Forming a behavioral assessment - a 'public image' When it comes to hospitals, how we perceive ourselves is not really as important as how the staff perceives us. Accordingly, nurses and doctors will often fail to make a proper assessment because they have developed a preconceived conclusion about a patient. Por example, a patient who frequently complains about very minor things actually causes the hospital staff to predetermine that the next complaint will have no merit. This is a dangerous situation that you want to avoid. I call it the "already/always way of thinking." Back in the early 1980s, a forty-nine-year-old man I'll call Bernard, a former television actor and producer, had become destitute. He survived by faking heart attacks. He would walk into an office building lobby in midtown Manhattan, grab his chest, and collapse to the floor. The security guard would call 911, and an ambulance would take him to the nearest hospital. This maneuver guaranteed a bed and three meals per day free of charge, because Bernard never carried any identification and gave fictitious names and addresses. The protocol in those days for a complaint of chest pain in a forty-nine-year-old male was three days in the coronary care unit and two more days in step-down. It took five days to rule out a heart attack. Bernard made his rounds to every hospital by doing his "act" in different parts of town. When he finally showed up two or three times to the same emergency room with the same paramedics picking him up, they were finally on to his fraud. However, there was no legal recourse. After a while, the emergency room doctors would discharge Bernard from the emergency room as soon as he stepped off the ambulance, believing that he was feigning another heart attack to get free room and board for a few days. They had engaged the "already/always" attitude toward Bernard. His new standard "treatment" became a subway token and directions to the nearest men's shelter. Bernard finally discontinued his short career as a hospital freeloader and went back to work as an actor. The danger he faced, how ever, was that if he had suffered a real heart attack during that period, he would not have been able to receive treatment because no one would have believed his symptoms to be real. Lucky for Bernard, that didn't happen. In another case, two nurses used this already/always way of listening to perpetrate a cover-up in a hospital. Mabel was a seventy-two-year-old woman who was agitated and confused. She screamed at the top of her lungs and shouted obscenities throughout most of the day. One morning the two nurses went into Mabel's room to transfer her to her bed from a stretcher after returning from a CAT scan. The two nurses put the stretcher next to the bed and forgot to lock the wheels. They told Mabel to scoot over, and she plummeted to the floor between the bed and the gurney. She screamed, complained of hip pain, and yelled, "You two bitches made me fall!" The two nurses picked Mabel up, put her in the bed, and agreed not to report the incident. They reasoned that since Mabel was screaming and shouting obscenities all the time, no one would pay any attention to her. If there were any injury, no one would discover it for a couple of days. By then no one would be able to determine who was liable. This scheme actually worked as planned. No one paid any attention to Mabel's complaints of pain because she had unwittingly trained all the staff not to listen to her. It was not until a physical therapist tried to manipulate the leg that he discovered there was something wrong with the hip. The point of this discussion is for you to be aware that when you enter the hospital as a patient, you create a "public" image. Your main audience is the nursing staff. The nurses will form a behavioral assessment based, in part, on the image that you project. Thus if they see you as a person who would not complain unless something were acutely wrong, the responses to your calls for assistance are likely to be quicker than for those patients perceived to be chronic whiners. Save the complaints for the real problems. Then accept nothing less than quick responses.