Compassionate Does Not Mean Time Consuming

I saw a statistic this week from the Center for Compassionate Leadership which stated that people feel the biggest hurdle to behaving compassionately is time. People feel that there is just not enough time in the day to perform all their tasks AND be compassionate. This is a common logical fallacy in patient care. Performing our jobs compassionately takes minimal additional time and often saves time down the road. Also, this belief values the provider’s time over the patient’s experience. It seems to say that compassion is a hurdle in the way of productivity, and that a provider’s productivity should take precedence in all situations. It’s a dehumanizing belief that plays out frequently in patient care. Today, I would like to share a few examples in which providing compassionate care would not take much additional time from the provider, but would make a huge difference in the life of the patient.

The first example has to do with a patient with a language barrier – he does not speak English at all. This patient has a spinal cord injury and uses a wheelchair for all mobility. He had received a custom wheelchair after his initial injury several years ago, but for some reason was attending therapy in a strangely rigged wheelchair that was not optimal for skin integrity or comfort. Finally, the therapists treating him realized, using a translation app, that he used this strange wheelchair for therapy because it fit in his car. The therapist informed him that his other chair would fit in the car too – the wheels could be removed and it was foldable. The patient was in shock. During the entire five year course of his recovery, no one had ever shown him how to use his primary mode of mobility.

This is simultaneously appalling and totally believable. I can picture the wheelchair vendor delivering this patient’s custom chair, and, not wanting to use a translation app, just waving goodbye after having the patient sit in it for a few minutes. I can picture inpatient therapists not asking the patient if he knew how to use his chair, assuming that the wheelchair vendor had trained him. I can picture outpatient therapists deciding not to ask about the rigged wheelchair because it would be too long of a story to get into google translate, and if the patient seemed fine with it, then whatever. But honestly, does it take a lot of extra time to say, “do you know how to get your other wheelchair into the car?” And, training this patient in how to use his wheelchair has the added benefit of being a billable service! I know this patient in particular was thrilled to be able to use his custom wheelchair outside of his home, partly for skin integrity reasons and partly because his rigged up wheelchair was really atrocious. But, if I were in this situation, I would feel seriously angry and embarrassed thinking back to all the providers who saw me struggling and did NOT help.

The next story also involves a wheelchair. One patient that I know of is eligible for a new power wheelchair in a few months. Typically, because they are so expensive, insurance companies have a certain amount of time to pass before a patient is eligible for a new chair – for this particular patient, he is eligible for a new chair every 5 years. His functional status and mobility needs have changed some in 5 years (which is not uncommon), and he and his family have been anxiously awaiting the chance to get a chair with some new features. For those unfamiliar with the process, it takes a lot of documentation to order a new chair including letters justifying the medical necessity for every single feature of the chair, which can be independently approved or denied, as well as medical documentation etc. It typically takes months between the initial request and the final receipt of the chair.

Well, out of the blue, about 2 months before this patient’s family was eligible to request a new chair, they received a letter that their request for a new power wheelchair had been denied, due to the patient having an inaccessible home. The patient’s mother was outraged, since this patient had been navigating his home in a power chair for over a decade. After much confusion and many phone calls, it became clear that an overzealous case manager had attempted to clear some things off her “to do” list and had applied for the wheelchair 2 months before this patient was actually eligible. This is problematic for two reasons: first, the case manager now has to go through the entire process again in the correct time frame, effectively doubling her workload on this case, and second, the patient will have much more difficulty receiving any new equipment because his case has been flagged for requesting a hugely expensive item outside of the allowable time frame. Perhaps equally problematic is that insurance issued a denial with rationale that had nothing to do with actual reason for the denial. The patient’s family is furious because getting the necessary medical equipment will be so much more difficult now. The most compassionate action by the case manager in this situation would have required zero extra time, since the best course of action was to do nothing for the remaining 2 months of ineligibility.

In my final example, one patient experienced a spinal cord injury. He went through an extensive job training program for people with disabilities, and graduated with a technical certificate. He is very proud of his hard work, especially as he had to overcome some social hurdles as well as physical hurdles in order to succeed. The only problem is that he can’t get a job in his field due to some outstanding legal situations. He feels humiliated and frustrated that his job training program set him up for failure by not giving him appropriate career counseling based on his entire life situation. He feels like he wasted a valuable opportunity by investing so much time and effort into a venture that was doomed from the start. If a vocational counselor had spoken to him honestly about his chosen field, he may have chosen differently, since his ultimate goal is to be employed full time. It would probably have required a 10 minute conversation, with a life time of payoff for this patient, who would have been able to gain employment with his new credentials. He was given sound generalized career advice, but that advice wasn’t sound for HIM.

All of these situations feel like low hanging fruit to me. It’s standard of care to teach a patient about new equipment. It’s really easy to check eligibility dates before completing a massive written request. Extra time isn’t needed to inform someone that it might be best to pursue a certification in a field where he can actually get a job. By skimping on compassion in the short term, no matter how pressed for time they might have felt, these providers have created way more work for themselves and for their patients in the long term, not to mention the other unintended consequences and emotional distress. The benefits of compassionate care are much more numerous than the perceived hardship of providing that type of care in the moment.