4th Apr 2018

Hostage Bargaining Syndrome identified

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Ever felt powerless in hospital?

When we land in hospital for an extended time, most of us put our faith and safety in the hands of the medical staff. It takes a brave person – or an advocate – to buck the system and not take things lying down (pun intended).

I was brought up in a small country town and the local police officer, bank manager and principal were revered figures. If there had been a doctor, she or he would also have been in that category – which leaves me, and many others, less likely to question authority figures.

It might also make us susceptible to HBS. Have you heard about this condition?

HBS is Hostage Bargaining Syndrome, a phenomenon where patients behave as if negotiating for their health from a position of fear and confusion.



Research that identified HBS was conducted by Monash Business School and the Texas A&M University.

Professor Tracey Danaher, from Monash’s marketing department, says researchers looking through sociology studies on hostages had observed a reluctance to challenge authority.

“We thought – this is similar to patients who are often very reluctant to assert their interests in the presence of doctors, who they see as experts,” she says.

“It may manifest as understating a concern, asking for less than what is desired or needed, or even remaining silent against one’s better judgement.”

Longer-stay hospital patients can be made to feel like exhibits who are talked about instead of with. And despite the best of intentions, time-poor medical staff are likely to shun a more collaborative approach to discussions about treatment and progress.

A shared decision-making approach, where doctors present options and patients explain their preferences, allows the medical team and the patient to share concerns, questions and information, Professor Danaher says.

The Monash-Texas University study found that the higher the stakes in a health decision, “the more entrenched the socially sanctioned roles of patient and doctor can become”.

It identified cancer and intensive care patients, and their families, as particularly likely to feel powerless in relation to their care.

The problem could be worse if medical errors or unexpected side-effects occurred.

“But this can be lessened if doctors share the responsibility for making decisions with the patients and their families,” the study says.

Professor Danaher explains that shared decision-making is more likely to lead to less invasive, less intensive treatments.

“For example, consumers advise hair stylists of their preferences and may give real-time feedback during the service. Patients should feel as comfortable doing this in medical care as they do in hair care, but this is not always the case.

“To do so, patients need to feel a true sense of partnership, where both parties feel safe in communicating with each other in a context of mutual trust.”

To subvert HBS, doctors must aim to be sensitive to the power imbalance, the study say.

They should then pursue shared decision-making and make patients feel comfortable about communicating their concerns and priorities.

Do you identify with Hostage Bargaining Syndrome?

 


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COMMENTS

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patti
12th Apr 2018
11:03am
I have had this experience, recently, spending 3 weeks in hospital following surgery and subsequent complications. I found it hard to negotiate with anyone, particularly doctors, at one point I asked to speak to the doctor to find out my care plan, but he didn't come.....3 days later I threatened to put in a formal complaint. Action was swift after that.....Doctor, Head Nurse and Discharge planner all appeared at my bedside within 2 hours. It is hard to negotiate when you are ill. I resent decisions being made about my health with no consultation. I wonder how I would have got on if I hadn't spoken up? Probably would have still been there!
Knows-a-lot
12th Apr 2018
11:27am
In 2016, I spent over 6 months in hospital. I asked questions about everything. The health system is falling apart due to the Lieberals funding it insufficiently, so it's only sane to question things.

"Longer-stay hospital patients can be made to feel like exhibits who are talked about instead of with"

That's due to the arrogance of most doctors.
MON
12th Apr 2018
11:35am
My wife and I have had the occasional non emergency stay in hospitals of our choice as advised by attending specialist with no issues. Recently late in the evening, my wife needed emergency attention and we called 000. The paramedics were 1st class, settling her down and transporting her. We have full private health cover and the paramedic asked which hospital and without thinking about our cover suggested as the public emergency hospital within 500 mtrs was well considered it was the best shot. And then it went down hill. My wife was presenting with what appeared pneumonia but staff decided she was abusing alcohol and for the next several hours treated for liver. Seriously, we enjoy a drink but not to that extreme, but staff kept asking and how many drinks do have each day dear! Oh and by the way the earlier injection should relieve the symptoms you came in with but how many drinks do you have each day! It wasn't till 10 hours later that a doctor attended and advised there were no liver problems and she was to be moved to a ward while they dealt with the pneumonia, oh and by the way the medication your doctor has you on presently to deal with your sleep and stress matters, we wouldn't recommend and will change. You'll what, I'm dealing with emotional stress due to the sudden death of my daughter and my GP whom I have extreme faith in has prescribed and you don't agree. No, we'll change says the hospital. Now we start to question our reliance on the GP. We are now in the ward and my wife is taken for a scan to check what, Oh the liver! Seriously, do I have a problem? No its just a precaution. On returning to the ward she is abruptly told that she is to be transported to another hospital without explanation. My son and I corner the matron demanding what is going on to get a blank stare and be told they need the bed. But what is wrong with my wife? She is transported to another hospital mid evening, goes through 2 ward changes and is released 8 hours later with serious warnings about the medication prescribed by her GP and provided with a different script. My wife was dealing with serious emotional stress and pneumonia which was managed well by the paramedics and absolutely ignored by the hospital. Lesson from this experience; know the hospitals and when the paramedics give you a choice select one that you want.
Blossom
14th Apr 2018
6:33pm
I know a guy who was transferred between hospitals, not once but a few times. They live at Plympton in the western suburbs of Adelaide. One of the hospitals he was transferred to was Mclaren Vale, south of Adelaide (not even a suburb). He went in and out of one of the hospitals a few times. The staff of one of them used to his ring wife and advise her which hospital he had been transferred to, whenever he was transferred from one of them a few kms from where they lived. The reason he was in hosptial was because he lost his footing getting out of a bus that had fairly high steps.
He had previously had a stroke and can't use his right arm properly.
He fractured his left arm and one of his legs and required surgery on both. Initially he also had difficulty feeding himself as he can't lift his right arm high enough and because of the fracture of his left arm and the necessary restriction of movement of his left arm. As he had pre-existing knee problems and his heart never takes kindly to anaesthetics and surgery he was initially placed in Cardiac Care before being transferred to Orthopaedics. That was when they started "playing musical hospitals". That meant delays in various therapies including Physio as some hospitals had none at all and naturally there was also different ones at different hospitals and some of them had different ideas. What wasn't revealed for a few weeks was that his wife had worked as a nurse many years before. MON, I agree with you that the paramedics are fantastic. Most of them have Nursing Diplomas (I have talked to a few over the years) and some do extra studies and know just as much as some of the Doctors, especially the odd intern. I also know a nurse who discovered a Dr. had put the cables for the ECG machine in the wrong spots which gave wierd readings. When the Nurse checked them and changed them she got proper readings. When she asked who put them on, he asked by and he was very embarrassed when she explained the situation. Even more so as the patient was then diagnosed with a heart attack. Pretty sad when an Enrolled Nurse has to show a fully qualified Dr. how to do it properly.
ROB
12th Apr 2018
1:18pm
No, I am a fugitive lol. Never been admitted to hospital and have no plans to. Why risk the issues with procedures and treatments if they can be avoided simply by using later technology products that are well proven and effective without the use of harmful drugs and procedures that thrown at us? Only another 25 years to go to make it to 100 hospital free years.
Puglet
12th Apr 2018
2:17pm
My father had been significantly disabled following a series of strokes. Finally he, his family and his doctors decided that he should not be resuscitated again. Unforunately he developed chest pain while out shopping and someone called the paramedics who took him to hospital where a young doctor decided to ignore the Not For Resuscitation (NFR) and resuscitated him. He was sent to ICU. When he regained consciousness a couple of hours later he loudly voiced his displeasure, as did his wife and consultants. That afternoon he said he was going home. We his family helped him to remove drips, monitors etc. The staff kept telling him he had to sign forms which he refused to do. He refused to take his medications and just went home. He died peacefully at home in his bed surrounded by his family two days later. The hospital can’t force patients to stay if they are of sound mind because this is false imprisonment or assault. They become very, very angry when patients refuse to do what they are told. More of us should do it more often!
robmur
12th Apr 2018
2:23pm
Yes, I've felt like that. I had a total knee replacement back in January this year. I was a week in hospital, but was sent home too early despite having arranged to go into rehab. When I went home I struck the very intense heat wave of day after day of very, very high temperatures in Melbourne. Despite our home having a cooling system, my body just couldn't cope with the heat after major surgery. Back into emergency at 7.00pm on a Saturday night. At 11.30pm I was transported by ambulance to a smaller hospital. Spent a week there with no rehab and little support from the visiting doctor. Again, rehab had been arranged, but at the last minute the location was changed because the original rehab place had to close several rooms because of a plumbing problem, and it would be at least four days before they could accept me. So, it was arranged for me to go to an alternative rehab location. That was OK until I was told by the hospital administration that I would have to pay the full cost of the ambulance despite having ambulance cover. All red tape which made me very angry. I said to the hospital administrator that my son would pick me up and take me home. That didn't sit well with the administrator as they had a duty of care. I dug in and said I'm going home. At the last minute they relented and said they would supply an ambulance. I spent another week in rehab. After almost four weeks away from home I was sent home. The whole thing was buggered up by the surgeon who should have sent me on to rehab instead of going home. His comments were, "You'll be OK, your wife is home, she'll be able to look after you and I'll prescribe enough medication for you". That was the worse thing that could have been said to me. I was nowhere near ready to go home as rehab was an important part of my recovery. I've had to go back into hospital last week for a knee manipulation and scar tissue clean out, all done by my favourite surgeon, who I'll see again next Tuesday. Doctors and hospitals, I hate them. But at 76 no doubt I haven't seen the last of them as I grow older. Who knows?
Charlie
12th Apr 2018
5:57pm
When changing shifts the doctors and nurses have to verbally give a brief to the new shift about what is going on. They prefer it if the patient doesn't enter the conversation, but I did when I understood the terminology.

Also in a public teaching hospital, people are talking (about you) and not to you, all the time.

Is this Monash Texas University in USA and is this about hospitals in the USA? So how does this apply to Australia?

In my experience, being in an Australian hospital, a lot depends on the doctor and nurse on a particular shift. They are all quite different.

My only conflict was about pain medication. I brought my own Brand and insisted they didn't
change me to the hospital brand because it wasn't as good.
This was all OK with the senior doctors, but one of the nurses tried to short cut the system and give me the hospital stuff, because it was too much trouble doing the proper security and unlocking my stuff in the presence of another nurse. After taking the same tablet 4 times a day for 10 years I knew it's exact size and shape so there was a confrontation.

Pharmacy also caused a problem by insisting the hospital tablets were the same as mine because they contained the same amount of medication. But these were a slow release tablet and I had researched them, finding out that my Brand had a US patent on the slow release mechanism and released at a different rate.

I didn't have any problem with the way I was treated overall, there were just different nurses with different personality and different gripes about the system.
Jack
12th Apr 2018
8:13pm
I spent 2 weeks in a NZ hospital before being retrieved back to an Australian hospital. The level of care between the 2 countries was so different. In NZ the medical care was fantastic. We were advised by a specialist and doctor on all results and treatment. Rather than operate in NZ (which would have meant I couldn't fly back to Australia for 2 months) I was brought back to Aust. The level of care and treatment was so poor, with limited interaction from the specialist and doctors.


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