In government hospitals, not everything goes as planned and the environment seems busier than usual. As a health care professional worker, you are expected to do your outmost best in a limited time frame which can be a bit stressful at first. Eventually you get used to the daily routine but do you ever get used to the health care system? It is known that the South African healthcare system is overwhelmed by a relentless burden of infectious and non-communicable diseases, social inequalities as well as insufficient human resources to help the population that is growing every single day (Mayosi & Benatar, 2014). Patients human rights are adhered to… but are they equal among each other?

Everyday a new patient is being admitted while there is another patient being discharged and that is how the cycle continues day in and day out. A 72-year-old-female was referred to physiotherapy after she had a right total hip replacement. A thorough subjective was done with her on day 1 post-op  and it was concluded that the patient will need assistance at home as she stays alone, does not shave a shower and has 2 flights of stairs that leads to her apartment. This indicated that family training was needed and thankfully, the daughter mentioned that she will take time off from work. The aim is to always give your patient’s the best treatment and to see them improve, whether it takes one day or a week. When assessing the patient on day 1 post-op, she had  minimal range in the operated (right) hip compared to the left side. Bed exercises were given and by day 2, the patient was able to stand up with a walking frame as her highest level of function with strict supervision and a +1 assistance but had to push through the pain experienced in the operated hip. Patient was not safe to take steps yet. However, as I arrived that morning, it was written in the patients notes that the plan is to discharge her the next day. No communication has been made from the doctor with regards to the physiotherapy progress of the patient prior to the decision.

From a personal physiotherapist perspective, that was not the most professional decision to make as the patient still needed to be taught how to walk upstairs and downstairs and to mobilize confidently. There had been no family training done as yet and no step-down placement application has been processed for the patient. This puts a lot of pressure on the physiotherapist’s rehab plan where sometimes patient’s do not always adapt easily. Although the patient was medically stable, holistically, she was not. The patient ended up voicing her opinion to me that day saying that she does not feel ready and confident to be discharged yet which put me in an uncomfortable position. Patients prefer to be involved in the decision-making of their care otherwise they feel like they are being ignored and end up feeling left out.  Shared decision making recognizes that medical decisions require interaction between patients and their doctors; that decisions be informed by the best available clinical evidence and that decisions reflect the individual patient’s considered goals and concerns. Identifying the medical problem and laying out the reasonable options are primarily the responsibility of the physician (Fowler, Levin & Sepucha, 2011).

Health care professionals in hospitals are responsible for providing services to patients to meet their acute-care needs, optimizing their function and supporting them with community services as they return home (Matmari, Uyeno & Heck, 2014). Although, the modern medical workplace is a stressful place for doctors, and this was evident to hospitals I have been to. Stress arises from long hours, constantly caring for ill people, facing death of people they have come to know, knowing that their occupation carries enormous responsibility and that people’s lives depend on them causing them to have to somehow play a role in all their patient’s lives, even though sometimes it is not always seen as “equal” treatment and care provided (Govender, Mutunzi & Okonta, 2012). Sometimes doctors have to treat new in-coming patients on demand and do not always have time to go back to older patient’s as often as they did before. Other factors include; high demands on time which interferes with doctors’ other responsibilities; dealing with emergencies; increasing demands from patients; information overload as well as administration (Govender, Mutunzi & Okonta, 2012). However, the stress factors doctors experience throughout working in hospitals day in and day out should not affect patient’s rights to have access to equal health care. I feel that if patients right’s are adhered to in the hospital, it makes physiotherapy rehabilitation more successful in the long run.

The influx of new patients should not have a direct effect on the patients who are currently receiving treatment. Section 27 of the Constitution states that every person has the right to have access to health care services, including reproductive health care and that respect must be shown to the right of access to health care services by not unfairly getting in the way of people accessing existing health care services, whether in the public or private sector (The Constitution and public health policy, 2019). In public hospitals that I have worked at, the pressure is more demanding and often the term “patient- centeredness” is negatively affected.  Patient- centeredness care can be defined as having 3 pillars: the needs of the patient comes first, ‘nothing about me without me’ meaning nothing is discussed about a patient without them being present and lastly, every patient is the only patient (Berwick, 2009). I think that patient- centeredness should be an on- going process for the patient to improve their outcome of rehabilitation.

Patients who are discharged are often in a vulnerable state (Hesselink et al., 2012) which could lead to a negative perspective on their condition and their rehabilitation. This therefore affects physiotherapy rehabilitation sessions where patients are not motivated to continue and see it as “time-wasting”. Do doctors take that into consideration? Patients who are not communicated as to why they are discharged so early often feel unprepared, have increased anxiety and a misunderstanding which is believed to increase hospital re-admissions and therefore, essentially acts as counteractive as the purpose of the quick discharge is top open bed space for another patient (Hesselink et al., 2012). Health facilities have to be accessible to everyone within the jurisdiction of a state.  Sometimes doctors try to make realistic decisions under stressful conditions and try to prioritize the patient load to see who needs assistance immediately vs someone who can wait a little longer or someone who can be discharged immediately for someone who needs emergency treatment. It is not always a “first come, first serve” process that doctors follow. I do believe doctors try their best to suit to everyone’s needs but it should be structured in a way, that patient’s receive equal treatment. Moreover, the aims of the National Health Act are to make effective health services available to the population equitably and efficiently; to protect, promote, respect and fulfill the rights of South Africans to progressively realize the constitutional right to health; and to establish a national health system that will provide people with the best possible health services that available resources can afford (Moyo, 2019).

If this were to arise again, I will ensure that patient centered care is prioritized and communication has taken place between the multi-disciplinary team. Whether you are a doctor, nurse, physiotherapist or occupational therapist or in the health care team, sometimes you have to try and put some time aside so you can aim to give your patient the best possible treatment as they are human too and have rights. The challenge is to further entrench these health care rights and to make sure that patients feel involved in their rehabilitation. Recognition of human rights is a political responsibility and it is necessary for the political leadership to take the bold step and to commit the country to respecting, protecting and promoting human rights at all times – even though it is still not fully done to this day.

References:

Berwick, D. (2009). What ‘Patient-Centered’ Should Mean: Confessions Of An Extremist. Health Affairs, 28(4), w555-w565. doi: 10.1377/hlthaff.28.4.w555

Discharge Cartoons and Comics. (2019). [Image]. Retrieved from https://www.cartoonstock.com/directory/d/discharge.asp 

Fowler, F., Levin, C., & Sepucha, K. (2011). Informing And Involving Patients To Improve The Quality Of Medical Decisions. Health Affairs, 30(4), 699-706. doi: 10.1377/hlthaff.2011.0003

Govender, I., Mutunzi, E., & Okonta, H. (2012). Stress among medical doctors working in public hospitals of the Ngaka Modiri Molema district (Mafikeng health region), North West province, South Africa. South African Journal Of Psychiatry, 18(2), 5. doi: 10.4102/sajpsychiatry.v18i2.337

Hesselink, G., Flink, M., Olsson, M., Barach, P., Dudzik-Urbaniak, E., & Orrego, C. et al. (2012). Are patients discharged with care? A qualitative study of perceptions and experiences of patients, family members and care providers. BMJ Quality & Safety, 21(Suppl 1), i39-i49. doi: 10.1136/bmjqs-2012-001165

Matmari, L., Uyeno, J., & Heck, C. (2014). Physiotherapists’ Perceptions of and Experiences with the Discharge Planning Process in Acute-Care General Internal Medicine Units in Ontario. Physiotherapy Canada, 66(3), 254-263. doi: 10.3138/ptc.2013-12

Mayosi, B., & Benatar, S. (2014). Health and Health Care in South Africa — 20 Years after Mandela. New England Journal Of Medicine, 371(14), 1344-1353. doi: 10.1056/nejmsr1405012

Moyo, K. (2019). Realising the right to health in South Africa [PDF] (pp. 10-15). Retrieved from https://www.fhr.org.za/files/7215/1247/1732/Health.pdf

The Constitution and public health policy. (2019). [PDF] (pp. 5-6). Retrieved from http://www.section27.org.za/wp-content/uploads/2010/04/Chapter2.pdf