It may be a long time coming, but what’s very much needed is a mechanism for identifying, by individual facility, specific systemic sources of patient stress. We might call this a Systemic-Stress EMM (SSEMM) audit. “EMM” denotes eradication, minimization, and mitigation. Depending on a source and its context, one of these three tactics will be more feasible than the other two.

Within the biomedical model, health professionals are probably among the most careful professionals in our society. They are not supposed to make mistakes, to have unforeseen events, or to be exhausted and worried; there is a strong emphasis on perfection, whether in diagnosis or treatment. In this demand for perfection, centrality operates through the health professional’s power over the patient in a relationship between the expert and the layperson.

UR nurses speak a different language than most other bedside nurses. In all settings, to justify payment or suggest an alternative status, the hospital UR nurse and the insurance UR nurse first discuss medical necessity criteria. If there is disagreement between the nurses about status and therefore payment, then the physicians discuss medical necessity during a scheduled peer-to-peer conference.

There is increased nursing frustration due to students re-asking questions that patients already answered during nurse triage. Students interview fewer patients and often interrupt nurses due to not knowing the optimal time to arrive at patient triage. This leads to frustration and hindered learning for students while disrupting nurse and resident workflow.

For older adults, healthcare can be complicated. They are more likely to experience duplication of services, multiple transitions between care settings, harm from medications, and lack of planning that incorporates the goals of patients and their families.