And as we reflect on Dr. Yeh's experience, let us not forget just how much worse it is in developing countries, where in some places a "visit" to the doctor could be a 20-mile or 2-day trek on foot, or where the doctor-patient ratio is 1 to 100,000 in some areas. Our discomfort here in the US as we go through the medical "system" is relevant and raises questions about how competent we really are, but watch a video about the abject poverty of Ebola victims in Sierra Leone and the rudimentary care they get and one feels almost guilty about our complaints here at home.
Notes from a Gurney: An ED Physician Reports on Her Stint as a Trauma Patient — Physician’s First Watch
Notes from a Gurney: An ED Physician Reports on Her Stint as a Trauma Patient
By the Editors
Dr. Charlotte Yeh was crossing the street in Washington, D.C., on her way to dinner when a car hit her. She ended up in a Level I trauma center, and the experience was sobering for its reminder that in our efforts to measure quality indicators, the patient may end up ignored or forgotten.
Her essay on the experience, which appears in Health Affairs, is the focus of a 10-minute interview with Clinical Conversations.
Reader Comments (9)
this has been getting worse the past decade and is accelerating with recent practice of medicine by administrators and politicians. the fact there are so few commenters shows how little time physicians have for real problems while "checking the boxes" forced on us by bean counters.
I know Charlotte well, and believe me, if this could happen to her that it can and must happen to less informed and outspoken patients thousands of times each day in all of our institutions, let alone Level I trauma units in the nation's capital. It is no wonder that so many less knowledgeable patients slip through the cracks of the current system. From her account it is clear that no one who encountered this patient before the rehab facility back home had ever learned two of the most time honored teachings in all of medicine: Sir Wm Osler's ""Listen to your patient, he is telling you the diagnosis," and Dr. Francis Peabody's "the secret in caring for the patient is CARING FOR THE PATIENT".
So while these providers were checking off institutionally prescribed lists of quality indicators, the patient was completely forgotten, her diagnoses missed, her comfort level and ability to function even in the short term forgotten, she was blamed for not being able to feel in her legs that her catheter was malfunctioning, indeed one would think she was expected to "take up her bed and walk" out of the facility so as not to take up precious space in the halls (or the maternity ward)... thus depressing individual and institutional productivity indicators. Sad indeed that this is where US healthcare has been taken by bean counters and bureaucrats in the name of quality improvement.
I was taken to Kings County Hospital in March following a bicycling accident. The treatment was incompitent at best, and sometimes down right dangerous. The drug dealer with a gunshot wound got better care than I. Pain medication wasn't ordered. I was dragged on to the xray table by my broken leg. Nothing you say will surprise me.
I think the culture of medicine has shifted towards seeing more patients, getting them in and out of the hospital, ordering the right tests to not miss a diagnosis and constantly fearing the lawyer that might get involved. Many of us physicians would love nothing more than seeing our patients happy, taken care of and healthy. But when we docs go in and out of the rooms in less than 10 minutes and order a barrage of tests and shower patients with meds and get frustrated when they don't do what we ask them well...then we breed this culture of medicine. The nurses, residents, health techs etc. all witness this and think to themselves "if the doc don't care why should I". But, nobody can convince me that I can truly care, show empathy, be authentic and make a difference in my patient's lives seeing them 2x per year for less than 10 minutes, followed by 10 minutes of charting.
When I go to the ER my only expectation is that anything life threatening is picked up and treated. I don't think diagnosing an MCL tear is necessary inpatient but would likely be diagnosed after the patient has had follow up after discharge. Being left alone and lonely on a gurney in the hallway is inevitable in our current health care system. It's the fact of life, such as traffic in Los Angeles. A foley cath that has shifted out of place may not take precedence no matter how often the patient complains of it because that day the nurse assigned to that patient may have had to cover a colleague's patient as well. With how much ER's cost these days I'm grateful that they even exist still.
I recently was hospitalized for pneumonia and atrial fib. My biggest problem was the wait in the ER to get to the room. The ER was cold and the bed very uncomfortable. The staff were caring, and I did not experience anyone not working. I did not like the getting wakened for vital signs in the middle of the night.
My overall experiende with the hosptial was good, but it may be also because I used to go to the hosptial and nurses still remembered me. I would rather not be in a hosptial. There are always some problems, and I got out as soon as I could, but my experience this time, and previous times was not as bad as the above. Also, you need to have someone that is with you who can get help for you if needed.
Dr. Yeh should be applauded for sharing her harrowing story, but as someone who could be a change agent in medicine, I think her solution (or lack thereof) misses the mark. She states that we should have different quality measures, however one of the reasons her doctors and nurses didn't have time for her is that they were busy clicking the boxes AARP-sponsored insurance companies (along with others) are demanding. How about less paperwork for all, fewer "quality measures" and just more time for patients? How about if one could bill as much for a really thorough H and P as they can for a CT scan? This would go a long way towards helping doctors and nurses do the real work of taking care of patients rather than checking boxes and ordering tests.
Unfortunately this is too commonplace in what has now become the "business" of medicine. Each person focuses on their little piece of the patient and ignores areas that do not pertain to them. As a family physician, I want to address issues related to the whole patient. However, these often extend beyond the standard 15 minute visit and taking time to address multiple patient issues often adversely impacts my patient numbers & RVUs.
I do hope the "medical community" does not think this is an isolated incident. This is typical service in hospital settings, not just the ER. Many of the staff treating patients in hospitals should not even be clerks in the gift shop. They are rude, irritated, and antagonistic. They seem to feel their own comfort is way more important than that of the patient and seem to have plenty of time to stand around chatting and laughing and enjoying coffee and pastries...right in the patient care areas . Every physician should spend a night anonymously as a patient to see the incompetence first hand. The MRI, CT, etc., technicians seem to be the exception and are normally professional and concerned about the comfort of patients. Forget about the nurses. They are too busy doing paperwork that should be the duties of an administrative person, not a highly paid "professional." You'll probably disregard my remarks as bitter banter. That would be a mistake. I have been a major surgical patient 3 times in the last 4 years. Many, many people die or have permanent disabilities as a result of poor care after surgery.. Admitting physicians are for the most part competent and caring. Little do they know the hostility that greets patients after surgery.