Mr. Smith was ready to be discharged home after his laryngectomy, an extensive operation that removes a patient’s throat due to cancer. In the opinion of Dr. Lu-Myers, he was a capable man who had passed his physical and occupational therapy evaluations with flying colors. Mr. Smith had fulfilled the doctor’s list of clinical discharge criteria, and she was eager to send him home. She planned to entrust him and his family to manage his dressing changes, as well as his tracheostomy and drain care, with the support of frequent outpatient nursing visits — all very routine protocol, especially for someone who seemed alert and capable.
The day before Mr. Smith was to be discharged, Dolores, his nurse, approached Dr. Lu-Myers with some concerns: “Mr. Smith seems depressed to me, and you know, his wife has never come by to visit. I’m worried about us discharging him.” Dolores explained that Mr. Smith was undergoing a divorce, his children were not around, and he would likely be living alone. With the responsibility for his care now a concern, it was unsafe to discharge him. The care team ultimately found him a temporary rehabilitation facility where he recovered for two weeks until he was ready to go home.
This fictionalized vignette highlights an important aspect of health care: Providers often have vastly different ways of seeing and treating patients, as differences in profession, specialty, experience, or background lead them to pay attention to particular signals or cues and influence how they approach problems. For instance, one person might assess a patient through a clinical lens, focusing on whether the patient meets clinical criteria for discharge, while another might see the patient through a personal or social lens, considering the patient’s broader support system at home...
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