Welcome to the Twenty-First Century

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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.

10 COMMENTS

  1. While I must agree that antibiotics and albuterol were probably ineffective and unnecessary as cited in your article, I must tell you that I am dismayed at your obvious bias against chicken soup. There is no room for such prejudice in medicine.In 1977 Nancy Caroline published a paper in JChest lending credence to chicken soup therapy. Abraham Ohry followed in 1999 with a paper in the Journal of the Canadian Medical Assn., calling chicken soup “essential”.Caroline, N – Chicken soup rebound and relapse of pneumonia: report of a case JChest 1977;71;123 DOI 10.1378/chest.71.1.123-bOhry, Is chicken soup an essential drug? A JAMC • 14 DÉC. 1999; 161 (12)

  2. You and I know we’re on the same page with regards to patient advocacy. And I continue to do that for my own Mom. She’s getting a new PCP starting next Wednesday (the PCP she’s been seeing is, in my opinion, a rather inept physician, but that’s a story for another day) and I’m going with her, just to make sure she’s going to get what she needs, in terms of her own care.And I have an advocate in my own corner. My wife is going with me next Tuesday for the second opinion on my heel wound. I’m glad she is, and it is a funny thing: I find I can advocate really well for others, but for myself I really suck. It’s not that I don’t know how – I just suck at doing it for myself. For example, I would never have thought to hand-carry my medical record with me down to the appointment. She told me in no uncertain terms that I need to so nothing is left out. And being a nurse herself, she can definitely mix it up with the other side of the counter if it comes down to that…

  3. Canada = Socialized Medicine = That’s about all they can afford. The truth is Chicken Soup tastes good, makes you feel better, even if it doesn’t cure you, and it’s hard to show that it can be harmful. Medication isn’t quite the same thing, but I take your point. Walt, I’m much the same as you. I’m much better at advocating for others than standing up for myself.

  4. Great post, TOTWTYTR. I wonder why all systems converge on “Teh Suck” over time? Got to be more than simple entropy.

  5. But Caroline was Jewish and died in Israel. Not much socialized in either, and Jewish mothers make damn good chicken soup… so I’m told. The very thought that you and I might have similarities causes a shudder. Say it isn’t so!

  6. The “normal” patient just doesn’t understand the hoops that us “abnormal medical” people experience- and I can tell you my own experiences-both for me personally, family and friends etc- no one can either communicate effectively or understand effectively. I am only glad that I’ve had the experience I have or else I would have been up a creek without a paddle- cause sometimes its even hard for us “abnormal medical” people! 🙂

  7. In nursing school, we were told that it was no longer allowed to call people ‘patients,’ as the workd patient implied a person with no input into their care. We were now to refer to them as ‘clients’ since that word implies a shared responsibility.Which would be fine, if people actually did ‘share’ responsibility for their own health, rather than expecting the doctor to perform miracles everytime they were seen.

  8. I think the problem is that many people are not equipped, intellectually or emotionally, to share responsibility. For more decades than I can count, people were told to trust doctors and not ask too many questions. Maybe the medical profession and the legal profession have decided to change the paradigm, but no one seems to have told the patients, uh, clients.

  9. Dear TOTWTYTR,If I am very good and eat all my veggies, will you teach me to be an attitude Major Leaguer and a Pro Bowl Ball Buster?Love,Lissa.(Word verification: flatomer. It’s an instrument that measures the quality of flatulence in a room.)

  10. Lissa, I think you are well on that path already. The difference is that you do it with a cheery facade and sweet demeanor. If anything, it’s way more effective than my “kill an ant with a sledge hammer” approach. You’ll be fine.

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