Problem: REALITY CHECK: The Bailout Crumbles Hillary was the lead consultant assigned to speak at a state-sponsored conference. The purpose of the conference was to review new and revised national regulations scheduled to be effective on January 1. Hillary scheduled four junior consultants to speak with her on a variety of topics. Rebecca, one of the more junior of the consultants, addressed the right of patients to ask questions. She spoke about a program for health care providers to encourage patients to speak up and ask questions about any concerns they may have regarding their care. Following her presentation, Rebecca asked for questions from the audience. One participant said, "I really don't understand the need for this regulation. Patients don't seem to have a problem complaining." Rebecca began to flounder as she attempted to continue answering the questions of what seemed to be a generally disgruntled person. Hillary listened intently but said nothing.

Jerome jumped to rescue Rebecca from the constant interruptions of that day's self-appointed antagonist in the audience. Jerome raised his hand, and after being recognized by Rebecca, he said, "Many patients are not afraid to ask questions and complain when they believe things are not going right. These often are ambulatory patients who can leave a particular provider if they become dissatisfied. Other, more seriously ill patients may fear some sort of retaliation if they complain. This is often the case in long-term care facilities." A nurse in the audience disagreed. Jerome said, "I realize this is not the case with all patients. This fear can often arise, however, with an elderly person or extremely ill individual who is weak and feels vulnerable to upsetting someone, believing that his or her care could be compromised if he or she asks too many questions or complains. Seniors have sometimes been abused at home or in another care setting and are often not willing to risk further confrontation." Figuring a picture is worth 1,000 words, Jerome had asked for an overhead projector and proceeded to show some newspaper clippings illustrating why some patients have developed a fear to ask questions. After the session was over, the audience member who had raised the issue approached Jerome and said, "All caregivers are not like the ones you displayed." Jerome said, "I agree. I tried to illustrate for you why some patients are fearful." Jerome looked for Rebecca but learned that she had left the conference following her presentation.

1. Do you agree with Jerome's attempted bailout of Rebecca to counteract a difficult encounter with an audience participant?

2. What approach would you have taken? Explain your answer.

3. What lessons may be learned from this case?

4. Discuss how the various teachings in this chapter apply to each character in this scenario, explaining how you would counsel each conference presenter to address similar situations in the future.