(no subject)

[electricland]

Still simmering quietly over my ER visit. I don't mind so much about me -- I knew I wasn't in imminent danger of death -- but when nobody at all seems to be moving out of the waiting room, there does come a point when you start to think "OK, seriously. There are no doctors working at this hospital, are there?" For instance, waiting with me were a mother and her teenage daughter, who had cracked heads with another girl while playing soccer and was now woozy and vomiting. They'd been there since, I'm not exactly sure, but no later than 9 p.m., and they were finally called around 3 a.m. That is Just Not Right.

The triage nurse told me it wasn't that they were especially busy -- and I could see they weren't -- but nearly all their examining rooms were full of people waiting to be admitted. Which, I'm sorry, is just a sign of basic bad management. Not underfunding, not understaffing, nothing to do with how our health system is funded -- just inefficiency and a lack of will to change. Meanwhile, nurses are sitting over at the desk chitchatting. I should add that not one person came to check on the girl with the head injury while we were waiting.

At 9 a.m. they opened up a section (which to add insult to injury was called "Minor Treatment") and started calling us in batches of five. And it didn't exactly go fast, but as I mentioned it took a doctor all of 5 minutes to come in, ask me a couple of basic questions, poke and prod a little, measure the circumference of my calves and send me for a Doppler ultrasound. Are you seriously telling me that a doctor could not be spared for 5 minutes over the 9 hours I was sitting in that waiting room? Even if the vascular lab wasn't open at night, poke me and prod me, send me home to my own bed and tell me to come back in the morning or if I start to have chest pain or shortness of breath. I can do that. Same with the kid who needed a couple of stitches on the bridge of his nose. Same, I'm sure, with any number of people who needed to see a doctor but would really have preferred not to spend their night in that very un-urgent ER.

So I went hunting and found a couple of interesting sites -- I'm sure there are many more:

Institute for Healthcare Improvement (patient flow section)
Society for Health Systems (a lot of it is members-only, but they've got some good stuff in their newsletters)

Slightly related thought: on Friday at book club I was chatting with SS, who recently had an excisional biopsy following an abnormal Pap smear. She said the doctor was one of the best in the country for what she might have, but she didn't like his bedside manner -- he never said "S, you must be really nervous, don't worry, you're doing great," or anything of that kind. Which struck me because my response to any statement like that would be "Of course I'm nervous, you idiot, I might have cancer. Can we get on with this very uncomfortable procedure, please?" Mind you, I tend to prefer my doctors clinical with a side of flippant, so it sounds like this guy and I would get on just fine.

Bedside manner is such a fuzzy concept. As long as my doctor isn't actually insulting or belittling me -- which is why Dr. Gregory House and I would not get on at all -- my main criterion is competence. Likability is optional.

Comments

[gurudata.livejournal.com]

Hiho,

Bedside manner is such a fuzzy concept. As long as my doctor isn't actually insulting or belittling me -- which is why Dr. Gregory House and I would not get on at all -- my main criterion is competence. Likability is optional.

Hmmm... I'm somewhere in between, I think. I like that my allergist, for example, remembers what I do for a living every year that I see him, and asks me how it's going. But I have no interest in a Doctor that's all shmoopy-shmoopy "Oh, you must be so scared". Some level of interpersonal connection is cool, overly supportive, no thanks.

Cu,
Andrew

[electricland.livejournal.com]

Point. If you have a long-term relationship with your doctor, it's nice if they recognize you. But I'm not sure I want deep sympathy from someone with a speculum up my nevermind, you probably don't want me to go there. Clinical and impersonal is good there.

[fairoriana.livejournal.com]

When I had my ER experience earlier this year, I was told that the reason we spent so much time in the waiting room was becuase there were a ton of ambulences coming in the other door.

[electricland.livejournal.com]

Ah, well, our advantage was that the paramedics used the same door we did, and we could see them!

[javahousejihad.livejournal.com]

The ER's aren't too good here either.
I had a swollen lower intestines and it took 4 hours.
&
My friend's appendix almost burst, but he drove home and called an ambulance(ticket to the front of the line).
&
I took this friend of mine to the ER after he had a car accident and had a bleeding head wound that we couldn't stop. We sat for two hours until an actual nurse walked through the waiting room and I grabbed her. After she brought my friend into get treated, she came back out and asked me who told us to sit and wait. I happily pointed the 'nurse' out.

[electricland.livejournal.com]

Oy.

There's just no excuse for that.

(Here an ambulance is NOT a ticket to the front of the line, but the paramedics have to wait until their patient's been seen, which drives them mad and leads to more artificial shortages.)

[ex-mthrtong.livejournal.com]

Two winters ago I had a biopsy after an abnormal pap smear & ended up having some worrisome looking tissue removed. I was referred to the doctor who did both by the college health services program; I haven't quite decided how I feel about him, though I did schedule my yearly exam with him again next month. The actual procedure (I forget what it's called, cry- something? When they freeze the cells/tissue off) was supposed to take exactly two minutes, so while he did it he told me a (not very funny and moderately tasteless) joke that is supposed to last exactly that long. He really loves chatting while he's examining me -- not smalltalk, but "what are your ambitions in life?" sort of conversations, and he'll stop what he's doing to lean around my stirruped legs and chat for a bit. The first time we met he kept saying that he knew exactly how I felt -- I am normally a very passive, nonconfrontational person, but I finally asked him (rhetorically, of course) if he'd ever had a pap smear before, much less an abnormal one. Suffice to say he makes me uncomfortable, but he does seem to be a good doctor, and I appreciate his familiarity with my situation at this point.

[electricland.livejournal.com]

yes, I love that "I know how you feel." Or "This will feel like X," when in fact it feels nothing at all like X, and why don't you just admit it?

My ob/gyn in Montreal was extremely flippant and aged and we got on wonderfully, because he knew what he was doing (I was describing one of my symptoms to his residents, and they were giving me the blank look, and he came in and I told him, and he said "Oh yes! [two-word description of exactly what I was experiencing]." I said "YES!" So sometimes they do know what they're doing.

Yours sounds less than charming, but I get that familiarity can be a plus. I'm so sorry you've had a grim time. And I believe the word is cryosurgery?

[ex-mthrtong.livejournal.com]

Before we moved here, I went to Family Planning for my ob-gyn checkups. You got whichever doctor was in that day, but I usually ended up with this Indian woman whose bedside manner had clearly been criticized. The first exam I had with her she was brisk and rude. Later she developed these awkward chat schedules -- that is, she would predictably make a comment about the weather while doing my breast exam, just before the pap smear she'd ask me how school was going, etc. As much as I was irritated by our first meeting, the later ones were creepier, because it was so clearly calculated.

There's some more specific cryo- word, but I forget what it is.

[elissa-carey.livejournal.com]

Oy, do I ever know about ER waiting rooms. *refrains from rattling off long anecdotes*

As for bedside manners, I'm more like you -- I don't mind if you don't chat at me other than to ask me questions about my condition. What I do mind is the experience I'd had while in the military and nearly two months pregnant: an asshole doctor who felt the need to belittle and berate me while I not only had a massive migraine, but had dry heaves/vomiting and extreme discomfort thanks to all the forced intravenous solutions.

(I'd originally gone in because I was just a little bit sick and feverish, and it being my first child, I was worried about fever possibly affecting him, thus necessitating a visit to the hospital. Because it was late at night, ER was the only thing "open." After I was seen (3-5 hours after I came in), I'd been sent home with basic precautions to take. When we got back home, it was to find a message on the answering machine telling us that we needed to go back, that there were "ketones" in my urine. We were both clueless as to what that meant, so off we went. Turns out that I was dehydrated, so they made the call to force two or more IV bags in me. If they'd simply let me know that, I would've been happy to GO HOME and drink a lot of water instead of enduring that asshole's nonsense.)

[electricland.livejournal.com]

Oh man, what a horrid experience. Bleh. You reeeeally have to wonder why some people went into medicine...