Sometimes it’s difficult to practice what I preach. But I try.
A couple of weeks ago, I spent the evening in the emergency room with our youngest son (don’t worry – he’s fine). I hate going to the ER, but every once in a while circumstances necessitate it. I called doctor friends in the relevant specialty, as well as our son’s pediatrician, to confirm the need for the trip. They said to go. So we went. And this particular ER encounter did not make me like the patient side of an emergency department any more than before.
We were there for an issue that is time-sensitive – it’s certainly on the list of things that need super-quick evaluation. It took longer than it should have to get through triage and into the actual ER (maybe 20 minutes or so), but to the hospital’s credit, once we were actually in the room, the ER resident saw us almost immediately, realized the potential urgency, and had the attending doctor come right away. They ordered the necessary test, called the department to make sure it would be done immediately, and let us know that my son was the next person on the list and would go up promptly.
We waited about fifteen minutes. I checked with the nurse, who informed me that “they’re on their way” to get my son for the test. We waited some more. After another fifteen minutes or so, I checked with the nurse again. The same reply: “They’re on their way.” Another ten minutes went by. I got the resident’s attention and asked him if he could call up and see what was happening. He told me that he didn’t have a way to call anyone else. Another ten minutes. Went to check with the nurse again, who at this point gave me a really annoyed look and repeated that “they’re on their way.”
Honestly, the only way that they could possibly have been “on their way” that whole time was if they had been coming from Ohio.
We waited far longer than we should have for the test that determined whether a surgical emergency existed. It should have been done immediately, but it took significantly longer than an hour to obtain. And my polite advocating for my son did not seem to be fruitful. One of my specialist friends called and texted several times to check up on us, and kept urging me to push harder to get that test done.
I pushed. And it was very frustrating. I kept my composure and stayed polite, but I was seething inside. The nurse made another phone call. And it worked.
When the woman came to transport my son, I don’t think it would have been possible for her to move any more slowly. She was perfectly pleasant but showed absolutely no sense of urgency. I smiled and helped her push the bed so that we could make better time.
Emergency departments are grossly overused. They are filled with people who have had sinus congestion for two weeks or lower back soreness for a month, symptoms which should be addressed in a physician’s office. I understand the frustration of ER personnel and the at-times jaded attitudes of the staff. But it is the job of the healthcare workers to get beyond the workplace frustrations and to look at each situation through the eyes of the patients and their families.
Yes, there are people who use emergency room resources when they’re not needed. But most of us go out of our way to avoid emergency rooms. When we’re there, it means we’re really concerned about something. Assuming people are being polite, medical personnel should not show annoyance. A person transporting a patient for a “STAT” test should look like she’s hurrying. Residents should know what phone numbers to call to expedite what needs to be expedited.
The test turned out normal. No need for surgery. A little rest would do the trick. The fact that it then took another hour-and-a-half to be discharged was merely an annoyance, not a worry.
But believe me, I get it. When I tell my clients and my readers to advocate for themselves and their loved ones, I know it’s hard. I know it’s a delicate balance between making sure you get what you need and not annoying people in the process. But it has to be done. And hospitals are working on seeing things from the patients’ side. The gentle reminders and the self-advocacy help them get there.
The bill for the ER visit arrived in our mail today. That’s a subject for another day…
Reading this piece it’s difficult to assess the issues without knowing the perceived emergency condition that you write about. Like myself, the attendant nurses, radiology technician, and to some extent the resident who saw your child, all may not share your concern about an immediately emergent condition. When patient and family members come to the emergency department, their only perspective is their self; regardless of your own knowledge, or that of sophisticated friends on the phone. Providers throughout the hospital, have to have, the entire array of patients before them. Their urgencies will not align with yours, when a sensitive issue seems ultimately urgent to you. You have to remember that there is a queue for all tests and procedures, and it is attended to, constantly, by available medical workers. If you write about a subject, and address it to an audience of medical consumers, or professionals, it would be prudent to specify particulars if you wish to address a perceived wrongful treatment.
Thank you for your comment! Most of my detailed discussion in regards to this post has been on the KevinMD site, where it was re-posted, so I will try to sum up:
The situation involved a possible testicular torsion – absolute time-sensitive surgical emergency. And the ER doctors immediately recognized it as such and reacted appropriately. The problem was a lack of recognition of the urgency along the chain of personnel who would take the next steps to ensure my child’s safety. The ER attending spoke with the ultrasound scheduler and was assured my son would be taken immediately, that there were no urgent cases before him. But somehow that message did not get through to the folks actually in the ultrasound area. It was a very large hospital. The walk from the emergency department to the ultrasound department on another floor (involves waiting for an elevator to move the gurney) takes about 7 minutes. Rather than bringing him up right away, they waited until the previous patient was done (perfectly reasonable – I certainly wouldn’t push another patient out of a test!) (maybe 10 minutes), waited for someone to come get that patient and transport him back to his room (maybe 15 minutes), cleaned that room (no idea how much time – maybe 5 or 10 minutes), sent someone from there who had no idea that the test was urgent down to the ER to get my son (more than 7 minutes, since she was not rushing), and bring him up to ultrasound (another 7 minutes). The person transporting him had no idea that this was a stat test – she was completely surprised when I told her and said she wished she had known. Had he gone straight up from the ER when the ER attending was assured that my son’s situation was top priority and into one of several unused, clean-and-ready rooms in the ultrasound department (so that the ultrasound tech could move on to him the moment she was finished with the prior patient), it likely would have saved a half-hour or 40 minutes (which, had there actually been a torsion, would have been critical). There was a problem with communication.
Workers in a hospital need to be empowered to give the best possible care to their patients. The ultrasound department (not just central scheduling) needs to be given information about the urgency of a test so that time is not wasted. Residents and nurses need to be able to reach the actual people involved in carrying out a test so they can advocate for their patients. When a test is ordered “stat,” it may simply mean that it needs to be done today – in this case, “stat” really meant “stat,” and everyone involved in the emergent chain of care needed to know that (and why it was so important). However, the particulars in this case are not unique – the delay really was a system problem. The communication issue was at the core. I would like the issues to be fixed for the benefit of all patients, not just for my family. Again, the ER physicians understood the urgency 100% and were given assurance from someone on the phone that this was top priority – the problem came after that when no one after that on-the-phone person knew the details of the situation or the urgency, and when the resident and ER nurse were unable to communicate the details directly to the people who needed to know. The next kid who comes in with a similar situation may actually have a torsion, and if care is delayed in the same manner the person could lose a testicle. And that should not happen.
I really didn’t care a bit about the delay in discharge home after the ultrasound ruled out a surgical emergency – an inconvenience doesn’t bother me, the folks working in the ER had more important things to attend to, and no safety was jeopardized by that wait (there were empty ER beds, so we weren’t preventing someone else from coming in).
Again, thank you for reading my post, and thank you for responding.