A matter of iron: Patient compliance

Dr. Larry Kirkland's story:

What I've come to think of as "the ferrous sulfate affair" may seem trivial but it was representative of the conflicts that occurred during my stay. Because of anemia from a chronic infection secondary to a pressure ulcer, I was placed on ferrous sulfate three times a day. That is not a prescription drug [as it can be bought over the counter]. Since I knew that ferrous sulfate can irritate the stomach, I requested that the pill be left on the table and told the nurse that I would take it during my meal, which had just arrived. The nurse said, "I can’t do that." I thought she was kidding, so I explained my concern and assured her that I'd take the pill 10 or 15 minutes later, adding jokingly, "I promise not to try to sell it." Her response was to pick up the pill cup and say, "I'll wait until you're ready." When I told her it might be a few minutes, she repeated that she'd wait. Rather than prolonging this demeaning and unnecessary charade, I told her to cancel the medication order.

Although I knew it would mean that the attending physicians wouldn't know all the medications I was taking, I had my wife bring some ferrous sulfate tables from home. The fact that I needed the iron was never mentioned in the negotiation over when I took it. Instead of honoring the patient's right to be involved in decisions, the nurse was practicing a form of "directly observed therapy," an approach usually reserved for patients who won't comply with antituberculosis therapy, drug addicts in methadone programs, prisoners, and mentally incapacitated patients.

It's possible that such a rigid approach had evolved at this hospital out of dealing regularly with emotionally fragile patients….But if the patient is a physician…conflicts will arise if he is treated in the same manner as, for example, a patient with brain damage….

I'd never before come across so many staff members seemingly fearful of using their own experience, common sense, and judgment in making a decision, nor so many who cited "policy” or "regulations" to explain a particular action. I could single out individuals, but it seems likely that a share of the blame for the pervasive disrespectful treatment I encountered at this hospital should be assigned to the hospital administration and the priorities it transmits to the staff through training, example and regulations….

I remember a time when the patient, not regulations or the "bottom line," was the central driving force in the system. Maybe this is naïve, but I fail to see how a return to more personal and compassionate attitudes would reduce safety or be economically unsound.

Advice to hospitalized patients on taking their home medications: Stick up for yourself, and discuss this with nurses and doctors in the hospital.

Read our Hospital Patient Bill of Rights story, or read Dr. Kirkland's source story in the June 2007 issue of the American Journal of Nursing.