Fail, fail, fail, fail, succeed

Defensive Practice

As a nurse, I’ve always had a problem with the idea of practicing “defensively.” I feel this is a trap that many doctors and nurses fall into – one that degrades care and ultimately robs the practitioner of exercising his or her agency in administering the best humanistic care possible.

For those outside of the healthcare professions, what I am talking about is the concept of practicing in such a way that you are more focused on protecting yourself – either from getting fired or being sued – than you are on the patient’s needs. I see this all the time, often from smart, good people. Here’s what is wrong with this picture, and what rubs me the wrong way.

Defensive medicine, by definition, means that you are acting from a position of fear. This is not the right mindset from which to care for sick people. It implies that the practitioner lacks confidence in both themselves and healthcare itself. It represents a profound breakdown of the system.

When caring for others in need, the emphasis should always start with a question: What can I do to help this person? If you are a doctor, you administer medical care to the best of your ability, and if you are a nurse you apply nursing science the same. The truth of the matter is that medicine and nursing are two sides of the same coin – they are symbiotically related. One doesn’t function without the other. When they are aligned, they become a potent force to solve problems in service of helping the patient. Often the solutions require a fair amount of creative thinking and maneuvering to get the patient the resources they need.

If one is constantly afraid of “breaking the rules” and is unable or unwilling to exercise their professional agency, they have failed the patient, their profession, and themselves. They may have gone into their field with the best of intentions, but they ultimately lacked the confidence and bravery necessary to do their job well. These professions are not for the weak-willed or the faint of heart.

The best rise to the top precisely because they are able to apply their intellect and grit for the greater good of those in need. They do not operate from a position of fear, and although they do not break the rules cavalierly, they most definitely break them as needed.

They are compelled to do so by their desire to contribute something meaningful to the lives of their fellow humans. They have dedicated themselves to their cause, and they fully intend to honor that commitment.

When you need them, they are there.