Transparency Might Kill the Deal, but not the Patient

Just having completed my first year of medical school my clinical experiences are limited, but my exposure to the world of healthcare is not. Having spent the 4 years of my undergraduate career working with the geriatric population I had great exposure. The sales team at the assisted living facility I worked at frequented the high spots on their tours with nervous families – the courtyard, the dining and activities rooms, the bar and fancy lobby – and just as often spouted out words of assurance to families about the services their family member would “receive”. Perhaps this informal and false reassurance was not legally wrong, but over time I came to know that regardless of legality the promises the salesmen/women recited held little truth. The deals were not transparent, and at a time when families desperately needed that kind of honesty.

These sales pitches flashed through my mind the day Mrs. A was being wheeled out in a stretcher with a significant cut to the right side of her face. I knew someone in my department had recently paged a nurse aide to walk her to her room after dinner – something that had been promised the family in one of those sales tours. No one ever came and so Mrs. A walked herself unsteadily until she tripped. In reality the facility was never staffed to be able to walk every resident back to his or her room and so despite the frequent promise it was rarely done. Luckily this hadn’t caused an issue, until this day – the day she fell. I started wondering what the family would be told. Would they get the truth, or as is often the case with geriatrics, would the system’s shortfall be blamed on the patient’s age and mental deficiencies?

This patient did not belong in the facility I worked in, and this would have been avoided had the family become ill disclosure and this patient been placed in full nursing care. Financial pressures to sign leases pushed the sales department to say whatever they had to in order to close the deal, and families were comforted by the show they put on. They were anything but transparent knowing full well the 2 staff nurse aides on each shift could never give the level of care being promised to 95 residents. Mrs. A spent 2 days in the hospital because of this lack of full honesty and disclosure – a stay that could easily have led to any of a host of hospital acquired diseases, to delirium, functional decline or a fall – all common in the elderly. It’s not hospital transparency exactly, but it’s a story that sticks with me in my medical training and reminds me just how important the things we say are.