A husband describing the death of his wife is not an invitation to attack him. A mother asking why a particular treatment was administered is not automatically spreading misinformation. A nurse who raises a concern about patients condition is not challenging someone's authority. They're taking this all wrong. We need to learn how to listen again. Because if we lose that ability, what happens to the relationship between patients and the people responsible for caring for them? Because it's already happening, right? Patients don't trust the doctors. Patients don't trust the nurses. Another advocacy case that I'm working on right now, they have zero trust in their care providers. And part of my job is talking to them to help them understand that, okay, I know that you've got a lot of really bad treatment and a lot of really bad recommendations.

43:23But this recommendation, I think is pretty good. Because now they don't know what to trust. They don't know who to trust and they don't trust anything that's being told to them. And then when the hospital or the providers or the care, you know, the nurses or whoever, they get upset because you don't trust them when they created this scenario. They created this. And now they're having to deal with the consequences. So I want to move away from COVID for just a second, because this is something else that I encounter in hospital advocacy. And I think it demonstrates why this conversation is still relevant. While, you know, I know people get tired of hearing about COVID, but it's just so relevant to what's happening in the hospitals and in the medical system right now. One of the most important things were taught in nursing school is to assess our patients.

44:24We're not simply there to just administer medications, complete documentation and follow orders. We are supposed to observe. We're supposed to recognize changes in the condition. We're supposed to understand why and what we're administering. And when something doesn't look right, we're supposed to speak up. But I sometimes wonder whether our healthcare system is, I don't know, it's just creating like this environment where completing the task becomes more important than understanding the patient. So let me give you an example. Imagine somebody is hospitalized with a serious infection. Okay, they're septic. They've received IV fluids and they're receiving multiple medications and they're being monitored. Great. Initially, the treatment plan may be entirely appropriate, but their condition starts changing.

45:26Kidney function begins to decline. Their creatinine starts trending upward. Maybe they're retaining fluid. They're breathing changes. Or maybe they're developing like new symptoms. Okay, at what point does somebody stop and say, wait a minute, we need to reevaluate what's happening here. Because that's the thing about medicine. A treatment that was appropriate on Monday may need to be adjusted by Wednesday. A laboratory value that technically falls within range doesn't necessarily tell you the whole story. What was the patient's baseline? What direction are their results moving? For instance, today I had someone who it their creatinine, which is a kidney value. Their creatinine is trending upward. It's every time there's a lab, it's gone up and she's getting labs frequently because she's doing IV antibiotics at home, specifically an IV antibiotic that is hard on the kidneys.

46:27So if you look her creatinine is still in the green. It's still within the normal limits, but it is higher than it was a couple days ago. That's higher than it was a week ago. That's higher than it was two weeks ago. It's trending upward and I would guess in another 24 to 48 hours, it's probably going to be outside of the range. So do you wait until that value is out of range before you intervene and reconsider the treatment plan? And the answer is no, we don't wait. You intervene now. Let's try to prevent harm, right? Do no harm. We're trying to prevent it. We have to think about the whole picture of what medications are they receiving, what other conditions do they have? What's the overall clinical presentation? This is critical thinking. And it's one of the reasons I get so frustrated when healthcare becomes so focused on checking boxes.

47:34You know, a protocol might tell you when to administer a medication or when to obtain a laboratory test or what intervention to initiate, you know, based on a particular result. But that protocol cannot replace the computer cannot replace the algorithm cannot replace understanding the individual patient. So the patient that I was talking about this is serious kidney infection and sepsis. You know, I'm going to keep the details limited just to protect her privacy, but she was discharged home with a pick line and IV antibiotics. Now, imagine being that patient. You've just experienced a serious hospitalization. You're exhausted. You're trying to recover. You have family at home. You have kids at home. And suddenly, you're responsible for coordinating complicated IV medication administration, home healthcare services, laboratory monitoring and follow-up visits. It's overwhelming.

48:43And those lab results that we're looking at are showing changes in kidney function, creatinine, trending upward. EGFR, it's, that's like the glomelular filtration rate that we're did not want to come out, but EGFR is way easier to say. That was declining. And we look at that to determine if they're able to handle these medications, right? One of the medications she's receiving is vancomycin. And this requires careful monitoring because of its potential effect on the kidney function. And this is where communication and reassessment just becomes so important. Because what happens was she was sent a whole new set of medications to administer to herself.

49:43The labs were received at the pharmacy, but hadn't been reviewed yet. So she would have just continued giving herself these medications. So I reached out to the pharmacy and they recalculated her vancomycin level and they reached out to the prescribing physician with concerns about changes in the creatinine. And the point is that that it's not that the medication shouldn't have been prescribed. It's not that her treatment plan is wrong. The point is that her condition was changing and the treatment needed to be reassessed. But no one was there to say, hey, we need to reassess this. Until maybe tomorrow or the next day when when the system kind of caught up to what was going on, I don't know. But this is what good healthcare looks like, right? There's a nurse you have an advocate on your side that's monitoring things who communicates with the pharmacist, the pharmacist communicates with the physician and then the physician makes changes and a decision and updates the entire care team.

51:00That's what healthcare looks like. Not blindly continuing something because that's what was originally ordered. If we were talking about some protocol, the protocol would just be to give her the antibiotic, right? You know, and that's what happened during COVID. We just focused on these protocols. And I want to emphasize that the pharmacist. They were doing exactly what we needed healthcare professionals to do. Looking at the information, recognizing a potential concern and communicating with the appropriate provider. Because a nurse looked at her labs and said, well, they're still normal. You know, and didn't feel that there was any concern. But here's what bothers me. Why do so many families feel that they need someone with a medical background standing beside them to make sure these conversations happen? I love being a patient advocate. But why am I so needed?

52:07I'd love to just be there because it helps and it makes the families feel good. But it's almost, it is absolutely necessary that I'm there, that an advocate is there. Because I mean, why are patients having to become experts in their own lab results just to feel confident that someone's looking at the whole picture? They turned to Google, they turned to chat GPT, they turned to GROC, you know, to help interpret all of these things because they don't trust what the medical professionals are telling them. And they need somebody on the outside to help. And I don't expect every nurse to know everything or every physician to have every answer. But I do expect that healthcare professionals be willing to ask questions, communicate, and reconsider a treatment plan when a patient's condition warrants it. That's not questioning, you know, questioning somebody's competence. That's practicing medicine. And I think we need more of that.

53:12So I want to, with all of that said, I want to speak directly to the nurses listening for a moment. You know, think back when you first started nursing. Do you remember like having that patient who just didn't look right? Maybe their vital signs weren't dramatically abnormal, maybe their lab results hadn't really changed significantly, but you could tell something was different because we were the nurse that was there for the patient. Days in a row, 12 hours a day. Their color was off. They were more of the lethargic than they had been. Their breathing was different. They weren't responding the way they had been. And you just knew something wasn't right. That, that's clinical judgment. That's the combination of education, experience, observation, and knowing your patient. And that's something that we cannot afford to lose. I worked in a, in neuro and cardiac step down before moving to other, you know, areas in healthcare. And one thing I learned is that patients don't always deteriorate according to a textbook.

54:22Sometimes the first indication that something is wrong is some subtle change. You know, and sometimes the person who recognizes that change is a family member. They might tell you my mom isn't acting like herself or he seems different today or the mom that comes into the ER and says, I don't know what's wrong, but I just know something's not right. And I think we need to be very careful about dismissing those observations because that family member may know something about the patient that isn't documented anywhere in the medical record. They know their loved ones, normal behaviors. They know their baseline. And they may recognize a change long before somebody looking at the chart does. But when healthcare becomes so focused on the protocols, we risk losing those important details. And I don't want to, I don't want this to sound like I'm attacking nurses or physicians, right. There's so many good ones out there. And I know what it's like to work in healthcare.

55:31I know what it's like to have too many responsibilities, too much documentation and just not enough time. I mean, it used to keep me up at night. You know, I'd go home feeling like I didn't do enough. I know that nurses are frequently put in situations where they're trying to do the work of multiple people. They cut staff even more after COVID. They took away help. And I know physicians are dealing with enormous administrative demands. They're pressured to admit so many patients and discharge them after a certain amount of time. When a nurse is responsible for too many patients, how much time do you have to sit down and actually just listen? It's so hard and it shouldn't be. When a physician only has a few minutes to evaluate somebody, you know, how much opportunity is there to explore the bigger picture? Again, I'm Ashley Caputo. And you've been listening to the nurses report on America Out Loud. Remember your health matters, your voice matters. And you deserve to be an active participant in your healthcare. Until next time, God bless you and take care of yourselves.

56:55Amen.