Second Opinion: ‘Bed-blockers’ begone: vulnerable patients need diagnosis, not dismissive terms

https://goo.gl/ko5rlT

So, following the lead of the current president of the British Geriatrics Society, the highly literate and entertaining David Oliver – see iti.ms/166DxIC – it is clearly time that we in Ireland developed a profanisaurus of ageing, highlighting the negativity of certain words and phrases, rooted in ageism and indifference to the needs of older people, and avoiding their use.

After “step-down”, there are a host of candidates jostling for a place in the Profanisaurus, starting with the terrible twins of “bed-blockers” and “delayed discharges”. Spawned from the same bedrock of the adversarial patient management system as “step-down”, these phrases imply action or inaction on the part of vulnerable patients and their families that prevent access to healthcare services for others.

In fact, the fault usually arises out of a series of system failures rather than failures by patients, including non-detection of complex illnesses, loss of function at entry to emergency departments, non-prioritisation of admissions and failure to provide due rehabilitation and support both during a hospital stay and afterwards, whether at home or in a nursing home.

All too often, doctors and nurses collude with this unhappy state of affairs by classifying patients (in further Profanisaurus terms) as “fit for discharge” or, worse still, “medically discharged”. While what they usually mean is that a specific input or treatment course may no longer be needed, this is unfortunate at two levels.

First, it is a complete misreading of the challenging nature of the hospital experience. Virtually anyone who can leave to get back to their own home, no matter how humble, will do so as soon as possible.

Second, it is a derogation of the broader duty of medical care above and beyond specific medical and surgical procedures. For example, if Mrs Murphy was continent, mobile and clear in her mind before admission, and is now impaired in all three areas, there are clearly medical and care issues that remain to be addressed through diagnosis, treatment, rehabilitation and support.

Equally, the lack of appropriate post-discharge support and rehabilitation or long-term care facilities (an unreleased Prospectus report for the Health Service Executive in 2006 showed glaring deficits in the provision of nursing-home places in urban areas) is the fault of the system, not of vulnerable older people. A more appropriate phrase might be “discharge support failure”.