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.

27 thoughts on “Talk to Me

  1. Great post, Quinn, and obviously a topic that touches a chord with lots of folks. I think your “tests” at the end of the post are great guidelines to use in case copyright is in question!

  2. I’m sorry you had to fight the ER for your friend but I am very glad you were there. I had to be the ER advocate for both of my parents at different times. Most importantly was seeing how bad the lines of communication in that one small hospital are, I can’t imagine what it’s like in a big city ER. I had to physically stop the x-ray technician from making my dad sit up for a chest x-ray. Dad had two crush vertebrae at the time, diagnosed at that very same hospital. I won’t go to the ER with out a strong advocate.

  3. I have had some horrible experiences in a emergency room last year, with my 82 year old mother, some of them didnt know anything, its not my job, i dont know who does that I tried not to lose my temper but when your with an 82 year old woman who is not responding to you, and cant talk all of the sudden, you want help

  4. How true that all is. But just not in the emergency room. Administrators, politicians, Everybody has their own agenda. However, they don’t remember what it was like when they needed that extra help but will raise a stink when they have to do it again. In the meantime, we are at somebody’s mercy every day.

  5. I hope that you print this post and the one from the day before and mail to every ER in town (Phoenix, I presume). Maybe I’ll do the same for Tucson. In my opinion there is no excuse for this. If I did my job this way I’d be fired on the spot. I hope the patient is doing better and does indeed get the care and attention he/she deserves come Monday. Thank God there are REAL patient advocates such as you who hang in there and at least keep trying to get the job done correctly. I hope when I have to go to the ER someday that my “advocate” will be a pain in the “A” and try to keep knocking down barriers.

  6. I’ve had similar experiences. I would try an urgent care center next time — we’ve gotten much better results there. ERs are pretty horrible at customer service, and especially undiagnosed problems.

  7. Your experience is appalling, and I do hope your friend recovers soon. I’m in Australia where we have a public and private health care system, and while I do not have health cover, so use the public system which is grossly underfunded, I know of some terrible mistakes that the private hospitals will not own up to and try and hush up. For anything serious I could not and would not trust a private hospital for exactly the reasons you have outlined: money is more important than medical care.
    I have a serious heart problem and enjoy world class care. A close relative went into cardiac arrest in a private hospital, because of a major error on their part, and couldn’t access the same level of care I get, because she has health insurance and was in a private hospital. I might have to wait in A&E for minor health issues, but I do know that your friend would have had priority treatment and would have been kept in until they found out what was wrong, thanks to an efficient triage system.
    I don’t know why your government is so against our system of health care as it means that care is based on need, not how much insurance cover you have. We may have to wait for elective surgery, but life threatening surgery is done immediately and incidents such as you have described rarely happen. People with long-term illnesses can count on good medical care without having to worry about meeting their insurance payments, or being refused cover at all.

  8. Quinn, Send your letter to the administrator/CEO of the hospital and also to department managers that you mentioned. CC your letter to JCAHO and Medicare accreditation agencies. You can find their addresses through Google.
    No need to threaten, just write what you wrote above including time, date and shift, names if you have them. Make sure that the CC on the letters is obvious.
    Believe me….you will get a response. Take it from one who recently retired from the health care industry and was involved in regulations.

  9. You are right about their potential image problem, and trying to find their PR person is a great idea. I suggest you add to your cc the head of the ER. He/she needs to have this info as much as those in an administrative or management position. Often department heads are too isolated, and unaware of how their staff functions.

    And, I hope you get satisfaction and a positive outcome from being pro-active, and will share the results as they evolve.

  10. It’s been more than 20 years since I worked in a medical school (not in the hospital) but what I read from your outline is something that does need to be addressed. I understand you don’t want to go back to this ER, nor would I, but I do wish you would take your talent and put these concerns, observations and recommendations to the next step–a letter to the hospital administration, or the dean of the medical school (if affiliated).

    When I worked at medical schools, two, I was often on the Committee to Repair Problems. We always had problems and the issues you raised are so common, but so rarely addressed unless someone raises the red flag and speaks up.

    Sometimes an outside observer can turn a bad situation around, and you may or could be the catalyst for some serious and positive change at this facility.

    Hospitals are accountable for their mistakes and failure to meet set standards. They are monitored and must meet those requirements or be penalized.

    More hugs.

    • You are absolutely right, and may have read deeply into the post, which was taken from a draft of my letter to the hospital. A copy will go to the administrator, but I’ll just get a “you should have called someone” letter. No, I’m digging through the hospitals website till I find the media liaison. They care about image. And if this is a communication problem from my part, it is an image problem for the PR person. It should create traction.

  11. I have had many similar experiences in the ER. I have 2 diseases which at some point disable me in great spasms of pain. I have no health insurance and thus am labeled as an addict looking for my next high. Becaise I am also aware and knowledgeable of my diseases I threaten the doctor. In all my emergency room visits, I have yet to ask for pain meds. I ask for care. I am ignored and pushed into a corner. yet my conditions could easily end up with me in cardiac arrest. On my last visit to the ER, being my second go around in that day….the doctor was being a continual jerk and told me I needed to do assorted things….My reply back to him through the voice of my companion(because my throat was swollen and I was unable to talk) was this “If she wanted to get high…we could go a few blocks down the street and get the drugs and it would be much easier and much less humiliating than coming here”. At that point the doctor realized this was indeed a serious condition present in his ER. I do think he was very glad to see me go, considering I knew more about the diseases than he did. He did not like to be upstaged.
    I avoid the ER at all costs now and have learned to somehow just deal with the ailments and pain of these diseases. Those without insurance and no funds to pay provide them with little in keeping their Lexus or vacations at the Hamptons. Yet we are the people of this land.

    • Another tragic story of American health care. It’s just awful. There does seem to be a lot of communication problems, ego, and accountability (or lack thereof) involved.

  12. Excellent documentation and {lack of} diagnosis. Best wishes to your friend. We should absolutely be met at the ER door with triage. Many folks illegally in the country goto the ER for any and all medical care. Wonder if this is a factor in insufficient personnel in the ER, leaving the important stuff to the inept.

    • We have very different views on immigration, which I’m happy to not argue over–my parents were immigrants to this country, and in an odd turn of events, briefly illegal. So my views on inclusion were shaped early. Sadly, illegals can’t enter this hospital, which is what the insurance-checking was about, instead of pain management. Nope, this was good ol’ fashioned bad American healthcare.

  13. Dear Quinn, I am so sorry for that entire situation. I suppose there is no other hospital nearby. Fortunately, though I find a lot of ER docs are just plain stupid, most of the ERs around here will get stuff done, and they do do triage first. I will pray that your friend is able to get in right away to see a specialist in the appropriate area, who will be able to begin resolving the situation.

    • The shocking thing is that there are almost as many hospitals around here as churches–and that’s a lot. My fury is that in the last five years, in four hospitals, in three states, this is the treatment we have ALWAYS gotten. The American medical system is broken. Thanks for the prayers. They are my best hope at the moment.

  14. I am also sorry you had such a bad experience.
    I hope your friend is healing quickly so you don’t have to go back.
    health and love coming your way

  15. Quinn! I’m so sorry. Hugs from germany, and wishes that your friend is on the mend soon.

    (Although this is clearly not a laughing matter, I love your reference to Dr. Quinn medicine woman. You’re an amazing writer).

    • Hugs are better medicine than anything that showed up in the last 24 hours! Yeah, I get asked that all the time, “Are you Dr. Quinn, Medicine Woman?” So now I just say, “Yes, Yes, I am.”

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