Talk to Me

After a horrible experience at a local hospital (well, it wasn’t my experience, I was a bystander), I began to wonder what the problem really was.

Image from Yalemedlaw.com

I find the question “What is this about, really?” very useful when I feel confused or frustrated. Sometimes what looks like “you are so thoughtless” is really “I’m very sensitive about that topic.” Occasionally, “He must be right and I must be wrong,” is really, “Yes, you did violate my trust.” Whatever the problem, it’s worth another look.

So I took apart the hospital experience. I went through layers, just like an art journal page. (And got more appreciation for layers, too).  Here are some layers I dug through, but did not explore, because they were part of the problem, but not the root of the problem:

• Not enough or wrong people doing the job. In an emergency room, the first person you should see is a triage expert who assesses the immediacy of your problem, not the administrator who asks for your insurance card.
• Wrong titles (“patient advocate” really was “My hospital, my rules. I represent the hospital, they sign my paycheck. Now get with the program.”)
• Not enough focus on the patient. If the first thing  you are given is not attention for your pain, but a sheet explaining color coding of employee job function by scrubs color and trim,  they’ve lost focus on what a hospital emergency room is.

The major problem was. . . lack of communication. OK, I teach communication, so every problem looks like a communication problem to me, but lack of clear communication is a slip away from a wrongful death lawsuit in an emergency room. Words I never want to hear from an emergency room doctor: “I don’t know if there is a [specialist] on duty today. They don’t tell us that. I’m just the emergency room doctor.”

Or, “The CAT scan is usually read in 20 minutes. Has it been an hour and a half already? Are you sure?”

Or, “I’ve called the Physician’s Assistant twice. She’s not answering. Here, I’ll order more pain medication for you. What did we give him before? Do you remember how long ago that was? Is his heart beat always that slow?”

When I asked, “Can you give me an overview of  what will happen next?” The reply, “”Well, as soon as I finish typing in these notes, I’m going to have to catch up on my paperwork. After that, I’m going to eat lunch, and then I have a meeting.”I was expecting a list of events that would lead to a medical treatment decision. Nope. In fact, we never got that.

No one in 24 hours could develop a plan that showed progress toward a solution. We were handed off, one to the next, each change of personnel started all over  with the same questions. When I said that we had given all of that information twice, I was told “Well, you need to give it again.” But no progress got made. What should have been a 50-yard dash was digging a hole at the 2-foot mark.

Following at a close second was the refusal of accountability. I understand CYA, but in a hospital, personal accountability for the responsibility of the job creates successful patient care. In 24 hours at the hospital, a specialist never showed up. The emergency room doctor handed off the patient to a hospitalist (doctor who does admissions) who listened to his lungs and signed a piece of paper. After that, all medical care was left to nurses or technicians. (I knew this from consulting my color-code chart).

Third, and most dangerous, is transforming medical care to a consumer service. I want the doctor to be the expert. That’s why a doctor has those enormous medical school bills I indirectly pay for. I am not the expert. I want expert advice in an emergency room. If I’m the consumer, I steer the conversation and the outcome. I get to choose. Making medical decisions for  the too-heavily-medicated-to-understand friend, based on a combination of hints given by a doctor and the administrator nixing choices because the insurance won’t cover them is not “doctor/patient consulting,” it’s bad medicine. It’s also a bad environment for sound financial decisions.

What was the outcome of all this? The patient stayed in the hospital for 24 hours, was never seen by a specialist, and released into my care, heavily medicated with an unresolved, pain-producing medical problem. I hope the pain medication makes it through the weekend, so we can start looking for a specialist on Monday morning. Because the one thing we are not doing is going to the emergency room. That’s just an expensive place to wait for Dr. Godot  for 24 hours.

—Quinn McDonald is not Dr. Quinn, Medicine Woman, although at the moment, she wishes she were. She doesn’t even play a doctor on TV. She’s a writer who is in charge of someone else’s medical decisions, and she’s not qualified for that.