Last week, I shared a story titled When the System Works It Works Well. A comment from a reader made me rethink this story and see a different perspective that I had not considered. I wanted to share it with you as it was an important realization that we must remember as nurse case managers and other healthcare team members.

The Comment:

Great story. In this case, as was the patient, healthcare professionals were thoughtful and willing to be flexible. The insurer was willing to work with both parties and approve payment. The result was a successful treatment and healthy outcome. The success can be attributed to thinking “out of the box” and questioning “by the book” responses. Well done!

Reflection on the Case

As I thought about the comment, I realized the injured worker was the force behind the success of this case. He was the one who, although in pain, scared, and worried about his future, asked the doctor to allow him to try conservative treatment. Even though two doctors thought surgery was the best option based on his presentation, the MRI, and their expertise, they listened to the patient and allowed him to try conservative treatment.

Yes, everything worked – but it was because the patient followed the plan of care: he participated in therapy despite the pain, was willing to go back to work, and used his knowledge of the industry he worked in to create a new position for himself that allowed him to return to gainful employment.

I know the doctor did not think the injured worker would do as well as he did. He thought he would come back after the first visit and agree to surgery. But the patient persisted and allowed his body to heal on its own. The team designed a plan that included medication, water therapy, and family support, which helped him get through the hard part of the process.


Several studies show that engaging patients in decision-making and behavior change should be how we (nurse case managers, physicians, therapists, and others involved in patient care) practice. Effectively engaging patients in their care improves health outcomes and satisfaction with the care experience, reduces costs, and even benefits the clinician experience.


Some take-a-ways I leave with you:

  • Listen to the patient.
  • Put the team together who will listen to the patient after options and ramifications are explained.
  • Give them time to heal naturally.
  • Utilize the non-surgical resources first.
  • Allow healthcare team members to use their expertise and resources to address challenges. It may take a little longer, but ultimately, we achieve a positive outcome for the patient.
  • Empower the patient to participate in THEIR plan of care.
  • Engage the family to support the patient.
  • Talk to the employer to find simple ways to bring someone back to work, utilizing the patient’s transferable skills to try something outside their comfort zone.
  • Celebrate your successes!

Thanks for reading this post. Please let me know if you have a comment you want to share as we get smarter together!

If you missed the original article When the System Works: It Works Well You can read it here:


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