Medicine isn’t what it used to be. There was a time that, at least in theory, patients could trust their doctors to give them the best care available. No longer. Medicine has become a labyrinth of regulation, insurance requirements, defensive medicine, staffing shortages, emergency department misuse, and muddied priorities.
Even in good hospitals, I mean really good hospitals, doctors and nurses are overworked, administrators are always looking for ways to cut costs (and corners) and patients are whinier, more demanding, and more litigious.
Did I mention the mounds of paperwork that this all creates. Sometimes doctors and nurses must feel more like clerk-typists than medical professionals.
All of which means that they have less time to spend with patients and treating patients. Not only that, they have less time to communicate with patients and that’s before the great physician – non physician jargon barrier drops into place.
All of this means that you can’t be a patient any more. Now, here in our new century, we have to be informed consumers of medical services. The problem here is that most people don’t know what they are consuming. Yeah, the Internet helps you become aware, but you can’t do that if you don’t even know where to start looking for the answers.
Let me give you a couple of examples of what I mean.
A friend of mine has a two year old son who has a number of medical conditions. One of which pre-disposes him to Pneumonia. Even in this age, people die from that, even if we under rate it’s deadliness. My friend has brought her son to the doctors several times over the past few days with respiratory problems. The doctor thinks it’s pneumonia, but hasn’t ordered a chest x-ray yet. They’ve put the child on antibiotics (another chicken soup medication) but so far it hasn’t helped. Today the kid started having more respiratory distress and so she once again returned to the doctor. Where they finally ordered a chest x-ray and gave Albuterol. There’s no real reason to give Albuterol, but that too falls into the category of chicken soup medication, so they gave it. If they are trying to mobilize secretions, Atrovent would likely be better, but my friend doesn’t know know that and doesn’t even know what to ask. If it were my kid, I’d demand to know why the chest X-ray wasn’t done earlier, why they were using Albuterol and not Atrovent, why they were taking a shotgun approach to medicine.
Here is another example. A few years ago my mother had to have a routine Colonoscopy. Not a huge deal, but if you’ve ever had one you know the pain in the uh, neck, part is the preparation. For those of you have not had one, I’ll skip the gross details and say only that you can not eat for almost twenty four hours before hand under the best of circumstances. I was with my mother when she made the appointment at the clinic. When they handed her the paperwork I noticed that she was scheduled for late in the day. I read through the directions and a quick calculation revealed that my mother would have to go without food for thirty six hours. Not because it was necessary, but because there was only one set of directions and it said flatly not to eat after noon the day before the procedure. My mother was about 80 at the time, and is a diabetic. I’m much younger and not a diabetic, but I couldn’t go that long without eating.
I took the paperwork back to the clerk and said that this was unacceptable and we needed to reschedule so that my mother had to go without food for the barest minimum time possible. The clerk decided to get into an attitude contest with me and declared that the time was the time and that was all there was to it. Which of course was unacceptable to me. Unfortunately for the clerk, she was an attitude Little Leaguer and I’m an attitude Major Leaguer. After she stopped whimpering she called the doctor out. He took one look at the paperwork and told her that she needed to reschedule my mother for first thing in the morning so that the time she was without food was minimized.
The point is not that I’m a Pro Bowl ball buster, but that if I hadn’t made an issue of it, my mother would have had to either suffer needlessly or just not get the procedure.
Everyone I know in EMS has similar stories about their friends and families. What happens to people that don’t have someone in their family that knows medicine and can advocate for them? How do they know that they are getting the right treatment or the right information? How do they sort through the jargon to know what they are really being told? Even when doctors try to talk to people at a lay person’s level, it seems that a lot of people don’t understand their conditions, their prognosis, or their options.
I don’t know how many patients I see that tell me they went to the hospital, but that the doctor didn’t tell them what was wrong with them. I used to think that this was lazy patients, but now I’m convinced that at least part of it is that no one takes the time to explain and make sure that the patient knows what’s going on before the patient leaves. I know that discharge instructions are issued, but do the patients really understand what they contain?
I don’t think this is going to get better soon, which isn’t particularly reassuring.