I can state without hesitation that Stanford Medical Center is a terrible place to be a patient. I arrived there unconscious, with a blood sugar level in excess of 800 mg/dl and was treated with total neglect for three days. Only after my wife demanded my transfer to Kaiser Permanente was I treated and diagnosed as diabetic. Stanford medical staff lives under the illusion that they are all gifted and demi-gods, at the least.
5
So, the doctors did better on the surveys... That's nice, but how did the patients do?
6
Having had three brain surgeries at the U. of U. hospital, I do have respect for the quality of care in that institution.
However, I recently received a phone call of the hospital saying I needed to drive down (around 100 miles) for another MRI but could not expect to go over the results with my brain surgeon, who is also the head of the department.
I find this inadequate and do not intend to have an MRI without going over the results with the brain surgeon. I realize that it would be the case were there a new abnormality. Nevertheless, I expect to talk with a doctor about the results as I age, even if the MRI is "normal."
However, I recently received a phone call of the hospital saying I needed to drive down (around 100 miles) for another MRI but could not expect to go over the results with my brain surgeon, who is also the head of the department.
I find this inadequate and do not intend to have an MRI without going over the results with the brain surgeon. I realize that it would be the case were there a new abnormality. Nevertheless, I expect to talk with a doctor about the results as I age, even if the MRI is "normal."
4
Perhaps doctors can also start reducing patient suffering (inflicted by the medical system) by starting with basic infection control: removing the ring, watch, and copious long sleeves the younger doctor seems to wearing in the main picture. I assume he wouldn't see patients without washing his hands, yet all those items that touch patients are probably not washed properly.
6
I fear the article's title is misleading. The term "inattentive care" is a misnomer. It should read: Hospitals choose more humane approach to caring for patients. The fact that our medical industry needs studies or financial penalties to motivate it into treating patients with empathy as opposed to a series of numbers and procedures should be more appalling to people. I realize that doctors and nurses are overworked and understaffed. I honor those who are devoted and genuinely invest in their patients but they are the exception and should be the norm. Treating a sick person in the way one would treat oneself or a loved one is a basic human concept not something that should require studies or financial incentives. A sense of empathy is part of the job.
3
Here are two suggestions for the physicians. First, include your patient's nurse in your visit to the inpatient making sure he/she knows your intentions rather than seeing your 'orders' later. Second, talk to the other physicians to whom you are consulting about your patient directly. Don't just leave it to your nurse or some other intermediary staff member to have to try to figure out what was on your mind when you made the consult! Yes, I am a nurse and I am from the UK. You would not get away with these practices in my country.
3
Great story. Physicians need to talk to patients and be a Good listener. There is No room for arrogant behavior. Patients just want Kindness, Caring and to be treated as a family member.
Also never Judge any Patient.
Also never Judge any Patient.
1
Had a cataract removed this morning. Had the other eye done two weeks ago. I had told the nurses that I had very sensitive skin and that they would need to roll the heart monitor stickes off rather than pulling or yanking. I came home with a bloody scratch above my eye because they yanked the drape off. While they were yanking I am saying ow, ow, ow, to no avail. This time I talk to the doctor, the nurses - everyone and remind them that I have very sensitive skin. I came home with a bloody patch above my eye and below my eye. The extra 30 seconds equates to money lost and she is sedated so what does it matter seems to be the attitude. During the follow up call last time when I reported the problem I was told "everyone complains about that" . My reply was why hasn't it been addressed? I feel for my Doctors but my attitude about administrators is devoid of respect. Any factory situation is just a factory situation - head 'em up - move em out.
8
What about waiting interminably for the doctor to see me after I've arrived for a scheduled appointment? Most of the excuses the nurse or receptionist give are very lame and evidence poor planning and disregard for patients' time.
1
To the Editor:
The best clinical care relies on best contemporary evidence aimed at improving outcomes meaningful to patients. Lets get the fundamentals right first. The middle aged man with a large heart attack will do much better with a percutaneous coronary intervention for acute stent insertion than the much cheaper option of drugs to unclog his blocked arteries. Whether he ends up being accommodated in a recovery room with a view or having gourmet food is an extra that is billed to private health insurance or billed as an out of his own pocket expense. Health care resources are limited, and need to be shared equitably to serve the needs of a whole population.
Although "Doctors Strive to Do Less Harm by Inattentive Care” (18 Feb) rightfully pleas for better patient experience through enhanced physical comfort, privacy and empathy as well as reduced sleep disruption, I worry that costly consumer surveys that are frequently used to interrogate non-clinical elements of a patients’ journey hold potential to divert scarce funds away from achieving the fundamentals. My hospital’s executive are increasingly distracted with Press Ganey consumer complaints about hard seats, poor standard of coffee and even the quality of television in outpatient waiting areas. The quality of medical and surgical care we deliver in a timely, personally affordable and cost-effective way seem to have been waylaid in the monthly Press Ganey reports the clinical staff are reprimanded about.
The best clinical care relies on best contemporary evidence aimed at improving outcomes meaningful to patients. Lets get the fundamentals right first. The middle aged man with a large heart attack will do much better with a percutaneous coronary intervention for acute stent insertion than the much cheaper option of drugs to unclog his blocked arteries. Whether he ends up being accommodated in a recovery room with a view or having gourmet food is an extra that is billed to private health insurance or billed as an out of his own pocket expense. Health care resources are limited, and need to be shared equitably to serve the needs of a whole population.
Although "Doctors Strive to Do Less Harm by Inattentive Care” (18 Feb) rightfully pleas for better patient experience through enhanced physical comfort, privacy and empathy as well as reduced sleep disruption, I worry that costly consumer surveys that are frequently used to interrogate non-clinical elements of a patients’ journey hold potential to divert scarce funds away from achieving the fundamentals. My hospital’s executive are increasingly distracted with Press Ganey consumer complaints about hard seats, poor standard of coffee and even the quality of television in outpatient waiting areas. The quality of medical and surgical care we deliver in a timely, personally affordable and cost-effective way seem to have been waylaid in the monthly Press Ganey reports the clinical staff are reprimanded about.
5
I am a RN with over 30 yrs experience, mostly in hospitals. What most don't see is that these interruptions in sleep, annoying policies, and esp the eternal wait for the discharge process are all to meet the onerous and ever increasing mandates of our federal govt. We are required to ask all those ridiculous questions of everyone, and to document pages and pages, in duplicate and triplicate. We are not allowed to utilize our education, experience, and nursing knowledge to decide that your ingrown toenail visit probably does not require extensive screening for domestic violence, cancer, tuberculosis, or alcoholism! The TLC that you are all looking for will come at the expense of your wellbeing, as there is not enough staffing to deliver basic care these days, much less all the extra time for customizing TLC care for each of my 8 patients....of which 5 are high acuity or critical.
3
Wait a minute- are you saying that those interruptions in sleep might be for a reason other that just torturing the patients and causing them to "suffer"? Wow, what an amazing idea
1
I do commend the doctors for trying to see the patients' points of view and treat people with respect.
In the past two years I had two very different conditions that were painful, scary and in the end undiagnosed. The doctors were mostly very nice and seemed to listen but no one every told me what was wrong. Eventually, I got better in both instances, after months. Accurate diagnoses, or a differential diagnosis, shared with the patient and evidence based treatments should be part of the equation.
In the past two years I had two very different conditions that were painful, scary and in the end undiagnosed. The doctors were mostly very nice and seemed to listen but no one every told me what was wrong. Eventually, I got better in both instances, after months. Accurate diagnoses, or a differential diagnosis, shared with the patient and evidence based treatments should be part of the equation.
3
My father, an internist, selected my numerous surgeons based on their excellent results not their less than charming personalities. He cautioned me that I would probably not like them but I would be sleeping while they worked and good outcomes are what is really important. I suspect they do poorly on these new patient charming based surveys.
7
Your comment implicitly suggests a lot of things, some very wrong ones being:
1. You cannot be an excellent surgeon without being inconsiderate to your patient.
2. Any doctor who cares about the patient's comfort and alleviating their suffering has lousy clinical outcomes.
3. Good outcomes can be assured even when you ignore the patient's pain and suffering.
4. Doctors have no more to learn about patient care, they just need to learn about new drugs and procedures and be good at them.
Please recognize that while we do not have to be touchy-feely about everything, taking the patient's comfort into consideration ensures they will work with the doctor better (think of dragging a child to some to a doctor for his own good vs explaining where you are taking him and what he can expect when he gets there). It also makes sure they expect and accept whatever pain or suffering is inevitable with the procedure. When they suffer less or willingly, their stress levels are lower and their healing is better. Good doctors have known that, so have good nurses and attentive family members. Making it more common practice is a good thing for everyone.
1. You cannot be an excellent surgeon without being inconsiderate to your patient.
2. Any doctor who cares about the patient's comfort and alleviating their suffering has lousy clinical outcomes.
3. Good outcomes can be assured even when you ignore the patient's pain and suffering.
4. Doctors have no more to learn about patient care, they just need to learn about new drugs and procedures and be good at them.
Please recognize that while we do not have to be touchy-feely about everything, taking the patient's comfort into consideration ensures they will work with the doctor better (think of dragging a child to some to a doctor for his own good vs explaining where you are taking him and what he can expect when he gets there). It also makes sure they expect and accept whatever pain or suffering is inevitable with the procedure. When they suffer less or willingly, their stress levels are lower and their healing is better. Good doctors have known that, so have good nurses and attentive family members. Making it more common practice is a good thing for everyone.
6
Your post points to a very important and never discussed part of medical care.
Where are the empirical statistics on outcomes for each doctor?
http://www.patient-safety.com/conflict-of-interest.htm
Where are the empirical statistics on outcomes for each doctor?
http://www.patient-safety.com/conflict-of-interest.htm
3
Perhaps I was not clear:
1: Never said my surgeons were inconsiderate. Just not charming, fun at parties, "likable" people personalities.
2: They never ignored my pain. Surgeon told me " I know two pain medicines very well. If they are not working for you I will refer you to our pain management anesthesiologist who knows all the medications to try, my specialty is surgery."
3:I was in an ICU my father managed. I was as far from ignored as you could get.
4:The radiologist and pathologist had no visible (pleasant or not) personalities. I did not care anymore than I cared about the personality of the people who designed the monitor I was connected to.
Many brilliant technically competent people is various fields have seemingly odd persona's. I do know a few charming, friendly surgeons but personality is not what they should be evaluated on.
1: Never said my surgeons were inconsiderate. Just not charming, fun at parties, "likable" people personalities.
2: They never ignored my pain. Surgeon told me " I know two pain medicines very well. If they are not working for you I will refer you to our pain management anesthesiologist who knows all the medications to try, my specialty is surgery."
3:I was in an ICU my father managed. I was as far from ignored as you could get.
4:The radiologist and pathologist had no visible (pleasant or not) personalities. I did not care anymore than I cared about the personality of the people who designed the monitor I was connected to.
Many brilliant technically competent people is various fields have seemingly odd persona's. I do know a few charming, friendly surgeons but personality is not what they should be evaluated on.
4
I have lots of experience both as a patient and as a family advocate at our nearest tertiary teaching hospital and I guess I didn't realize how lucky we are. The nurses are consistently awesome---competent and caring. Very good doctors, and the facilities are excellent. Good food, too. Sometimes doctor coordination and communication gets a little garbled, but that's one reason patients need an advocate with them.
If I have a pet peeve, it is that physicians tend to pooh-pooh the fear and pain involved in procedures. One example: starting IVs, and other needle sticks. WHY can't all doctors write standing orders for nurses to *offer* a little lidocaine injection to patients who want it prior to starting an IV or other major puncture? For lots of patients this one improvement could reduce their fear and stress load significantly.
If I have a pet peeve, it is that physicians tend to pooh-pooh the fear and pain involved in procedures. One example: starting IVs, and other needle sticks. WHY can't all doctors write standing orders for nurses to *offer* a little lidocaine injection to patients who want it prior to starting an IV or other major puncture? For lots of patients this one improvement could reduce their fear and stress load significantly.
7
Had a family member in hospital in nyc. A friend (very experienced md) recommended a donute pillow for the patient who was suffering from discomfort of being in bed in restrains. Nursing staff comment their job is to stabilize patient. Could not get support everyone so busy. Basic decency missing.
4
Doctors, Nurses, and Patients all have room for improvement. Patients should seek treatment sooner (when options are greater) rather than later when invasive procedures are required. A healthy life style will reduce the amount of prescriptions the patient is on and remove red herrings from the diagnostic process.
Nurses need to see each patient with a fresh set of eyes and not let the fact that have had so many drug seeking patients detract from the possibility that there current patient is in real pain.
Doctors need to given more time with each patient. They should wash their hands and stethoscopes! Also they ask their patients to turn off their televisions and ipads. Patient education only works if both parties take it seriously.
Also, every patient should be given a pad, a pen and an envelope to hold the business cards of everyone professional who interacts with them.
Nurses need to see each patient with a fresh set of eyes and not let the fact that have had so many drug seeking patients detract from the possibility that there current patient is in real pain.
Doctors need to given more time with each patient. They should wash their hands and stethoscopes! Also they ask their patients to turn off their televisions and ipads. Patient education only works if both parties take it seriously.
Also, every patient should be given a pad, a pen and an envelope to hold the business cards of everyone professional who interacts with them.
2
Dear Thomas,
You must be very young. Patients should "seek treatment sooner?" What if the patient doesn't feel sick? Or gets suddenly injured? I know someone who kept seeking medical care and was misdiagnosed for years. Turns out she had a brain tumor. There are many diseases that are not preventable by "a healthy lifestyle."
You must be very young. Patients should "seek treatment sooner?" What if the patient doesn't feel sick? Or gets suddenly injured? I know someone who kept seeking medical care and was misdiagnosed for years. Turns out she had a brain tumor. There are many diseases that are not preventable by "a healthy lifestyle."
3
My Mom has been hospitalized many times, first for a successful bout with cancer and many times since for the aftereffects of years of chemo. I've seen the nurses making faces at reasonable requests, I've seen the doctors become affronted when questioned about post hospital care and I've heard the many, many careless catty comments hospital staff make about patients, families and each other. Subsequently, my family and I do everything possible to stay out of doctors offices and hospitals. I would suggest that hospitals be run like any other workplace - conduct yourself professionally with your customer in mind.
8
I worked as a nurse in a large Chicago hospital many years ago. I was on a days/nights rotation. Perhaps being a newly graduated nurse I was still idealistic, but when working nights, I believed that I needed to let my patients sleep whenever possible. I made my rounds with a flashlight with a 4x4 gauze rubber banded over the light so that I could check the patients, their IV's and not wake them by coming in the room and throwing the overhead light on. I moved quietly, whispered if I had to speak, and didn't shout down the halls to co workers if there was no emergency. It wasn't rocket science, it was common sense and manners. I've also been a patient a lot in recent years, and have sometimes been upset by how much I've had to advocate for myself in the face of doctors ignoring my symptoms and needs. I've more than once been grateful for my nursing training and my years as an assertive patient advocate, because if I'd not strongly advocated for myself, I'm not sure I'd still be alive. I suffered a great deal...complications of surgery that weren't addressed until I went elsewhere for help, obvious med allergic reaction that was ignored for two days, and snarky comments that were just inter-service grousing that had no business being vented at a patient. Also, many doctors don't realize the power that their words have with patients. An offhand remark can cause real anxiety and anguish. I'm glad that preventable suffering is being looked at, but are they asking the nurses?
11
Perhaps you remember when there were signs on the streets that read "Quiet Please. Hospital."
1
The Press Ganey surveys are for marketing purposes, not measuring clinical outcomes. The questions are appropriate for consumer transactions in settings where a customer can easily take their business elsewhere the next time. That does not apply to health care.
The changes in staffing in health care (replacing RNS with medical assistants, aides or care technicians) that replace professionals with legal and ethical obligations outside of the employer/employee relationship have been driven by profit making forces. Easing suffering takes time, and time is money. Humans tend to treat others they way they are being treated. Hospital administrators and their staffs are tone deaf to this fact of human nature.
The changes in staffing in health care (replacing RNS with medical assistants, aides or care technicians) that replace professionals with legal and ethical obligations outside of the employer/employee relationship have been driven by profit making forces. Easing suffering takes time, and time is money. Humans tend to treat others they way they are being treated. Hospital administrators and their staffs are tone deaf to this fact of human nature.
5
I think that an emphasis on reducing suffering is very noble. The problem is that sometimes the most obvious things are overlooked. I broke my foot on a Saturday evening and waited 7 hours before I was seen. Meanwhile I was shivering from shock and absolutely miserable. Another time I was in the hospital due to an unknown blood issue. They did not know what I had. When evening came around and the hospital became quiet, a dark, inconsolable feeling came over me. I really hope they succeed, but inattentive care covers many a varied thing.
4
Too bad we can only evaluate our physicians with the same tools we evaluate our used cars. Patients get surveyed so much now that only the most severely upset respond. Only a fraction of our patients respond (I never do) to such surveys that are designed to "rate their medical care." In the meantime, as a profession, we struggle to self police and provide excellent care to many even if that care is not what they want. I get a higher rating for agreeing with a patient that refuses vaccines, than from one that i take a firm stance against their misperceptions, no matter how polite i am about it.
8
Well said. We get more of what we measure. Measuring the wrong thing means we get more of it. Doctors need to get their associations to brainstorm and draw up proper ways of collecting and analyzing patient care data. By avoiding this they invite the MBAs and CPAs to come in and do it. Money talks and everything else walks. Doctors need basic courses in commonsense economics and finance as part of their medical education, or they will get squeezed like all the other technical professions in the US.
7
Haha. You said it Dr. Gould. I would suggest for patient comfort: fewer surveys that only allow you to answer pre-set questions. Ask patients to tell what concerned them, and you may get some eye-opening information.
1
Dr Gould I feel like hugging you when you talk about those ratings. A patient's mother gave the lowest rating because I did not agree to diagnose her son as "bipolar" which you may have observed is a very popular diagnosis among mediocre psychiatrist who give to any irritable child or adult instead of making the connection that most of those irritable affects are due to depression, anxiety, or pain (in the elderly and very ill). Many adult patients and the parents of children and adolescents want the bipolar diagnosis (which is most of the time only a "shotgun diagnosis" b/c with it mediocre and careless doctors cover every possible symptom) because it is equal to a disability check, and they get furious if they do not get it from you.
2
Interesting timing with this article. I recently decided to quit using my OB/GYN of many years because I had grown weary of her lack of empathy. Sadly, I doubt she will gain any empathy for menopause patients until she actually becomes one. Also sadly, I doubt she will notice I am gone.
9
Satisfaction survey results provide important information for change, as the examples cited in this article demonstrate. You don't have to wait for the survey to find out whether you hit the mark with your patient.
Ask patients to complete a card printed with these three sentences. I've been a patient before and something that impressed me was _________. This time I'm concerned about _________. I'd also like you to know ____________.
The written comments are a 3-step roadmap to creating an experience in which your patient feels respected, cared for and important.
Ask patients to complete a card printed with these three sentences. I've been a patient before and something that impressed me was _________. This time I'm concerned about _________. I'd also like you to know ____________.
The written comments are a 3-step roadmap to creating an experience in which your patient feels respected, cared for and important.
2
I hate "fill in the blank" questionnaires almost as much as Likert scales. What if nothing impressed me? What if I have three things I would like to know instead of one? How about just talking to me? If my doctor handed this to me it would not make me feel "respected, cared for and important." I would feel like just another form-filler and someone the doctor can't bother to talk with. I'd drop it into the round file.
2
Doctors don't have time for this. Their job is to administer proper medical care, not to be your priest or best friend or discuss your hopes and dreams. Get real.
1
All of this misses the point. Doctors are not the ones in charge. It is the insurance companies. The reason that doctors do some things is to avoid being sued for not doing them. The reason they do not do other things is the insurer's fear, no matter how groundless or minute, that they might be sued for not doing them.
When doctors are not in charge, as is increasingly the case in surgical facilities when a doctor parachutes in, surges, and is out before his scalpel is cold, these decisions are made by on-site nursing staff. They work by a strict playbook that the healthcare management company has cleared with, you guessed it, the insurance company. Their job is, basically, to keep you from dying while they might be liable. Nothing more.
Professionals out there: am I wrong about this?
When doctors are not in charge, as is increasingly the case in surgical facilities when a doctor parachutes in, surges, and is out before his scalpel is cold, these decisions are made by on-site nursing staff. They work by a strict playbook that the healthcare management company has cleared with, you guessed it, the insurance company. Their job is, basically, to keep you from dying while they might be liable. Nothing more.
Professionals out there: am I wrong about this?
6
When I got my first job in a hospital as a new nurse, they were much too busy to pay much attention to me, never mind training. So they assigned me to one patient, a man who was relatively healthy, but demanding of the nurses time. I spent the entire day with him, fixing his pillow, getting him fresh water, talking to him to reduce his anxiety, helping him open the food containers and just trying to be pleasant. The whole time I felt so foolish, useless and ineffective. By the end of the day, he insisted on calling in the nursing supervisor and told her, "this lady is the best nurse I have ever had!"
Which made me laugh at first, but upon reflection made me rethink a career as a hospital nurse. I have been doing private duty nursing for almost 20 years now. Mostly what I do is exactly the same things I did for that man, and my patients are overwhelmingly very happy.
Which made me laugh at first, but upon reflection made me rethink a career as a hospital nurse. I have been doing private duty nursing for almost 20 years now. Mostly what I do is exactly the same things I did for that man, and my patients are overwhelmingly very happy.
6
Humanistic care is not only the best care to strive for but listening to patients leads to more accurate diagnoses and better outcomes.
3
“These are our care standards. Do you think you can always do it for every person every time?”
I am a critical care nurse and I can tell you now no one would ever be hired if they had to promise to enter into a perfect relationship with every patient every time. This is another example of unrealistic expectations by management that has no idea of what goes on in real life. I try to always deliver good care, every time, understanding that what I do makes a difference. But i cannot make the promise of perfection.
I am a critical care nurse and I can tell you now no one would ever be hired if they had to promise to enter into a perfect relationship with every patient every time. This is another example of unrealistic expectations by management that has no idea of what goes on in real life. I try to always deliver good care, every time, understanding that what I do makes a difference. But i cannot make the promise of perfection.
8
"The problem (with suffering) is how to measure it and what to do about it". What patients are looking for and needing is an answer for their illness but more fundamentally a human connection. That is how we will "cure" suffering. No pill, no procedure, no surgery will cure suffering. When a patient feels lost in the hospital, uncared for, overlooked, suffering is the result. Hospitals are industrial institutions where the patient is the machine that needs fixing, the doctors, nurses, techs, are the line assembly workers trying to correct the defect(s). A good out come is the patient discharged with what ever ailment they came in with corrected to a reasonable extent, "You're fixed! Go home now." In nursing school we are taught various nursing theories but the one that has stuck with me is a caring model where the nurse relates to the patient as a person foremost. At the time, learning this theory seemed silly and a waste of time. However, when working on the medical surgical floor the patient, instead of a human being, becomes a complex set of problems and the nursing shift becomes a chaotic exercise in correcting the problems, putting out fires, leaving the unfixed problems to the next shift. The humanity of the patient is completely lost. When suffering, patients and families don't look for a pill. They look for understanding, connection, compassion. These things come from the nurse, the doctor, the house keeper, the lab tech, taking care of them.
3
I had a thyroidectomy at Yale New Haven in fall of 2012 and experienced an almost complete loss of my voice within a few days of surgery. The surgeon's office staff kept telling me something other than the surgery must have caused it and soon the surgeon left for a new position in another state. After a number of calls seeking help, they referred me to a Yale Laryngology specialist who promptly examined me and told me I had a paralyzed vocal cord and might never regain my voice, then simply left it at that. When I complained later in a survey and provided his name and asked to speak with someone about the incident, I never received a contact. Given this experience, I am skeptical of doctors' (and their office personnel) good intentions to allay patients' suffering.
5
Dear CBS,
You don't say if you regained your voice. I am sorry you had this happen to you. It is shameful that the people who treated you were so callous. I hope you have found a much better and more compassionate doctor for your condition if you still need it.
You don't say if you regained your voice. I am sorry you had this happen to you. It is shameful that the people who treated you were so callous. I hope you have found a much better and more compassionate doctor for your condition if you still need it.
2
It is a good article to read. Since we are focusing on the BUSINESS aspect of medicine, I see that most of the places quoted here are academic centers ( Harvard,Yale, Stanford..) where number of patients seen by a physician is not as critical as in community hospitals. We spend '5 minutes' on the patients not because we don't like to see patients or has to be done early and run to our wives. It is because we have to see 25 plus patients to stay in business. I will be very happy to see only 10-15 patients, spending 45 minutes with each patient.
3
The compassionate care I received in the Fortis Hospital in Kangra India could be a model for other medical facilities. The doctors checked on me several times a day, The hospital administrator took special interest in my condition. The nurses brushed my hair, massaged my back and sang devotional songs as they preformed their duties. I had MRIs and X-rays. The total cost for a two week stay for a fractured vertebrae was $1,700.
3
Healthcare spending in the U.S. totals about $3.8 trillion annually. 8% of that amount goes to pay providers, while 30% is consumed by administrative costs.
You would think that all of those administrators could figure out how to run hospitals so that doctors and nurses had sufficient time to care for their patients in the way they deserve to be cared for.
Instead, our healthcare system has devolved into a corporate-industrial model, in which management looks for ways to squeeze labor to do the work more "efficiently," by reducing staffing levels. This then necessitates the hiring of even more administrators to manage Press-Ganey surveys and provide "coaching" so that overworked, harried providers can continue to see maximum numbers of patients but employ slick marketing techniques to fool their patients into thinking that they are getting thoughtful, unhurried care.
You would think that all of those administrators could figure out how to run hospitals so that doctors and nurses had sufficient time to care for their patients in the way they deserve to be cared for.
Instead, our healthcare system has devolved into a corporate-industrial model, in which management looks for ways to squeeze labor to do the work more "efficiently," by reducing staffing levels. This then necessitates the hiring of even more administrators to manage Press-Ganey surveys and provide "coaching" so that overworked, harried providers can continue to see maximum numbers of patients but employ slick marketing techniques to fool their patients into thinking that they are getting thoughtful, unhurried care.
4
I am currently helping an elderly neighbor with Parkinson's disease. Her husband recently had a medical issue that has put him in a rehab facility. We go to see him daily and have lunch with him. He eats very little and has lost a lot of weight and strength. Here's my point. The food tastes terrible, so today I took some meatloaf and mashed potatoes for him to eat. He loved it. Why is it that the facilities must follow a dietary regime that is healthy, but not palatable? It's ok to die of starvation and the day by day increasing weakness, but God forbid they have some salt in their diets. It's like legal homicide. For crying out loud, he's in his 80's and just wants to come home, but he can't because he is too weak. Give the man some decent food and maybe he can do the physical therapy and get the heck out of there. Talk about suffering.
5
Good article--this stuff is so obvious that the real question is why medical personnel have neglected patient suffering for so long. By the way, the headline is hilarious: I expected to read that doctors intended to mitigate patient suffering by ignoring the patient! How about: "Doctors Strive to Avoid the Harm of Inattentive Care"
4
I couldn't quantify the suffering I experienced after major abdominal cancer surgery at City of Hope. Apparently pain management is just a couple of words, not a practice. I ended up sobbing in agony more than once. The head nurse told me to cut it out, as I was disturbing other patients. When I begged for my mother (I was 49), City of Hope called County mental health workers to have me committed to a mental hospital. (They failed.) Why not give me access to stronger pain relief, rather than a scolding and an effective incarceration? Think I cry as a hobby? I dread another surgery, if the nurses at City of Hope are any indication of the state of the art.
9
If it was so terrible- why don't you just forgoe the surgery next time? Perhaps a little gratitude for the doctors who took care of your cancer is in order
RFB: Apparently you have never experienced agonizing pain. I hope for your sake you do not. Your answer is beyond flippant. Perhaps a little compassion for the patient is in order.
3
I wished the Doctors, nurses and administrators at NYU had seen and implemented this minimize suffering piece. A successful quadruple bypass surgery had the usual post surgical patient monitoring where every three hours I was awakened for vitals. Real suffering was realized by me when my Ablation surgery was to be performed a month later, my on site Cardiologist rushed me to the E/R with Atrial Flutter and my MRSA was identified from my first long stay a month earlier. No infectious disease Doctor was assigned to me, my surgeons physician's assistants treated me for months with ineffective antibiotics that contributed to multiple soft tissue abscesses, one removed surgically. Nearly 7 months later I was readmitted to NYU to deal with a very painful devouring of the Clavical & Sternum joint by the still rampant MRSA. My MIDdecember surgery finally resulted in a Infectious disease Doctor assigned and an eight week regimen of a vacuum surgical dressing, a PICC inserted in my bicep for powerful antibiotics to be infused daily with negative side effects for my kidneys that required a quick change to a better antibiotic for me. Oral antibiotics have been prescribed now and at some point my much delayed Cardio PT can begin. This nine month process involved much suffering!
2
From my visits with physicians, especially in hospital was that if you blinked an eye, you missed it. We need more physicians, and to do that transform medical education and hoops to jump through to become an MD and of course insurance reimbursement that reward or don't reward based on specialty /or not, procedures vs time spending/sorting out planning/smaller procedures etc..
-not Renard..
-not Renard..
1
Inattentive care has its place.
In the wrong place it will get you a big fat tort lawsuit for negligence.
In the wrong place it will get you a big fat tort lawsuit for negligence.
1
I have often wondered about a number of the practices mentioned in this article.
One of the main sources of patient suffering is noisy rooms that prevent or interrupt sleep. I have always wondered why tests are done in the middle of the night, why particularly noisy patients are not cautioned , why loud - machines can't be silenced.
It is commendable that at last the viewpoint and superfluous sufferings of patients are being considered by the medical establishment. Common sense suggests this should have been done long ago.
I think of how too subconscious objections and criticisms have been held in abeyance all the years by most people who feel them. Perhaps most of us are just 'sheep' most of the time.
One of the main sources of patient suffering is noisy rooms that prevent or interrupt sleep. I have always wondered why tests are done in the middle of the night, why particularly noisy patients are not cautioned , why loud - machines can't be silenced.
It is commendable that at last the viewpoint and superfluous sufferings of patients are being considered by the medical establishment. Common sense suggests this should have been done long ago.
I think of how too subconscious objections and criticisms have been held in abeyance all the years by most people who feel them. Perhaps most of us are just 'sheep' most of the time.
2
Here are some reasons some tests may be done in the middle of the night:
1. They are urgent and cannot wait until morning.
2. The MRI, or CT scanner (or other equipment) has to be utilized 24/7 because they are so busy. Outpatient tests are often done during the day and inpatients at night.
3. The technician was out sick and another had to be called in and there is a huge backlog of tests ordered.
I was a technologist in hospitals for over 30 years. We hear all about doctors and nurses but little about diagnostic technologists who are also sometimes overworked. They are skilled and an important part of the team. Also, they can be either kind or callous regarding patient comfort. By the way, I object to the term "suffering" when what is meant is inconvenience. Some of the examples given here are of suffering but many are not.
1. They are urgent and cannot wait until morning.
2. The MRI, or CT scanner (or other equipment) has to be utilized 24/7 because they are so busy. Outpatient tests are often done during the day and inpatients at night.
3. The technician was out sick and another had to be called in and there is a huge backlog of tests ordered.
I was a technologist in hospitals for over 30 years. We hear all about doctors and nurses but little about diagnostic technologists who are also sometimes overworked. They are skilled and an important part of the team. Also, they can be either kind or callous regarding patient comfort. By the way, I object to the term "suffering" when what is meant is inconvenience. Some of the examples given here are of suffering but many are not.
1
Just reading this made me feel better.
1
And then, there is this:
http://archinte.jamanetwork.com/article.aspx?articleid=1108766
This peer-reviewed research article, published in Archives of Internal Medicine in 2012, was a prospective study of nearly 52,000 patient respondents to a medical care satisfaction survey, with 6 years of follow-up data. Conclusion? "In a nationally representative sample, higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality." Yes, that's right, the hospitals which catered more to patient creature comforts and avoided inconveniences like waking patients at night for vitals or triaging people according to illness severity (meaning that your 10/10 migraine is going to be a lesser priority than someone else's 8/10 heart attack), were more likely to kill you with kindness.
I'm not saying we shouldn't treat people with courtesy and decency at all times, but I am saying that some of the annoyances of hospitalization happen because we don't have infinite resources, or because hospital rules were made to protect the sickest patients, but which inconvenience those who are somewhat healthier.
http://archinte.jamanetwork.com/article.aspx?articleid=1108766
This peer-reviewed research article, published in Archives of Internal Medicine in 2012, was a prospective study of nearly 52,000 patient respondents to a medical care satisfaction survey, with 6 years of follow-up data. Conclusion? "In a nationally representative sample, higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality." Yes, that's right, the hospitals which catered more to patient creature comforts and avoided inconveniences like waking patients at night for vitals or triaging people according to illness severity (meaning that your 10/10 migraine is going to be a lesser priority than someone else's 8/10 heart attack), were more likely to kill you with kindness.
I'm not saying we shouldn't treat people with courtesy and decency at all times, but I am saying that some of the annoyances of hospitalization happen because we don't have infinite resources, or because hospital rules were made to protect the sickest patients, but which inconvenience those who are somewhat healthier.
5
That article has been roundly discredited. The authors measured the experiences of patients across all providers over the course of 12 months and outcomes years later. Improving the patient experience does not kill patients.
4
Brian, it depends on how you improve the patient experience. If you don't take vital signs in potentially unstable patients at night because they prefer to sleep, or you provide extra-attentive nursing care to the patient whose family is most demanding instead of the one who is sickest, then indeed you are biasing outcomes negatively in order to improve patient satisfaction survey results. A similar problem exists in the world of academia- professors who are easy graders, and those who water down their material to appear more approachable routinely get rated higher by students, but objective testing shows that some less popular professors frequently achieve greater learning.
1
Stanford......not true about how they are working to mitigate suffering. My husband was a patient in the last 3 weeks for 5 days. He was so sleep deprived, between the multiple blood draws and vitals, either his demented roommate kept him awake or the snoring, or the noise on the unit. He could not wait to leave. Before you say well he could leave, yes, but these are basic go getting well. Sleep.
Dr. Amir, as a 5 year cancer patient you are failing at the stated goal.
Dr. Amir, as a 5 year cancer patient you are failing at the stated goal.
5
If he is so unhappy with the medical treatment, why doesn't he leave and go home? Is someone actually forcing him to be in the hospital? If he is there voluntarily, he can go home if the care is so awful. Sounds like being "sleep deprived" is probably the least of his problems- but people like you seem to thing that a hospital is a hotel which should have service and amenities, rather that somewhere that saves peoples' lives
REally- the doctor is failing at his stated goal? How long would you have survived without cancer treatment?
People who are healthy enough to be at home, even just barely healthy enough, are generally not allowed to stay in the hospital. So, you are saying if one is very ill and doesn't like the care, just go home and die?
The problem of inattentiveness by doctors and nurses also is experienced in some so-called private practices. Lack of communication, 3-minute MD check-ups, and waiting.
The problem as I see after the poisoning (aka chemo) is that providers (docs and nurses) think and behave as though YOU the patient is beholden to them. So, you can wait, you don't need to be told services are running behind, docs can spend 3 minutes and keep their eyes on their computers.
I HIRE these providers to do a service for me. I am their "boss", and for what I've just experienced, I'd NEVER refer a patient to the practice I've gone to these past 5 months. I get better care for my car than I do for me body.
It's health BUSINESS, no "care" provided -- in hospitals and in private practices. Not all, but too many w/in the USA.
The problem as I see after the poisoning (aka chemo) is that providers (docs and nurses) think and behave as though YOU the patient is beholden to them. So, you can wait, you don't need to be told services are running behind, docs can spend 3 minutes and keep their eyes on their computers.
I HIRE these providers to do a service for me. I am their "boss", and for what I've just experienced, I'd NEVER refer a patient to the practice I've gone to these past 5 months. I get better care for my car than I do for me body.
It's health BUSINESS, no "care" provided -- in hospitals and in private practices. Not all, but too many w/in the USA.
12
I think this is a profound oversimplification. I strongly doubt any of your providers forget even for a moment that they are there to serve you. The problem is that they are also there to serve others - who have similar needs to yours. In medicine we have struggled to solve the problem where a patient needs more time than expected - which leads to a delay for everyone else who needs to be seen. In another industry, you can tell the client their time for their appointment is up - but that doesn't seem to fly in medicine. Your providers are not trying to run behind but they are unable to walk out on another patient who is in need. You can and should fault them for this but don't misconstrue this.
7
It's almost amusing if not so dysfunctional, that the medical profession has not really been interested in listening to their clients. When ill, people are vulnerable, fragile and need support. Is that not obvious? Another issue is communication both with patients and across specialties. The human body is so complex-a very integrated system. But medical professionals are very segmented and uncoordinated. If doctors have trouble speaking with clients, they are even worse at consulting with each other!
7
Health care needs to be redesigned from the ground up. Today's model is "all about the doctors". It has little to do with patient experience.
To wit, the NYT finds it interesting that a physician in a prestigious medical center takes the time to talk to patients about their "experience". In what other sector or industry would this be considered noteworthy?
I witnessed the most atrocious, callous care imaginable, when a close friend, near death, became a "teaching case" at a top ranked health system nationally. He had 5 consultant clinic specialists--- all talking about lab and other diagnostic test values, but not about death and dying.
As for patient satisfaction, what a joke. We saw the posters aimed at health employees with the "Shush..." sign for silence to remind staff of the patient desire for quiet (and the fact that the question is on the standard Medicare patient satisfaction survey). Meanwhile, a jackhammer was creating a nursing station right outside the patient's door.
The other patient in the semi private room had an extended family party, including infants, while my friend was dying. The hospital refused our request for a different room. The health system CEO is rewarded in compensation at >$2M per year. I doubt that patient satisfaction has anything to do with his job evaluation or bonus. Instead, such execs are highly compensated for vertical and horizontal consolidation, to create unaccountable health system cartels to raise prices!
To wit, the NYT finds it interesting that a physician in a prestigious medical center takes the time to talk to patients about their "experience". In what other sector or industry would this be considered noteworthy?
I witnessed the most atrocious, callous care imaginable, when a close friend, near death, became a "teaching case" at a top ranked health system nationally. He had 5 consultant clinic specialists--- all talking about lab and other diagnostic test values, but not about death and dying.
As for patient satisfaction, what a joke. We saw the posters aimed at health employees with the "Shush..." sign for silence to remind staff of the patient desire for quiet (and the fact that the question is on the standard Medicare patient satisfaction survey). Meanwhile, a jackhammer was creating a nursing station right outside the patient's door.
The other patient in the semi private room had an extended family party, including infants, while my friend was dying. The hospital refused our request for a different room. The health system CEO is rewarded in compensation at >$2M per year. I doubt that patient satisfaction has anything to do with his job evaluation or bonus. Instead, such execs are highly compensated for vertical and horizontal consolidation, to create unaccountable health system cartels to raise prices!
16
You are mistaken today's healthcare in USA is about the financial office, about making money for the Hospitals and the Insurance Companies. Doctors and all other providers of actual care are used by administration with little or no regard or respect.
7
I remember being hugely pregnant, past my due date, horribly uncomfortable and a young male doctor said to me "Wow, I've never seen such bad stretch marks before." My husband punched him in the chest and told him he was a idiot. Put that in your survey!
27
My mother was recently hospitalized because she shattered her hip bone in a fall, and the experience there was enlightening. It took two days for her hip replacement surgery to happen, many hours after it was supposed to take place. She was in a lot of pain the entire time, and our questions as to when the surgery would actually take place were met with speculation on the part of the nurses, since no one actually knew. Her release was no different.
My mother was constantly woken up by the intercom requesting a nurse's presence in another room. When she wanted to go for a walk with the walker, she couldn't, because all of the walkers were locked in a closet for the evening and the people who had keys had gone home.
The worst part was the overwhelming vibe of stress and unhappiness. The patients were unhappy, the workers were stressed, the visitors were worried. The feeling of misery seemed to permeate every room and hallway. I got depressed just visiting her.
All of this reminded me of something I went through: getting arrested during the Republican National Convention in New York City in 2004. Being shuffled along in a process with no communication as to when I might get a phone call, a lawyer, or an arraignment; dealing with corrections officers who were as stressed and seemingly uninformed as the people on the other side of the bars, unappetizing food, and the miserable atmosphere were all the same.
A hospital shouldn't feel like Central Booking.
My mother was constantly woken up by the intercom requesting a nurse's presence in another room. When she wanted to go for a walk with the walker, she couldn't, because all of the walkers were locked in a closet for the evening and the people who had keys had gone home.
The worst part was the overwhelming vibe of stress and unhappiness. The patients were unhappy, the workers were stressed, the visitors were worried. The feeling of misery seemed to permeate every room and hallway. I got depressed just visiting her.
All of this reminded me of something I went through: getting arrested during the Republican National Convention in New York City in 2004. Being shuffled along in a process with no communication as to when I might get a phone call, a lawyer, or an arraignment; dealing with corrections officers who were as stressed and seemingly uninformed as the people on the other side of the bars, unappetizing food, and the miserable atmosphere were all the same.
A hospital shouldn't feel like Central Booking.
23
Perhaps you might want to name that hospital to help those choosing where to go. I am so sorry for all the unnecessary suffering your mother endured.
3
All my life I've found that when I'm ill, sleep is immensely healing. But when I had a major operation a few years ago, the hospital made sure that no one could sleep
(nurses' conversations in front of sleeping patients when the same conversation could have taken place elsewhere, televisions blaring 24/7 with no patient control, reacting to requests for less noise with contempt, etc.). I could not sleep for the entire 96 hours I was there.
(nurses' conversations in front of sleeping patients when the same conversation could have taken place elsewhere, televisions blaring 24/7 with no patient control, reacting to requests for less noise with contempt, etc.). I could not sleep for the entire 96 hours I was there.
11
And now every doctor can learn a great deal more by reading these comments. It is amazing how lacking in empathy and imagination these doctors seem to be. I guess it is the luck of the draw for patients - if they accidentally choose a doctor with a great personality, a sense of humor they probably have a better chance of recovery or faster recovery but if they get an old sour puss the reverse is probably true. My god, it's almost like the campaign to get Paris cabdrivers to smile for tourists. It worked.
2
One problem with polls:
I, a retired Ph.D. with relevant medical experience, was so angry at my repeated mistreatment in a "highly-rated" hospital in downtown Hendersonville, N.C., that I could not even put up with filling out the survey provided me.
Not even weeks later. Indeed, the repeated bad treatment still leaves me fuming. And it has changed my opinion of hospitals 180 degrees.
I, a retired Ph.D. with relevant medical experience, was so angry at my repeated mistreatment in a "highly-rated" hospital in downtown Hendersonville, N.C., that I could not even put up with filling out the survey provided me.
Not even weeks later. Indeed, the repeated bad treatment still leaves me fuming. And it has changed my opinion of hospitals 180 degrees.
12
you allow repeated bad experiences at 1 hospital change your opinion not of that hospital but of hospitals... You shouldn't have opened with that PhD.
My aged parents-late 80s-have a cardiologist who routinely makes them wait in an uncomfortable crowded waiting room for three or more hours before he sees them. My cousin takes her much more frail and infirm parents to the same doctor and gets the same treatment (my uncle is in a wheelchair and incontinent). A three hour wait plus a battery of tests turns this into a five or six hour abusive ordeal that is the height of medical arrogance. In the age of cell phones there is no reason for anyone, much less a frail elder, to wait three hours to see a doctor.
23
So go to another doctor. It's the same everywhere. The problem here is that you think that doctor " routinely makes them wait in an uncomfortable crowded waiting room for three or more hours before he sees them".
It's completely ridiculous. You obviously have no understanding at all of how the health care system works.
Go to another doctor and see if it's better.
It's completely ridiculous. You obviously have no understanding at all of how the health care system works.
Go to another doctor and see if it's better.
5
Time to change doctors!
1
I agree - patients should find providers they want to see!
As a registered nurse with 37 years experience in hospital nursing I learned early on that you can not teach empathy. Any care giver...nurse, doctor, assistant, dietary worker, housekeeping etc that can show empathy is often the person the patient remembers from their hospital stay.
Nurses are caring for the patient for eight hours or more....doctors see them for around five minutes. Yet, this article emphasizes the doctor's "awakening" when they see comments left by patients. Time for medical schools to teach "bedside manners" with an emphasis on actually understanding a patient's stress and suffering, which began as soon as they were admitted to a hospital.
Nurses are caring for the patient for eight hours or more....doctors see them for around five minutes. Yet, this article emphasizes the doctor's "awakening" when they see comments left by patients. Time for medical schools to teach "bedside manners" with an emphasis on actually understanding a patient's stress and suffering, which began as soon as they were admitted to a hospital.
19
Janus, this is distressing to hear from a nurse who has as much experience as you have. That is a very pithy remark about the 5mins and indeed you should know better. You should know exactly what those physicians are doing when they are not at the bedside. The comment on empathy is a strange one - particularly that you would focus it on physicians alone. You are right that empathy is likely hard to teach. But you should appreciate the barriers to spending more time at the bedside. You have the luxury for caring for a panel of 4 to 6 patients - your physicians do not.
2
Once again, nurses know everything, doctors know nothing. Nurses are there to protect the patients from the unfeeling, uncaring doctors who don't care if they do the patient harm, and all they care about is money and feeding their egos?
Right? What a joke. If you are truly a nurse you should know better.
Right? What a joke. If you are truly a nurse you should know better.
1
There seem to be a number of comments from nurses blaming this all on doctors, but during both of my maternity stays, it was the nurses who pushed the middle of the night blood pressure checks, baby weight checks, etc. In fact, when I asked when things couldn't wait until morning I was told that nursing staff needed to do x number of checks during their shift. My doctors had nothing to do with it, although hospital policy probably did. By the second kid (a speedy, uncomplicated delivery), I told the nursing staff that they were not to come into my room before 6 am (baby was rooming in) unless they could get the doctor on the phone and explain why these checks couldn't wait until morning. Suddenly the charge nurse was willing to forego the late night/early morning checks (who wants to wake a doctor who has finally gone home after delivering babies for the last 24 hours), demonstrating just how unnecessary these checks were. I had some great nurses during my deliveries and recovery but I also had some truly terrible care (a woman who told me (incorrectly) I couldn't breastfeed my baby due to a medication they had given me during the labor; another woman who refused to help me shower when I finally reached my recovery room after almost 48 hours in blood and birth fluids because she just couldn't be bothered). An uncaring nurse can do a lot of damage.
4
A recent stay in a local hospital led me to two conclusions... (1) The staff was VERY caring and capable.... (2) The COMMUNICATION between the staff members (ranging from nurses aides thru MDs) concerning my case ranged from very poor to non-existent. Numerous instances of the lack of knowledge of ordered actions either already taken or yet to do depended on my reminder.
Often annoying and occasionally somewhat scary.
Often annoying and occasionally somewhat scary.
8
Wanna reduce patient suffering? Has anybody experienced the "death by billing" that is very prevalent in the US after any hospital admission? How about if the hospital stop harassing patients with never ending itemized bills for overpriced services and supplies that the average patient will continue to receive month after month following a hospital stay? Somebody has to pay for those oversized CEO and MD paychecks not to speak of the debt that those students incur going through Medical School.
5
Big pay checks - At least the doctors have spent years training - and those student debts! But the CEOs - the pay differential for these folks is enormous - they take home millions and most have not spent those years in medical training as they are not doctors. The higher reaches of the admin have the real inflated and unjustified pay checks.
15
Even if the bills made sense this would be a problem, but they don't. Even the simplest visit to the ER generates volumes of inconsistent paperwork, requests for the same information over and over again, and in one recent case, a call from a lawyer that another employee said it was OK to ignore. Huh?
3
Nurses are not the angels of the medical field, and just as many nurses can fall prey to the mentality of monotony or just as Doctors suffer from "god complex" failures, so too nurses are just as human, so listening to nurses is not the 100% cure for the problem, though it does help and they do need to listen to nurses.
you cannot listen to a patient, or apply your focus to them to properly diagnose or prescribe, if you only spend ten minutes with each one and then rush them out of the office with "let's see what happens till next visit" theories.
Now it "is" true that the individual nurses who "know" these doctors can often be more informative to the patient than the doctor is, for they already know the individual inequities of each doctor and their falling and failings.
Doctors have proven there is a need for some form of control over their mentality and practice, for once they get their freedom and license, they pretty much rule their practice by will and whim. If they develop a god complex, and an ego that prevents them from listening to a patient, from diagnosing and treating them properly, they need therapy themselves and trained, re-training to allow for more concern and compassion for their patients, or it just stays a huge meat grinder that it has become, all at the hands of profit minded health industries and doctors far too willing to simply follow along with them.
you cannot listen to a patient, or apply your focus to them to properly diagnose or prescribe, if you only spend ten minutes with each one and then rush them out of the office with "let's see what happens till next visit" theories.
Now it "is" true that the individual nurses who "know" these doctors can often be more informative to the patient than the doctor is, for they already know the individual inequities of each doctor and their falling and failings.
Doctors have proven there is a need for some form of control over their mentality and practice, for once they get their freedom and license, they pretty much rule their practice by will and whim. If they develop a god complex, and an ego that prevents them from listening to a patient, from diagnosing and treating them properly, they need therapy themselves and trained, re-training to allow for more concern and compassion for their patients, or it just stays a huge meat grinder that it has become, all at the hands of profit minded health industries and doctors far too willing to simply follow along with them.
2
Having worked as a medical social worker for the past 4 years I have witnessed the degree that suffering is not addressed by the medical field and the subsequent costs, emotional, physical, and financial, to the individual and society as a whole. The field of Palliative Care has been growing since evidenced based studies have begun to show how suffering impacts overall health and the ability to heal, however, addressing suffering should not be left to one field of medicine. Anyone interested in gaining an understanding of how to address the broad category of "reducing suffering" should refer to the work of Harvey Max Chochinov, M.D., and the Dignity in Care Program out of the Manitoba Palliative Care Research Unit. http://www.dignityincare.ca/en/toolkit.html
Readings and tools are available on their website. It can start with the Patient Dignity Question, "What do I need to know about you as a person to give you the best care possible."
Readings and tools are available on their website. It can start with the Patient Dignity Question, "What do I need to know about you as a person to give you the best care possible."
6
So, according to you social workers like you are the most caring individuals a patient may be lucky to meet and the remedy to the current problems in healthcare?
2
Alberto- of course. Social workers and nurses exist to protect the poor patients from the unfeeling, uncaring doctors who care about nothing but their incomes and inflating their egos. Patients are so lucky to have them to protect them from the doctors!
1
It isn't that doctors uniformly don't care. Many do. But if you need something practical, like help to the bathroom, securing a wheelchair through Medicare, or someone to listen to your frustrations about your illness, you will be much more likely to receive those kinds of things from a social worker or a nurse than from a doctor. If a social worker or nurse points out that some doctors come across as uncaring (and they do) I don't understand why people jump all over them.
1
Syntax alert! Most misleading headline I've ever seen in the New York Times!
16
That's an interesting headline. Try it this way, "By Inattentive Care, Doctors Strive to Do Less Harm." At first glance, that's what I thought it meant. Tom, letter below, seems to have taken it that way -- if the doctors pay no attention, patients are likely to be harmed less. How about something like "By Paying More Attention, Doctors Reduce Patient Suffering"?
11
Well, in 1977 there was a doctors' strike in L.A. County Hospital. The death rate at the hospital plummeted during the strike.
We have recently been put through living hell due to doctors interjecting their personal opinions. and/or not following through with other doctors who place orders in ER. Nurses seemingly control these doctors by second guessing doctors orders delaying medication arrival times, tests and even meals.Doctors don't care it is less material they have to study. Files are open to everyone. Infections rates are out of sight patient almost had leg amputated after visiting er 4 times 3 months continually losing motor abilities, and were turned away.. doc doing nothing just wanting us released and put on fast track to wait another 4 months! By then no legs! As far as privacy you have absolutely none! Due to the errors we have been put through it makes me really question health care and the lack of good intelligent compassionate doctors. Then you get into pharmacuticals and medical equipment and start realizing doctors are the ones with the stock in pharmacuticals and they have absolutely no need or want to solve patients medical issues just keep writing those drug scripts they get a kick back from. Our experience made us start eating veggies, plants and brown rice, taking one baby aspirin a day and no sugar! It is a shame when a young person feels invisible and is treated worse than an abused animal, wanting to depart this insensitive non caring world. Docs are not on our agenda and we are doing everything in order to stay healthy away from infection city.NO PRIVACY
1
Your room can never be quiet if there is another patient and his or her doctors vistors etc. Its hard enough to be sick enough to be hopsitalized, why isnt every room a single room.
6
The current cost to remodel an ICU room for example is close to a million dollars. If our currently financially challenged hospitals undertook such an initiative it would be prohibitive from a cost perspective.
2
I work for a prominent NYC hospital in the Patient Centered Care department. we work with Press Ganey to collect patient satisfaction data and we review the patient comments daily. The survey asks questions about the entire visit from admission and discharge info to nurses and physicians.
All of the patient feedback is taken seriously and it helps us improve the patient experience. We report scores and comments on a regular basis.
There is absolutely more work to be done, and i'm glad to see that these efforts are being recognized.
All of the patient feedback is taken seriously and it helps us improve the patient experience. We report scores and comments on a regular basis.
There is absolutely more work to be done, and i'm glad to see that these efforts are being recognized.
1
In my experience, as the child of a patient, and the person who filled out the Press Ganey questionnaires sent on behalf of NY Presbyterian, they don't begin to ask the right questions and give you only a tiny box to raise anything else. For instance, they ask tons of questions about whether the person who mopped the floor was courteous or whether the person who wheeled you to a test smiled, but offer no questions that would give you a chance to explain instances of gross incompetence (like having to fight to get someone to not give you a shot that was destined for someone else, not you, but the person giving the shot doesn't read ID bracelets).
12
Your department is a perfect example of the waste of resources in health care. Your "Patient Centered Care Department" should be shut down and the resources put to actual health care use, rather than the salaries of people like yourself, survey costs, and office supplies.
6
One other thing I would say about the Press Ganey questionnaires sent out on behalf of Ny Presbyterian (or at least the ones I filled out) is that although they tell you they are anonymous (unless you want to identify yourself) they are not truly anonymous unless you turn them over and see the spot on the edge of the page where they have printed the patient's ID number and, as I recall, date of admission or discharge. I tore this bit off before I returned them to make sure they really were anonymous. Frankly, I think being a bit more transparent would go a long way toward improving patient/hospital relations.
Would also like to say I found the Press Ganey questionnaires sent out on behalf of Calvary HOspital, in the Bronx, much more useful and transparent. They actually asked questions that related to things that would seriously impact the hospital experience/patient care. But Calvary is such a well-run place they almost didn't need to do this. They were so responsive and transparent, it would have been extremely unlikely that a problem would not have been disclosed until after discharge (or, in this case, death). I know it meant something to my mother to have some control over the last days of her life (i.e., to feel free to call the head of nursing if there was a problem and to actually get a response, to have people discuss things with her rather than automatically assume they needed to ignore her and talk to me, etc.)
Would also like to say I found the Press Ganey questionnaires sent out on behalf of Calvary HOspital, in the Bronx, much more useful and transparent. They actually asked questions that related to things that would seriously impact the hospital experience/patient care. But Calvary is such a well-run place they almost didn't need to do this. They were so responsive and transparent, it would have been extremely unlikely that a problem would not have been disclosed until after discharge (or, in this case, death). I know it meant something to my mother to have some control over the last days of her life (i.e., to feel free to call the head of nursing if there was a problem and to actually get a response, to have people discuss things with her rather than automatically assume they needed to ignore her and talk to me, etc.)
1
Thank goodness they are finally paying some attention. I remember being sent home from the hospital before I should have been because "you can't sleep well here with all the noise." Nurses laughing all night, radios on, interruptions, you name it.
5
Do physicians treat patients differently according to education? In terms of giving care, we know that articulate, educated patients receive, perhaps because they demand, better care.
Still, physicians often treat all patients as having a low to mediocre appreciation of data and analysis. The patient as partner in care is frustrated as the patient does not have ready access to all charted data. Data is filtered.
Still, physicians often treat all patients as having a low to mediocre appreciation of data and analysis. The patient as partner in care is frustrated as the patient does not have ready access to all charted data. Data is filtered.
2
Patients have the right to request access to their medical records. So what's the problem? They can feel free to keep copies of all of their records and bring them on office visits.
2
My doctor is so thoughtful and polite he often asks me if I want this or that test. I finally realized I need to tell him to please say if he recommends it, if he does. I have learned that when I follow his suggestions, things go much better. When asked if I want a certain medication (like for pain) or a test, I almost never want it! Later, I find out he was right and I should have done it. The relationship may be unusual but he is very unique and smart. I always feel listened to and respected and I believe that so do his other patients. Almost my entire family now goes to this doctor and we all trust and respect him.
Quite possibly the most stupid, misleading headline I have ever seen in the New York Times. "Inattentive" is not the point. Try "considerate."
6
Doctors should wear masks when they visit the bedside if they have a cold.
My father, who had COPD could not be around anyone with a cold, because for him it would mean bronchitis or pneumonia. We would make him wear a mask if he went to a doctor's office so he would not contract anything. But we could not protect dad from his primary doctor when he sat on his bed and examined him at the hospital--all the while sneezing and coughing. Shortly thereafter my dad had bronchitis, and we knew the source.
I once asked a nurse why they don't wear masks when they are sick, and her reply was that it makes patients uncomfortable. I think that is just ridiculous. No one who is hospitalized needs a cold on top of what they already have.
My father, who had COPD could not be around anyone with a cold, because for him it would mean bronchitis or pneumonia. We would make him wear a mask if he went to a doctor's office so he would not contract anything. But we could not protect dad from his primary doctor when he sat on his bed and examined him at the hospital--all the while sneezing and coughing. Shortly thereafter my dad had bronchitis, and we knew the source.
I once asked a nurse why they don't wear masks when they are sick, and her reply was that it makes patients uncomfortable. I think that is just ridiculous. No one who is hospitalized needs a cold on top of what they already have.
4
In my experience, it is children's hospitals who are least concerned with patient suffering. They know the patients haven't any say in being there, and that usually the parents don't either. The doctors know their diagnoses and recommendations carry very nearly the force of law, because if a parent decides not to follow them, they could lose their child to the state for medical neglect.
So they don't worry over the suffering child. I know. My son had two bone marrow transplants as a child. Only the nurses cared about his suffering. The doctors acted as if the suffering was necessary as some Puritanical proof that my son was worthy of their care.
I remember going into his room late one afternoon after work to pick up my night shift of providing care. He'd had a nose bleed since about six am. The room looked like a bad slasher movie. Blood was everywhere. Why wouldn't it quit? Because he had no platelets. Why didn't he have any platelets? Because that's an expected condition of bone marrow transplant patients. Why wasn't he provided any platelets? Because, the doctor said, the hospital was low on them. I was flabbergasted. Nobody told us the hospital was low. I could have gotten him a hundred donations within the day. Instead, he just let my child bleed in misery.
That was just one instance of many. Medical care should be directed at relieving suffering, not imposing it, but that wasn't my experience with my son through two bone marrow transplants.
So they don't worry over the suffering child. I know. My son had two bone marrow transplants as a child. Only the nurses cared about his suffering. The doctors acted as if the suffering was necessary as some Puritanical proof that my son was worthy of their care.
I remember going into his room late one afternoon after work to pick up my night shift of providing care. He'd had a nose bleed since about six am. The room looked like a bad slasher movie. Blood was everywhere. Why wouldn't it quit? Because he had no platelets. Why didn't he have any platelets? Because that's an expected condition of bone marrow transplant patients. Why wasn't he provided any platelets? Because, the doctor said, the hospital was low on them. I was flabbergasted. Nobody told us the hospital was low. I could have gotten him a hundred donations within the day. Instead, he just let my child bleed in misery.
That was just one instance of many. Medical care should be directed at relieving suffering, not imposing it, but that wasn't my experience with my son through two bone marrow transplants.
11
Tell me about it.
I have been wrestling with a seemingly minor records issue with my NYU Langone-affiliated primary care practice for several months that has me so distressed I am thinking of leaving the city, if not the country.
When I had an "annual physical" last summer (what I recall as 15 minutes of weighing & blood work, during which time the doc mostly had her back to me), to juice up the bill the doctor or one of her minions threw in all sorts of stuff that couldn't possibly have been done on me since I am a woman (all my life) and have no need for things like PSA tests. After Medicare basically denied all of this and I received the bill I looked at it and asked them to take off these things, as I was particularly concerned about inaccurate records. The firm's position, since like October, as been "it doesn't matter what's on the bill, since Medicare wouldn't pay anything anyway, so you still owe us that amount of money."
They don't seem to understand that(1) people like to receive accurate itemized bills of services they have actually received and (2) some people, like me, really worry about the effect of inaccurate electronic records. Just today, when I once again tried to insist to the practice's director of finances that I don't want inaccurate medical records, he whined that accuracy would require a manual override!
This is so stressful and seems so unnecessary.
I have been wrestling with a seemingly minor records issue with my NYU Langone-affiliated primary care practice for several months that has me so distressed I am thinking of leaving the city, if not the country.
When I had an "annual physical" last summer (what I recall as 15 minutes of weighing & blood work, during which time the doc mostly had her back to me), to juice up the bill the doctor or one of her minions threw in all sorts of stuff that couldn't possibly have been done on me since I am a woman (all my life) and have no need for things like PSA tests. After Medicare basically denied all of this and I received the bill I looked at it and asked them to take off these things, as I was particularly concerned about inaccurate records. The firm's position, since like October, as been "it doesn't matter what's on the bill, since Medicare wouldn't pay anything anyway, so you still owe us that amount of money."
They don't seem to understand that(1) people like to receive accurate itemized bills of services they have actually received and (2) some people, like me, really worry about the effect of inaccurate electronic records. Just today, when I once again tried to insist to the practice's director of finances that I don't want inaccurate medical records, he whined that accuracy would require a manual override!
This is so stressful and seems so unnecessary.
12
You need to call them up and say you will report the situation to the appropriate state insurance authorities unless the situation is resolved. It will work.
4
I have Stage IV endometrial cancer and am currently being treated at the Mayo Clinic. When I chose Mayo, I naively expected the best treatment in the world. I was so wrong. My surgeon was a bright young woman whose favorite phrase was "But, this is what all my patients do." It didn't matter what I was protesting...including a drug to which I was allergic...she quickly retorted with her favorite phrase. My oncologist is a bright young man whom I believe must have skipped medical school on the day they taught compassion. I suffered horribly as a result of side effects from a new drug prescribed for me. The side effects are less common, according to the literature less than 11% of patients reported the side effects I did, but none the less, I suffered terribly from overwhelming anxiety, depression and suicial thoughts. When I called for assistance, the nurse's first words were, "How odd." When the oncologist called me back, he left a message and said, "I understand you are struggling a bit. I don't have any answers for you. But call if you have questions." Clearly the message at Mayo is...be the standard patient and we'll be able to treat you just fine. Otherwise, don't count on it. The state of health care today is beyond appalling!
16
So sorry for what you are going through. One thing to keep in mind with young doctors is many have been coached their whole lives -- coached for the SATs, coached for MCATs, coached to get good grades, probably coached to get good residencies, so is very difficult who good or bad they really are until they are out there in the real world.
5
Are you asking for the gravely ill patient to have compassion for the young doctor?
1
My wife had a shunt set in her brain last July to correct a hydrocephalus condition. The condition has lasted a long time --- and its diagnosis was missed by the "best" doctors --- until we found "better" ones. In the process of the surgery and rehabilitation therapy that followed --- I learned how physicians and nurses at Mount Sinai in Manhattan listened carefully to me and to my wife. I was surprised to be declared a "credible witness" regarding my wife's condition and rehabilitation. I was ignored by other doctors who just would not listen to me. And I am not a "screamer" --- or a person who imparts incorrect, false or imprecise information. This article only scratches the surface of what can and should be the protocols for communication with physicians. "Lack of communication" does not begin to describe the frustration I encountered --- until I found knowledgeable doctors --- and nurses --- who not only listened to me --- but followed-up and helped my wife reach a much higher level of function. And to answer what may be lingering --- "No!" --- we did not institute any lawsuit primarily because the cognitive issues attendant to hydrocephalus remain a medical issue --- and we did not want to endure the rigors of a civil suit and its "discovery" process --- although in laymen's perception --- there were/are doctors who just "missed" the diagnosis --- or maybe ignored it. The surgery at Sinai and the follow-up has achieved great progress. And the communication continues.
9
You were lucky. There are serious neglect errors, and poor outcomes not only at Mt. Sinai Hospital, but also at Columbia Presbyterian, NYU Hospital, and other "best" hospitals. Careful doctors are the minority. And most of those financially successful "best" hospitals are focused first on money, and second on money. In my experience patients come in fourth or fifth place after money, inflated egos, covering their backs, and the pleasing of favorites.
6
Fifteen years ago, my late mother began chemotherapy treatments that put her cancer into remission, but left her in constant, excruciating pain. Technically, the treatments saved her life, but made her WANT to die. If anyone had asked her, "Did our treatments make your life better", I know what the answer would have been.
6
William Hurt's movie "The Doctor" already documents much of the corrupt thinking that underlies what this article describes. The movie is about a doctor who becomes a patient a sees things from the other side. One memorable line from the movie is: "It talks!" he exclaims from his bedside.
4
The root cause of inattentive care is that some years back, the accountants took over medical practices -- so many patients per day; so many minutes per patient. A good follow up to this piece would be one about the economics of medicine. And surely insurance companies would be a key thread in that multi-layered saga.
20
That is exactly correct
4
Suffering? How about receiving the hospital bills, doctor bills, Pharma bills, etc. a month after my operation.
7
Years ago, a day after returning home from a hospitalization, I received a very irate call from the admin assistant to my specialist. She accused me of keeping a reimbursement check that my insurance company had sent to me by mistake. I had actually returned that check through the mail - it was already enroute to the office. She acted like I had committed some felony. It was completely the fault of the insurance company. She was really, really nasty. On the other hand, so was her boss. He was one of the worse - and totally useless in my treatment. I was very glad to be rid of the both of them - they deserved each other.
4
Wow. Lots of comments on this one. Must have hit a nerve with all of us who have actually been patients and suffered through the non-treatment given us by those who are supposed to be caring for our welfare.
Perhaps if we had 'names' instead of numbers and faceless faces, we'd be treated better. Or maybe we should be morph into a 'smart phone'; at least those 'caring' for us would acknowledge we exist.
Perhaps if we had 'names' instead of numbers and faceless faces, we'd be treated better. Or maybe we should be morph into a 'smart phone'; at least those 'caring' for us would acknowledge we exist.
7
Most of patients' discomfort is caused by poor bedside manners and lack of thoughtfull care. The idea of wakening the attending for blood work done at unusual hours, a prior measure of good quality by most programs' standards, is brilliant. But the honeymoon of good ratings will be over soon. Doctors' rating for comfort and suffering management will be easily manipulated by VIPs, real or imagined, drug seekers, psychopaths or just misled patients at the expense of other patients and eventually the quality of care.
1
Granted, inattentive care might do less harm; but are the doctors really trying it, or just loafing?
1
The day after surgery I had an early-morning blood-draw that was actually helpful to both me and the lab tech. Things were not so hectic that early. I told her lymph nodes had been removed on the right, so maybe for now she'd want to draw blood on the other side. She was glad I'd spoken up and told me it was not just for now, it was for always. No more IV or blood draws from the left arm. Then she said "Wow, I actually taught someone something today". I think she was genuinely pleased. No one ever bothered to tell me about that restriction again. I would never have known.
If teaching/learning moments have to come in the quiet before dawn, I'll take it. Too often in the busy daylight, the patient is treated as an inconvenient vessel for his disease, never engaged or even spoken to.
If teaching/learning moments have to come in the quiet before dawn, I'll take it. Too often in the busy daylight, the patient is treated as an inconvenient vessel for his disease, never engaged or even spoken to.
10
First quick thought - I have a friend my age, early 70's, who is prominent pediatric specialist well known locally and around the world. Her husband was recently hospitalized at one of these world class Boston area hospitals with a serious problem in the same organ/body system in which she is an expert with children. She found his care erratic, sometimes inappropriate, the house staff brusque and not paying close attention. She said to one of his doctors that there was an issue with some lab values and his treatment. The doctor, surely half her age, said "Aren't you a wife first?" As though a doctor is supposed to leave her brain at the door….
My friend told me she was thinking of writing a book on medical arrogance. Knowing her, if she does write such a book it will be smart, well written, and to the point.
My friend told me she was thinking of writing a book on medical arrogance. Knowing her, if she does write such a book it will be smart, well written, and to the point.
31
I hope at least one person learns from this comment that the most famous and successful hospitals owe a very large part of their reputation to the money making abilities and to the marketing and advertising, and that just a humble fraction is due to actual great care by a few conscientious staff members.
8
When I had a hip replaced, I had virtually no pain after surgery or any time thereafter, so I generally turned down the nurse's suggestions that I take pain medication. But at midnight on the first night after surgery, she told me that if I didn't take it, I wouldn't be able to sleep. Boy, was she right, not because of pain, but because of the constant sleep interruptions, the interminable alarm on the saline solution intravenous line, the intercom calling for staff, the noise of the ankle cuffs, the lab work wake-ups, etc. The next two nights, I took her advice and took a strong pain medication that I didn't really need, just to get some sleep. Unnecessary suffering indeed!
9
I have been practicing medicine for forty years. And have been a patient plenty. The major cause of "inattentive care," at least in the outpatient settings with which I'm familiar, has been the demands of electronic health records. They are designed to capture billable activities and to gather piles of (usually unreliable and/or misleading) data, with the result that they devour practitioners' time and misdirect their focus. There was a simpler computerized data storage system where I work, years ago. It supplemented paper records and was a helpful tool. The newer systems, promoted and financed by government, are an abomination.
27
The new systems are private, from private companies that thanks to corrupt congressmen and congresswomen get subsidies and tax credits paid by most taxpayers. The Veterans Administration electronic medical records is be much better than all the ones by private companies I have worked with.
4
I agree. My electronic medical record is a jumble of errors and omissions. I am able to access parts of it from my computer. There are parts I can't see but I imagine those parts also have errors. Luckily my doctor knows me well and I am still able to speak up for myself.
I am a physician. I treat patients with respect and care. I do this because it is the right thing to do.
Surveys are all about profit. They address patient care issues but only if they will impact the bottom line. Press Ganey makes money doing surveys and hospitals want high rankings to make more money.
Let's care for our fellow man the way we know that we should. The way we want our parents taken care of.
If doctors were not harassed by insurance companies, threatened by malpractice concerns and over regulated ( Medicare and others), most would be kind, caring medical professionals.
This is why doctors, for the most part, enter the profession!
Surveys are all about profit. They address patient care issues but only if they will impact the bottom line. Press Ganey makes money doing surveys and hospitals want high rankings to make more money.
Let's care for our fellow man the way we know that we should. The way we want our parents taken care of.
If doctors were not harassed by insurance companies, threatened by malpractice concerns and over regulated ( Medicare and others), most would be kind, caring medical professionals.
This is why doctors, for the most part, enter the profession!
27
You are absolutely right dear Matthew surveys done by the hospitals are usually about maximizing profits with "patient satisfaction" because the goodness of their hearts as an excuse.
I agree completely. The surveys seem to ask all the wrong questions and none of the right ones. I have known a lot of doctors in over 30 years of hospital work (I am now retired). Most were both skilled and kind. It is good to hear there are still doctors, like you, who are both competent and caring because it is the right thing to do. Years ago, doctors and staff talked about the patients and the medical issues. Money was almost never mentioned and a high level of professionalism was the norm. These seemingly well-intentioned but off-the-mark "satisfaction surveys" weren't needed when hospitals treated patients like respected people instead of revenue streams.
This is pretty much why I went into Psychiatry.
except for operating room nurses, nurses are a waste of time and money. hospitals wld do better if they fired half of them ! no I aint no doc !
2
Are you aware how much nurses actually do? They are the glue of the hospital and without them many things would never get done. Doctors are not the only qualified individuals in hospitals. Obviously you "ain't no doc" since you failed to see this. Next time you think about insulting a career why don't you try educating yourself a little more. Oh and try not to use "text talk" on a well-written NY times post which you clearly know nothing about.
11
Try being cared for in the hospital without them, pal.
9
Nurses don't just hand out pills and change bedpans. They start IV's, administer many kinds of bedside treatments and closely monitor patients' conditions. Understand that nurses often save lives. In the ICU, you had better have a good nurse because the doctor will be there for a few minutes daily but your nurse is there all the time. The nurse makes sure that the treatments ordered are carried out and some may be quite complex. If your condition worsens, the nurse will be the first to see the changes and alert your doctor or the doctor on call. He or she has had to go through a great deal of training during and after nursing school to become a competent ICU nurse. There are also such highly skilled nurses in neonatal nurseries and cardiac care units.
Press Ganeys do not measure suffering, and I have a myriad of complaints about it as a survey; unfortunately, it doesn't seem like there is anything that is "better" out there.
We should all spend some time as a patient, or even as patient's family members. Conversely, patients should spend a day working as a physician, with our multiple competing priorities and understand that sometimes, we are doing our best.
We should all spend some time as a patient, or even as patient's family members. Conversely, patients should spend a day working as a physician, with our multiple competing priorities and understand that sometimes, we are doing our best.
5
The most night-marish 'suffering' I experienced was that of the so-called nuclear testing in which I was entered into a metal encasement (like a tomb) that felt claustrophobic for long periods of time. It is a medical abomination. The medical "scientists" over-seeing this torture said not a word throughout more than two hours: I could have been an eggplant being cooked for dinner, given the total insensitivity by these medical 'overseers' to the inhumane procedure they were putting me through. I still feel the outrage.
13
One thing mentioned, which I felt was sorely underaddressed, was the incessant need for nurses to wake me every hour to take vitals. After receiving bypass surgery, this continued for six nights. I was trying to rest, and recuperate, but never got enough sleep until I went home. Every 4 hours should be enough, especially since I can be monitored from the nurse's station.
7
What a great-and important-article. Now if only my medical system (Kaiser Permenente) would take this to heart.
1
I don't know what the Utah doctors did to improve so much, but I can just about assure you that what you are writing is misleading, and potentially a lie.
First of all, you are giving apples to orange statistics. The UNIVERSITY used to be in the thirtieth percentile, but now HALF OF DOCTORS are in the 90th percentile. Why not just give the new percentile?
Then, assuming there was some major jump in scores, does anyone really think it is possible to improve that much on a curved scale? After all, they are competing with multiple hospitals who are taking the same survey and receiving the same feedback. To have any major jump in the average of all doctors would be nearly miraculous.
I can tell you first hand that these surveys essentially take people who more or less excelled in school, care a lot about what they do, and are good learners, and then put them all on a curve. A raw score of 90%, which is very good and means 9 out of 10 times someone gives a doctor a top grade curves to about the 15th percentile in many specialties (you are graded against these peers). Scores just don't increase that much with coaching, and are also dependent on patient populations.
I will bet that if the Times dug into it they could figure out that they are being taken for a ride, and then feeding it back to the rest of us. My only question is why do you want to support surveys for your audience? I will bet you cannot find one bit of proof they work.
First of all, you are giving apples to orange statistics. The UNIVERSITY used to be in the thirtieth percentile, but now HALF OF DOCTORS are in the 90th percentile. Why not just give the new percentile?
Then, assuming there was some major jump in scores, does anyone really think it is possible to improve that much on a curved scale? After all, they are competing with multiple hospitals who are taking the same survey and receiving the same feedback. To have any major jump in the average of all doctors would be nearly miraculous.
I can tell you first hand that these surveys essentially take people who more or less excelled in school, care a lot about what they do, and are good learners, and then put them all on a curve. A raw score of 90%, which is very good and means 9 out of 10 times someone gives a doctor a top grade curves to about the 15th percentile in many specialties (you are graded against these peers). Scores just don't increase that much with coaching, and are also dependent on patient populations.
I will bet that if the Times dug into it they could figure out that they are being taken for a ride, and then feeding it back to the rest of us. My only question is why do you want to support surveys for your audience? I will bet you cannot find one bit of proof they work.
10
All you say is sensible. Surveying whether the patient is happy with the wait times, the attitude of the nurses, even of the doctor, says nothing about the usefulness of the medical treatment. Most patients only know if they got better not necessarily why. It could just be "tincture of time," as one of my nurse friends used to say. A doctor can be kind and pleasant, prompt and reassuring. But, if he or she doesn't know what they are doing, none of that will matter.
1
Finally, hopefully, medical professionals are paying attention.
I can only speak about the two major hospitals in Boca Raton, Florida.
80% of the nurses and aides barely speak understandable English. That's bad enough for families of a patient, but impossible for any elderly patient.
Everyone who comes into the hospital room to do any procedure, even as simple as changing a bandage, just throws the refuse on the floor. And, then, someone else comes along, the lowest level person, to clean the room, and I have seen those people only halfway clean the room and leave refuse on the floor. I have even seen some level of nurse (don't know what) change an IV line and when there was bleeding and blood on the floor, just leave the blood on the floor, and when I asked someone to clean it, it took 6 hours.
As far as "suffering?" It's accepted by the staff as normal unless someone is coding. As far as doctors doing rounds? There is no schedule that the patient or any family member can count on. And, most of the time, it's not the regular doctor the patient knows. It's an attending physician, somehow getting paid by the regular doctor, who shows up when he or she has time, no schedule.
It doesn't matter whether the patient has no advocates or many famiy member advocates. The level of care cannot even be rated on a scale of 1 to 10 because it's below 1.
I can only speak about the two major hospitals in Boca Raton, Florida.
80% of the nurses and aides barely speak understandable English. That's bad enough for families of a patient, but impossible for any elderly patient.
Everyone who comes into the hospital room to do any procedure, even as simple as changing a bandage, just throws the refuse on the floor. And, then, someone else comes along, the lowest level person, to clean the room, and I have seen those people only halfway clean the room and leave refuse on the floor. I have even seen some level of nurse (don't know what) change an IV line and when there was bleeding and blood on the floor, just leave the blood on the floor, and when I asked someone to clean it, it took 6 hours.
As far as "suffering?" It's accepted by the staff as normal unless someone is coding. As far as doctors doing rounds? There is no schedule that the patient or any family member can count on. And, most of the time, it's not the regular doctor the patient knows. It's an attending physician, somehow getting paid by the regular doctor, who shows up when he or she has time, no schedule.
It doesn't matter whether the patient has no advocates or many famiy member advocates. The level of care cannot even be rated on a scale of 1 to 10 because it's below 1.
9
I agree with Alexandra but it's not just in Boca Raton!
I get treatment through the VA. "Suffering" and VA go hand-in-hand. Understandable English? Of nine different doctors I have seen, only ONE is American! The rest have been from India, Poland, China and Nigeria. Some, I can understand most of what they say but others... Well, I ask them to write down what they are saying and when I get home, I look it up on the Internet.
Another part of the "suffering" is getting the wrong information. I've had four doctors in cardiology and seldom do they agree with the previous physician. It is very confusing.
Another, is waiting for treatment. After waiting 2 1/2 YEARS to see a cardiologist, I had to write Sen. John Cornyn (TX) to be seen. Now, they are talking surgery... Would surgery have been necessary had I not been forced to wait 2 1/2 years to be seen?? Who knows??
The reigning president KNOWS of these issues and MANY MORE with the VA but instead of spending more money for quality care, he gives benefits and tax money to illegal aliens. A change in THAT policy could relieve suffering as well!
I get treatment through the VA. "Suffering" and VA go hand-in-hand. Understandable English? Of nine different doctors I have seen, only ONE is American! The rest have been from India, Poland, China and Nigeria. Some, I can understand most of what they say but others... Well, I ask them to write down what they are saying and when I get home, I look it up on the Internet.
Another part of the "suffering" is getting the wrong information. I've had four doctors in cardiology and seldom do they agree with the previous physician. It is very confusing.
Another, is waiting for treatment. After waiting 2 1/2 YEARS to see a cardiologist, I had to write Sen. John Cornyn (TX) to be seen. Now, they are talking surgery... Would surgery have been necessary had I not been forced to wait 2 1/2 years to be seen?? Who knows??
The reigning president KNOWS of these issues and MANY MORE with the VA but instead of spending more money for quality care, he gives benefits and tax money to illegal aliens. A change in THAT policy could relieve suffering as well!
4
Frank, I'm always surprised when vets don't know about Bill S. 1982 (Feb 2014) a bill designed to bring about huge changes to help vets with their healthcare. Who voted no on it to cause it's defeat? Every single Republican senator. Who wrote the bill and voted yes on it? The democrats and supported by Obama.
All the veterans groups supported this bill and were deeply disappointed by the partisanship which harmed their healthcare future. Look at the benefits this bill would have provided for veterans, including the much needed help for paralyzed vets, new medical centers and pay for veterans benefits… even when the GOP shuts down the government.
http://www.pva.org/site/apps/nlnet/content2.aspx?c=ajIRK9NJLcJ2E&b=6...
All the veterans groups supported this bill and were deeply disappointed by the partisanship which harmed their healthcare future. Look at the benefits this bill would have provided for veterans, including the much needed help for paralyzed vets, new medical centers and pay for veterans benefits… even when the GOP shuts down the government.
http://www.pva.org/site/apps/nlnet/content2.aspx?c=ajIRK9NJLcJ2E&b=6...
8
Let's give our doctors a break. They are being squeezed by insurance companies and hospitals. Rules about who can be admitted and for how long. Constantly having to get "authorization" before being able to give the patient treatments. Adhering to hospital metrics. Several long-time doctors I know have expressed great dissatisfaction about how medicine is practiced today vs when they started in the profession. AND they are not getting rich. Just check how much your insurance pays them. It can be as low as $12 for a visit.
Yes they could do more on the suffering front but let's remember that they are human and under great stress themselves.
Yes they could do more on the suffering front but let's remember that they are human and under great stress themselves.
15
Yes, doctors are under a lot of stress. I'm sure, though, that they knew this when they chose a career as a doctor. Whether insurance pays $12 or $200 for a visit is immaterial... Did they become doctors to help people or to get rich??
The patients are under an even greater amount of stress, in many cases, as they worry not only about their possible demise but about their families and the financial costs of treatment. A friend of mine, undergoing cancer treatment, is currently $40,000 in debt and counting.
The doctors... The hospitals, making an effort to relieve the patient's suffering can increase the patient rate of survival and response to treatment.
The patients are under an even greater amount of stress, in many cases, as they worry not only about their possible demise but about their families and the financial costs of treatment. A friend of mine, undergoing cancer treatment, is currently $40,000 in debt and counting.
The doctors... The hospitals, making an effort to relieve the patient's suffering can increase the patient rate of survival and response to treatment.
3
It may be less about the doctors, though I have had some whose personalities would fit better in a laboratory than with patients, than about the culture of the hospital and health care systems they operate within. The system has become health care capitalism and all about marketplace promotion, with the profits funneled to the top "executives". Not exactly Goldman Sachs, but similar.
8
Agreed. It's not just the doctors. It's the medical system that needs an overhaul. Insurance companies and hospital administrators is a good place to start.
6
I volunteer as a patient advisor in a hospital. A couple of pieces of general advice for patients on how to reduce the kind of suffering outlined in this piece: 1) always have a family member or friend who will advocate for you; 2) always speak up ASAP about everything that concerns you. Hospitals want to know what's going on with your care and will address issues directly, but you've got to communicate. Nothing works through telepathy.
9
Why should a patient even need an advocate? Shouldn't the fact that the patient is a patient in a hospital/rehab setting ring a bell to those caring for them?
Think about that.
Think about that.
15
Yes, I hear this advice over and over, but how on earth can a patient conceivably always have an advocate with them? Many people are single and you can't ask a friend to be there every minute, the most devoted relative can't be there every minute as people have to sleep, most family members are likely to have jobs and obligations. It is CRAZY to say have an advocate with you always. Although yes it would help, but it is simply not possible for most people.
8
Maybe they shouldn't "need" an advocate but it is still a very good idea. If you are very ill, perhaps unable to communicate well due to that, it is good to have a loved one or friend to help you. I once watched the wife of a comatose gentleman question every procedure and test her husband was receiving. She was a medical librarian with a great deal of savvy about medicine. Her husband recovered completely after months in a coma. He could have died as his condition was that dire. I believe the wife's constant leaning on and questioning of the doctors was a main factor in his survival.
1
It's not only in-hospital that inattention hurts (kills) patients -- it's in-office too. If I had a nickel for every time a doctor called in an erroneous prescription......
3
Often when I try to bring a patient into the discussion regarding their medical workup or treatment I get this response - "you're the doctor." A lot of people just want you to make them better, what ever it takes.
2
What I see is the major obstacle to quality healthcare for the 99.9% of the population is the for-profit-private Health Insurance which pays for 15 minutes visits, ehich besides time for documentation leaves little time to question the patient, so it is the rule rather than the excepcion that doctors miss important information and make many mistakes. When in training I was told that "Fortunately patients are difficult to kill," so even if you make mistakes in your evaluation and treatment you are unlikely to cause the patient to die. Doctors should refuse to see patients every 15 minutes, and patients should refuse to see doctors who do not dedicate time to carefully evaluate their complaints. I think it is because most people, both doctors and patients conformism and aversion to criticize and defy the current Medicine Practice system that things do not get better in this country which main ruling principle is to make money from anything without caring about the impact and harm on others. While is quite valid for a physician to want to earn enough to have a decent place to live, to pay for the education of children, to pay for vacations, to have good health insurance, to save for retirement. Executives and intermediaries from Insurance Companies are the ones who need to be eliminated not doctors. To do good medical work you don't need a genius, but only of a doctor of regular intelligence, with enough time to collect the dots that need to be connected. No more no less.
17
Alberto, I could not agree with your comments more. Easy to spot someone who actually knows how things work. The general public unfortunately has very little idea, as evidenced by the vast majority of these comments.
1
Nuns and nurses are rapidly dissapearing due to similar arrogance of who knows more. There is only one solution put through the experience the doctors and government people and columnists who crafted our system. Maybe they may understand.
Pain, fear, is so real. Not only doctors will be the problem. Nursing changes rapidly as the most important and present care providers ___the nurses ___ are in large numbers becoming Physicians Assistants, going into other fields. There are unbelievably great doctors possibly Gods angels.:-) But no there is no care for the average patient. Doctors fly in and out. Rush through charts; tie up the nurses and leave.
What stupid survey? I have personally returned to hospital many saying; ask me these questions? Give me,a line or two to inform u. No it is,a survey of what the hospitals think I need? Is the patient a thing or another human being ?
When someone is,seriously ill or long time ill for example they are a pin cushion!! Veins collapse. No such questions appear.
Sometimes in a given shift the kindest and most humble person who dispenses hope is the nurses aid.
Pain, fear, is so real. Not only doctors will be the problem. Nursing changes rapidly as the most important and present care providers ___the nurses ___ are in large numbers becoming Physicians Assistants, going into other fields. There are unbelievably great doctors possibly Gods angels.:-) But no there is no care for the average patient. Doctors fly in and out. Rush through charts; tie up the nurses and leave.
What stupid survey? I have personally returned to hospital many saying; ask me these questions? Give me,a line or two to inform u. No it is,a survey of what the hospitals think I need? Is the patient a thing or another human being ?
When someone is,seriously ill or long time ill for example they are a pin cushion!! Veins collapse. No such questions appear.
Sometimes in a given shift the kindest and most humble person who dispenses hope is the nurses aid.
2
The “last mile” in healthcare is the hand-holding rather than the computer mouse holding, the fingers palpating rather than typing or clicking away on screens, the look in the eyes rather than the starring at the flickering monitor or pad. Our streamlined electronic medical records are specialty specific and not patient specific. Even within specialties, we have templates and Care-paths for example for coronary artery disease patients, valvular heart disease patients, and patients with electric diseases of the heart. The patients have to fit the templates and the data points and deviations from the “pre-prescribed illness” are not tolerated. Our data point driven records do not accommodate human feelings, aspirations, and failures. I cannot find a field to report what my patient enjoys in life, what is he/she want to enjoy in the future. Spending time on “last mile” in healthcare showed me that my patient with a severe valve problem is afraid to get her valve replaced since she is the primary babysitter of her grandchildren. It is on this “last mile” that my patients shared the titles of the last books they are reading, the last wedding or funeral they have been to, and overall their human experience.The “last mile” in health care should be seen as an opportunity to get off the electronic medical highway and grasp the triumphs and failures of our fellow human. We should not cede this mile under the pressures of efficiency and Care-paths.
13
I gave birth to twins via c-section at St. Mary's in West Palm Beach, the same hospital at which a mentally ill 17-year-old recently successfully posed as a doctor for a month. There is no nursery there, which was supposedly for my benefit so that I could bond with my babies. That is a lie, the hospital doesn't have a nursery so it could reduce staffing.
My first memory of holding the twins was when I was still in recovery and a nurse was trying to force me to breast feed. I could barely talk, move or think, I was just out of major surgery, I had had some major complications and they were trying to force me to breast feed.
There were constantly nurses coming into the room, day and night, to run tests or check on the twins or me. They often woke up the babies, the left U.S. with two crying babies to comfort. There was not one moment that anyone gave me to recover or even sleep for more than two hours.
I went home beyond exhausted. I deserved way more concern for my recovery and needed nurses to care for the twins while I recovered from the surgery. In what other circumstance would we take a person just out of surgery and expect them to care for a newborn?
It was barbaric and I am still bitter about the utter lack of concern for my physical and emotional well being.
My first memory of holding the twins was when I was still in recovery and a nurse was trying to force me to breast feed. I could barely talk, move or think, I was just out of major surgery, I had had some major complications and they were trying to force me to breast feed.
There were constantly nurses coming into the room, day and night, to run tests or check on the twins or me. They often woke up the babies, the left U.S. with two crying babies to comfort. There was not one moment that anyone gave me to recover or even sleep for more than two hours.
I went home beyond exhausted. I deserved way more concern for my recovery and needed nurses to care for the twins while I recovered from the surgery. In what other circumstance would we take a person just out of surgery and expect them to care for a newborn?
It was barbaric and I am still bitter about the utter lack of concern for my physical and emotional well being.
15
You acknowledge that you had major surgery - which requires regular post-op monitoring. Please know that without that monitoring, the risk of major complications is there. Please also know that women post-delivery who have insisted on being left alone have drowned in hospital bathtubs, and had major reactions to foods brought in from the outside by caring but unknowing relatives. You went home due to the care of the hospital staff. End of story. Some appreciation for the care that you received would be a normal reaction, not dictating what you prefer for your care.
9
Oh, oh, LuckyDog...I suspect from the tone of your remarks that you may be part of the problem?
5
My 5 days in the hospital following an "emergency" c section were brutal, as well (emergency, because they'd put it off, and put it off, as the doctors went from one shift change to another, as I got sicker and sicker from a chorio infection - my water had broken more than 24 hours prior). My family was across the country, and my husband (who I divorced 18 months later; he was abusive and narcissistic) had freaked out and left after complaining about the long labor and uncomfortable pillows (for him) in the delivery room.
I was so sick, temp of 103+ for days, and I was expected to care for my baby all on my own. Fortunately after day 2 they realized I was really alone (no family, no husband), and took my son to the nursery overnight so I could sleep a few hours. Still, I was woken every couple of hours to nurse, but at least he was safe as I'd nearly dropped him from the hospital bed before, I just couldn't stay awake. They had me on a clear liquid diet my ENTIRE stay - 5 days - and I was woken again, and again through the night.
Halfway through my stay they moved the maternity ward to a different floor due to construction; I had to pack all my things and load them onto a cart, and deliver it to the hallway. I wasn't supposed to lift more than 10 pounds, but I had to lift the car seat, luggage, etc. myself. Then, finally, when it was time to move they put me in a wheelchair to move me to the other room. What a joke!
I was so sick, temp of 103+ for days, and I was expected to care for my baby all on my own. Fortunately after day 2 they realized I was really alone (no family, no husband), and took my son to the nursery overnight so I could sleep a few hours. Still, I was woken every couple of hours to nurse, but at least he was safe as I'd nearly dropped him from the hospital bed before, I just couldn't stay awake. They had me on a clear liquid diet my ENTIRE stay - 5 days - and I was woken again, and again through the night.
Halfway through my stay they moved the maternity ward to a different floor due to construction; I had to pack all my things and load them onto a cart, and deliver it to the hallway. I wasn't supposed to lift more than 10 pounds, but I had to lift the car seat, luggage, etc. myself. Then, finally, when it was time to move they put me in a wheelchair to move me to the other room. What a joke!
1
When my mom was in ICU after major surgery, they taped her hand to a board to keep her IV lines in place. Her hand became grotesquely swollen and purple from the board. I'm still convinced that something got broken. And no one cared. I'll never forget that. It's so emblematic of the level of suffering that patients are simply expected to endure. Before her surgery, on the ward, my brother brought a white noise machine, turned off the lights, drew the drapes and closed the door to give my mom as much rest as was possible and unless it was truly necessary, no one was let in. Did we get grief about it? Yes, but he'd worked in several hospitals and knew that getting any measure of real sleep was invaluable for her to survive her illness.
14
Yes, hospitals are harming patients by constantly interfering with sleep.
4
Bravo for your brother! I wish I had done more for my mom when she was in hospital. They kept coming for vitals and glucose and all sorts of things. It was only on the final morning (of the day she died) that i derived some sense to tell the nurse that no one was going to touch her till they did some thing about the pain first.
Lesson for next time a family member is in hospital but too late to help mum.
Lesson for next time a family member is in hospital but too late to help mum.
3
NYTimes, you need a new headline. "Doctors Strive to Do Less Harm by Inattentive Care"? May conform to many people's ideas of doctors and their overtreatment, but I don't think that you meant to say that.
11
My thoughts exactly! First do no care!
3
Yes, the headline was a bit oxymoronic.
2
Screwy headlines are one of my pet peeves. I am pretty sure the headline writers are not the same people as those who write the articles. The headlines often give the opposite impression of what the article says. This headline made me laugh at least.
I don't think inattentive care is the answer!
6
As the population ages there are more and more dementia patients who require an extraordinary amount of attention. These patients have no voice and they don’t complete surveys. If they could, they would say: “You don’t have enough nurses aides and nobody answers the call button so my choice is to lie here and soil my underwear or get up, yanking out my IV’s and risk breaking a hip on the way to the bathroom.” Dementia patients, many of whom have diseases like Alzheimer’s (no cure) are often completely ignored in the hospital. If their suffering is to be reduced, hospitals will have to dedicate certain floors to patients with dementia, and add extra staff—something most hospitals don’t seem willing to do.
9
How can you discuss patient suffering and not touch on staffing?
8
I worked for close to 3 years working in the telemetry (cardio) unit of a major Brooklyn hospital. The fact that the routine of the floor was very stressful for the patients already under pressure from their health issues was pretty self-evident. From vital done every 4 hours around the clock, blood work, shreaking monitors, sundowning neighbors, bright lights, cables and wires and IV lines tangled up all over the place, my heart would explode if I had to be a patient there. The mind boggles, reading this article, at just how disconnected the treating staff can be from the patients and the unnecessary, avoidable stress that is put on them by a rigid culture on at least some hospital floors. And not only does this affect patients directly, but also indirectly by interfering with the nursing staff ability to provide best possible care.
9
While this article puts the spotlight on doctors, considerable patient "suffering" occurs because of poor hiring and training of support personnel. The importance of excellent first contact staff cannot be underestimated. Patients who are very ill, experiencing painful conditions or simply worn out from chemo treatments or imaging appointments need to be treated with respect for their conditions. Administrators who make patients stand in lines for several minutes to fill out paperwork or answer questions can cause real physical issues for patients. Not having a comfortable place for patients in wheelchairs to wait or for young children to be cared for is a problem with generic medical facilities.
Staff failures to follow-through on orders from doctors, to make arrangements for tests needed prior to appointments or treatments and simple mistakes by staff in making appointments which then require a return visit create many difficulties for patients; the doctor may never become aware of these problems, but they do affect patient satisfaction. This is especially true of large outpatient facilities which seem like factories and do cause real physical suffering to young and old alike.
The mindfulness of every person in the chain of providing health care affects the satisfaction of patients. Hiring excellent support staff at every level and paying them well would significantly improve patient care.
Staff failures to follow-through on orders from doctors, to make arrangements for tests needed prior to appointments or treatments and simple mistakes by staff in making appointments which then require a return visit create many difficulties for patients; the doctor may never become aware of these problems, but they do affect patient satisfaction. This is especially true of large outpatient facilities which seem like factories and do cause real physical suffering to young and old alike.
The mindfulness of every person in the chain of providing health care affects the satisfaction of patients. Hiring excellent support staff at every level and paying them well would significantly improve patient care.
5
Funny - I thought the headline meant that one of the ways doctors strive to do less harm is by paying less attention to their patients. It actually makes sense that way, too. My mother died from, essentially, too much attention from doctors.
7
The headline is GREATLY misleading!
2
The quality of the "food" served to patients at most hospitals also contributes to patient suffering. I wouldn't feed my dog half the stuff my dad didn't eat when he was hospitalized.
5
True. But in my experience, the Dilaudid did something that made all food taste like cardboard.
2
The “last mile’ was a phrase coined in the 90’s to indicate the inefficiencies and bottleneck phenomenon encountered by telecommunication companies frustrated with speed of internet after investing billions of dollars in laying down fiber-optic cables across the continent and the oceans. This “last mile” was the product of the traditional copper wires that connect the substations to the outlets on various houses, apartments and offices. It is in health care delivery that we see this “last mile” phenomenon now and the frustration of health economist, administrators, and proponents of electronic medical records is on pare with what we observed before in the telecommunication sector. However, after we as patients and caregivers have accepted the vertical and horizontal integration of health care over the past decade, we are all now faced with the “robocare concept” that is devaluing the importance of empathy, hand-holding, understanding the psychosocial circumstances of our patients and furthermore degrading the humanity of the health care profession. It is what healthcare efficiency experts see as “slow lanes” that our patients appreciate as ‘listening to my concerns”, “taking the time to help”, “ caring for the person and not the disease”.
5
Surprise, surprise, doctors have finally come to the realization that their primary stakeholders are their patients, as opposed to maximizing their billings.
4
During a hospital stay when I had mono but it was not yet diagnosed, I stayed in the hospital for three days. The pain was so bad the strongest meds they had did not relieve it. The only thing I wanted was to sleep. The nurses were in Union negotiations and all night they talked and even yelled about their grievances. When I could sleep through the loud all night commosion on the floor they came in to wake me up several times during the night. I would have given anything for peace and quiet. You feel like they have no clue how much the patients in those beds would just like to sleep through the long night. How can anyone in health care lack empathy for their patients this way? Waking patients up at night is the biggest complaint I hear from anyone who had to stay in the hospital.
5
This is great, and long-overdue. My father was in a hospital for a heart infection. He was very ill. Unfortunately, his sleep was constantly interrupted by the squawking of a loudspeaker about two feet from his head. All the pages for nurses all night and all day long were broadcast in each patient's room. My father complained about the noise, got someone to wrap the loudspeaker in towels, and we got dad some ear plugs, but nothing really worked. It seemed ridiculous that someone who is really ill should have their sleep interrupted like that.
5
Luckily, I've never been hospitalized. But I've heard horror stories from plenty of people who have -- same things as this article mentions. Not valuing the need for SLEEP in healing (!) constitutes a refusal to follow evidence-based medicine, given the importance of sleep. Hearing how awful hospitals are (and experiencing enough doctors' offices where much of this happens, too -- people not keeping you informed and all) is a huge inspiration to me to really live a healthy lifestyle. I know there are no guarantees, but you can definitely stack the deck more toward aging and dying while having minimal contact with the professional medical world. Since I dread that kind of encounter more than almost anything, this whole situation does provide some serious motivation toward healthy living, at least.
1
We work for survival, not because our jobs are fulfilling or necessary. When your incentive for working is to make money, you are going to do what you can to make as much as possible. How can this capitalist society complain about the natural consequence of making profits be the reason for this business? For any business?
Hierarchies supported by amassed possessions are the rotten core of human organization. We have to acknowledge this and move to a system of guaranteed basic incomes. Then only those who really want to will practice medicine, educate our young, design reliable ignition switches and play college ball. Society will pay more if the job goes begging, and doctors and garbage collectors and day care providers will earn what they deserve.
Hierarchies supported by amassed possessions are the rotten core of human organization. We have to acknowledge this and move to a system of guaranteed basic incomes. Then only those who really want to will practice medicine, educate our young, design reliable ignition switches and play college ball. Society will pay more if the job goes begging, and doctors and garbage collectors and day care providers will earn what they deserve.
3
The least attentive care in any hospital is in emergency departments. They are overcrowded, understaffed, and deficient in the triage and diagnostic skills required to do an even reasonably efficient job. Very few even contrive to separate likely contagious patients from those who are not. Very few manage to bring an on-call specialist in when a puzzling or unusual case presents.
In my local ER, in the last 16 months, I'm aware of two cases. One was a small child who presented with blood in his urine, and was sent home with what his parents were told was a food allergy that would soon abate. He vomited blood within 9 hours, went back to the ER by ambulance, was choppered out to Children's Hospital in Denver, and died there awaiting a liver transplant.
The other was a man in his 20s, who presented in what was, by all accounts, full adrenal crisis and died shortly afterwards of undiagnosed and untreated Addison's disease after casual failures of diagnosis in the ER and a recommendation to see a doctor, which he did. Absent the full records from the ER, the doctor, too, appears to have missed the diagnosis, which was apparently textbook.
The largest malpractice award in the history of the state arose from such a case--a man in his 30s who presented with severe neck pain and numbness and tingling in his arms and legs. Not evaluated, he was sent home with advice to take something for the pain and rest. He woke up quadriplegic.
In my local ER, in the last 16 months, I'm aware of two cases. One was a small child who presented with blood in his urine, and was sent home with what his parents were told was a food allergy that would soon abate. He vomited blood within 9 hours, went back to the ER by ambulance, was choppered out to Children's Hospital in Denver, and died there awaiting a liver transplant.
The other was a man in his 20s, who presented in what was, by all accounts, full adrenal crisis and died shortly afterwards of undiagnosed and untreated Addison's disease after casual failures of diagnosis in the ER and a recommendation to see a doctor, which he did. Absent the full records from the ER, the doctor, too, appears to have missed the diagnosis, which was apparently textbook.
The largest malpractice award in the history of the state arose from such a case--a man in his 30s who presented with severe neck pain and numbness and tingling in his arms and legs. Not evaluated, he was sent home with advice to take something for the pain and rest. He woke up quadriplegic.
6
As a medical student and graduate student in health policy, I am concerned about the emergence of physician ranking systems such as the one described in Utah.
While these physician accountability program look great on the surface, there may be many hidden dangers lurking underneath. Publicly publishing the results of physician satisfaction surveys incentivizes doctors to provide whatever services their patients request. These services are frequently medically unnecessary, and more often that we might think, harmful to the patient. A doctor who is overly concerned with his or her ranking may be tempted to perform or order such services. Not only would this behavior lead to increased patient suffering, but it will also increase medical costs. In fact, it would be interesting to see how much the highest-ranked doctors spent on medical services compared to their lower-ranked peers.
It is important to take these considerations into account, and balance them with the ever-important goal of improving the patient experience.
While these physician accountability program look great on the surface, there may be many hidden dangers lurking underneath. Publicly publishing the results of physician satisfaction surveys incentivizes doctors to provide whatever services their patients request. These services are frequently medically unnecessary, and more often that we might think, harmful to the patient. A doctor who is overly concerned with his or her ranking may be tempted to perform or order such services. Not only would this behavior lead to increased patient suffering, but it will also increase medical costs. In fact, it would be interesting to see how much the highest-ranked doctors spent on medical services compared to their lower-ranked peers.
It is important to take these considerations into account, and balance them with the ever-important goal of improving the patient experience.
7
Yeah,yeah,but with the medical industry promising to police itself and reduce deaths by avoidable medical errors -100,000 in the US each year- the hidden dangers in trying almost ANYTHING would be an improvement over waiting another 10 or 20 years and seeing if 1-2 million die ......that suddenly they miraculously decreased their error rates is a dream........even a little would show that it IS possible..I know , hold your breath.
3
And these rating systems have a funny way of measuring - they give credit only if the patient says I like my doctor "all" the time - not most of the time or some of the time. Really? Sure we all want "all" the time. But wouldn't we be happy with "most" of the time? We elect our government based on "some" to at best "most" of the time choices - not all the time. Who agrees with Mr. Obama all the time? No one - not even his wife.
3
Note to doctors:
Direct some of your attention back to medicine and less to revenue generation. You can whine all you want about the cost of malpractice insurance, etc., etc, but the bottom line is that you're doing just fine, especially compared to your colleagues in Europe.
Realize that many of your patients have higher and higher deductibles and co-pays, and that they will have to fork over a growing portion of your outlandish charges. Stop billing my insurer three times the going rate for a long-established medical test procedure. Ask yourselves why it took three physicians and $4,000 charged to my insurer to diagnose a simple sinus infection. End the opaqueness and secrecy of your profession and let patients know in advance what you charge for your services. Ensure that the providers who assist you in a procedure are also in the patient's network. Stop your practice of waving good morning to an elderly patient in the hospital and then billing Medicare for the greeting. Neurologists, stop prescribing MRIs (on your personally owned equipment) for everyone who walks through the door with a headache.
After you take care of these kinds of abuses, we'll discuss how difficult it is to communicate with you outside of paid appointments, and why you seem to think it's fine to hide behind incompetent and rude office staff.
Patient suffering takes many forms and not all are medical, although the consequences may be.
Direct some of your attention back to medicine and less to revenue generation. You can whine all you want about the cost of malpractice insurance, etc., etc, but the bottom line is that you're doing just fine, especially compared to your colleagues in Europe.
Realize that many of your patients have higher and higher deductibles and co-pays, and that they will have to fork over a growing portion of your outlandish charges. Stop billing my insurer three times the going rate for a long-established medical test procedure. Ask yourselves why it took three physicians and $4,000 charged to my insurer to diagnose a simple sinus infection. End the opaqueness and secrecy of your profession and let patients know in advance what you charge for your services. Ensure that the providers who assist you in a procedure are also in the patient's network. Stop your practice of waving good morning to an elderly patient in the hospital and then billing Medicare for the greeting. Neurologists, stop prescribing MRIs (on your personally owned equipment) for everyone who walks through the door with a headache.
After you take care of these kinds of abuses, we'll discuss how difficult it is to communicate with you outside of paid appointments, and why you seem to think it's fine to hide behind incompetent and rude office staff.
Patient suffering takes many forms and not all are medical, although the consequences may be.
19
Hospital "food" =garbage calories
Hospital "rest" = rude ,numerous and unnecessary interruptions in an already noisy environment
Avoidable medical errors kill 100,000 every year in the US - very few MD's confess to their own deadly mistakes.....
Good news + those that are only injured by the mistakes, 900,000 , add to the bottom line buy staying longer.
Hospital= filth, strongest and deadly bacteria and viruses so if you don't have pneumonia
yet...
Every two weeks ,even though they're getting paid,avoidable medical errors kill more than 9/11 !
Solution to working long hours? Work fewer and stop hating your job!
Now the pharmaceutical industry............
Hospital "rest" = rude ,numerous and unnecessary interruptions in an already noisy environment
Avoidable medical errors kill 100,000 every year in the US - very few MD's confess to their own deadly mistakes.....
Good news + those that are only injured by the mistakes, 900,000 , add to the bottom line buy staying longer.
Hospital= filth, strongest and deadly bacteria and viruses so if you don't have pneumonia
yet...
Every two weeks ,even though they're getting paid,avoidable medical errors kill more than 9/11 !
Solution to working long hours? Work fewer and stop hating your job!
Now the pharmaceutical industry............
3
Entering into an American hospital is a traumatizing, dehumanizing event. I wouldn't wish it on my worst enemy. "Suffering" is a perfect word to describe it. And then, on top of all the suffering, you get an enormous bill for it.
The issue is quite simple. Treat patients like human beings. Maybe a survey will help, but empathy would do much better. They should teach that in med school.
The issue is quite simple. Treat patients like human beings. Maybe a survey will help, but empathy would do much better. They should teach that in med school.
6
I was desperate to get out in a recent emergency stay (my first) with surgery in a hospital. The surgeon did a great job. The hospital was horrible. They threw you in a bed with monitors on, never greeted you or asked how you were, blew off requests. They answered bells and moved you down the line, always a different person. Fortunately I was able to get out in one day.
A friend who has more surgeries says she always lies about bowel movements etc. to get out of the hospital quicker.
A friend who has more surgeries says she always lies about bowel movements etc. to get out of the hospital quicker.
4
Not just American hospitals though. Waking up patients at unseemly hours for doctors convenience is universal and worse in other cultures where doctors are treated as God. This practice needs to go everywhere and forever - sleep is essential for healing.
2
Perhaps psychologists can help manage the psychological impact of medical illness and care being described.
http://store.elsevier.com/Psychology-and-Geriatrics/isbn-9780124201231/
http://store.elsevier.com/Psychology-and-Geriatrics/isbn-9780124201231/
4
This waking patients up in the middle of the night for staff convenience is a HUGE factor. If you don't rest properly it seriously compromises healing. And as the article points out, being more considerate - that's all it takes, common consideration - doesn't cost a penny.
7
I don't think I will ever get over the time I was in the hospital because my blood pressure rose to over 210/120 or somewhere in that area. I lay on that gurney in the room while doctors and nurses came, adjusted machines, smiled or not, and left without saying anything.
Finally I asked a nurse why everyone was going in and out and if I was going to be okay. She looked at me as if she had just seen me, and said "Oh, we're waiting to see if you have a stroke" and on that note, she left the room.
Well, I didn't have a stroke. But I sure as hades almost did when she said that as I had no idea I was in that bad a shape. Eventually, I started demanding to see a doctor who finally came and explained what was happening to me and things got better --- but I had to make a fuss to have it happen, didn't I.
Finally I asked a nurse why everyone was going in and out and if I was going to be okay. She looked at me as if she had just seen me, and said "Oh, we're waiting to see if you have a stroke" and on that note, she left the room.
Well, I didn't have a stroke. But I sure as hades almost did when she said that as I had no idea I was in that bad a shape. Eventually, I started demanding to see a doctor who finally came and explained what was happening to me and things got better --- but I had to make a fuss to have it happen, didn't I.
10
This article glosses over a lot of harsh realities, and conflates a variety of issues. To think that listening and communication will solve all of our problems cited here is horribly naive.
Take 4 AM labs, for example. Doctors don't order 4 AM labs to irritate patients. We do it because labs take time to run. You can't change that. Surgeons go to the Operating Room or internists to clinics by 730 or 8 AM, and results are usually needed to make a plan for the day (assuming the labs are indicated - ordering unnecessary tests is very much a separate issue and usually is driven by the same desire to please patients and increase Press Ganey scores that is being celebrated by this author).
So Dr. Bennick - what are we supposed to do? Let the patient sleep in, draw the labs at 8 AM, and then get called out of surgical cases or office visits to interpret the results and make a plan? Not gonna work. Wait until the end of the day to make plans, thereby delaying discharges and lengthening hospital stays? Ask the hospital administrators whether they'll let that fly for even a single day.
The point is that these systems are complex, and things which irritate patients are not just the result of a lack of effort or personal shortcomings of doctors or nurses. The physician leaders quoted in this article would do well to remember that.
Take 4 AM labs, for example. Doctors don't order 4 AM labs to irritate patients. We do it because labs take time to run. You can't change that. Surgeons go to the Operating Room or internists to clinics by 730 or 8 AM, and results are usually needed to make a plan for the day (assuming the labs are indicated - ordering unnecessary tests is very much a separate issue and usually is driven by the same desire to please patients and increase Press Ganey scores that is being celebrated by this author).
So Dr. Bennick - what are we supposed to do? Let the patient sleep in, draw the labs at 8 AM, and then get called out of surgical cases or office visits to interpret the results and make a plan? Not gonna work. Wait until the end of the day to make plans, thereby delaying discharges and lengthening hospital stays? Ask the hospital administrators whether they'll let that fly for even a single day.
The point is that these systems are complex, and things which irritate patients are not just the result of a lack of effort or personal shortcomings of doctors or nurses. The physician leaders quoted in this article would do well to remember that.
49
"Let the patient sleep in, draw the labs at 8 AM, and then get called out of surgical cases or office visits to interpret the results and make a plan? Not gonna work."
Yes! That is exactly what you should do. Your post precisely illustrates the problem.
Yes! That is exactly what you should do. Your post precisely illustrates the problem.
2
Sir, with all due respect, so many hospitals have gone to using hospitalists, that your argue fails. They aren't doing clinic. They are 9-5ers watching the clock until their shift is over.
5
MainerMD, What Me and Fred fail to understand is that before you go to the operating room at 7:30 AM ,you have ALREADY made your morning rounds on your patient's in the hospital starting around 6:00am If those 4:00 am labs aren't available surgeries will be cancelled and discharges delayed. One reason why I did NOT go into surgery. The hours are terrible!
3
I also wish the medical establishment -- or some forward thinking entrepreneurs - would focus their attention on two examples low-hanging fruit that adversely affects patient outcomes: breathing tubes, and low-hanging fruit.
Two close relatives of mine have recently had complications based on abrasions and swelling caused by breathing tubes. In one case, this extended his hospital stay, and he ended up getting blood clots and having a small stroke. My sister is a speech pathologist and regularly sees people recovering from throat injuries caused by these tubes.
Another opportunity is around catheters. Holy smokes, can they make them more painful. I don't know what it is, but there must be a better way.
Two close relatives of mine have recently had complications based on abrasions and swelling caused by breathing tubes. In one case, this extended his hospital stay, and he ended up getting blood clots and having a small stroke. My sister is a speech pathologist and regularly sees people recovering from throat injuries caused by these tubes.
Another opportunity is around catheters. Holy smokes, can they make them more painful. I don't know what it is, but there must be a better way.
5
In paragraph one, I meant "catheters" where I wrote "low-hanging fruit" the second time.
Like many professions, the bits and pieces we patients interface with, seem very fragmented. The primary issue seems to be Doctors are simply too busy. Before one might be admitted to a hospital, we usually have a merry go round of specialist we wait to see, and pray our results and test are being co-ordinated. I can understand Physicians like anyone else probably want to maximize their income without getting burned out. Seems human nature Doctors grow weary of vague questions.
1
Its not necessarily the doctors that are the prime force in thus. It is the hospitals, clinics, physician groups, etc. run by MBA's not MD's. One reason many doctors are busy is that they are pushed to be that way by administrators. Some doctors would prefer to spend more time with pts but they wil be penalized by top brass for this.
16
"Doctors grow weary of vague questions." Then perhaps they need to choose another profession. This comment is extremely insulting to patients. "Vague" is in the eye of a beholder. Perhaps the physician is such a poor communicator that it is necessary for the patient to start with a broad, general question and then work from there.
2
This may or may not be true, but it is not the focus of this article. The focus of this article is the quality, not necessarily, the quantity of communication. Decades ago when the pressures you mention were nonexistent, there were still plenty of brusque (if not rude), insensitive physicians with condescending attitudes toward their patients. What was their excuse?
2
Wondering if medical staff's failure to comprehend the importance of healing sleep in the hospital is rooted in the sleep deprivation they are expected to undergo during their own training. Someone who subliminally thinks "I worked 48 hours straight and I survived; sleep is overrated" may extend that thinking, without even realizing it, to their patients. But, of course, running on empty only works temporarily even for a healthy person; it doesn't work at all for one who is ill.
61
I personally have an issue with IV sets. There is as solution to this problem, and I instruct every doctor to order same. Yet this never seems to get to the people DOING the IVs, causing serious suffering both physical and psychological. Usually the IV et is a failure as well. Not following these orders does nobody any good.
A great deal of suffering can be alleviated by listening, placing the orders and ensure staff follows them.
A great deal of suffering can be alleviated by listening, placing the orders and ensure staff follows them.
2
You didn't actually say what the problem with IV sets is, or the solution.
1
Recently, learning I needed open heart surgery, the first cardiologist I saw responded to my concerns, not about the surgery, nor the fear of dying, but the pain and depression that might follow during my recuperation. She stated, "What you need to worry about is stroking out on the operating table."
Needless to say, I found another doctor, one who listened to my concerns and addressed them with calm and positive reassurance.
Needless to say, I found another doctor, one who listened to my concerns and addressed them with calm and positive reassurance.
21
I honestly do not see what is the big problem with her statement. She was likely trying to present the most serious risk of your undergoing the procedure. What is the problem with that?
The biggest problem in the medical sphere is the dominance of the profit motive in determining care exacerbated by the insurance industry to intolerable levels. Profit motive and humanitarianism mix about as well as oil and water.
25
A trip to the ER can be an exercise in total frustration. It is often made due to the fact that internists no longer take calls after office hours. On weekends, their hospitalists do not work, either. So, one is told to go to the ER.
Upon arrival, if one is merely ill, take a number and get in a LONG line. All the gunshot victims/heart attacks/strokes are in front of you. Vomiting and can't stop? No one will put you on any type of fluids and give you anti-nausea meds - you must wait to be seen and evaluated, being sicker and sicker in the meantime.
If one has chronic respiratory problems and is on Medicare, one will most likely be admitted for observation when what was really needed was a prescription for a short course of oral steroids and perhaps, an hour on oxygen. And because this was not an admission, but an observation, there will be significantly higher co-pays involved, and it can affect whether any willed nursing care will be paid for by Medicare if the patient is neither sill enough to be admitted, nor well enough to go home.
Suffering? Yes, all this causes suffering - far more than one might think because these are elderly patients, often alone. Ambulatory care centers cannot give fluids and do not want to deal with elderly patients with breathing problems, but hospital ER's are not the appropriate place, either.
We need far better alternatives.
Upon arrival, if one is merely ill, take a number and get in a LONG line. All the gunshot victims/heart attacks/strokes are in front of you. Vomiting and can't stop? No one will put you on any type of fluids and give you anti-nausea meds - you must wait to be seen and evaluated, being sicker and sicker in the meantime.
If one has chronic respiratory problems and is on Medicare, one will most likely be admitted for observation when what was really needed was a prescription for a short course of oral steroids and perhaps, an hour on oxygen. And because this was not an admission, but an observation, there will be significantly higher co-pays involved, and it can affect whether any willed nursing care will be paid for by Medicare if the patient is neither sill enough to be admitted, nor well enough to go home.
Suffering? Yes, all this causes suffering - far more than one might think because these are elderly patients, often alone. Ambulatory care centers cannot give fluids and do not want to deal with elderly patients with breathing problems, but hospital ER's are not the appropriate place, either.
We need far better alternatives.
32
Did no one edit the title of this article? On first glance, it seems to suggest that doctors are striving to do less harm to patients by providing inattentive care.
22
I wondered about that, too -- it was part of the reason why I clicked on it.
That was my reaction to the headline, as well. I almost skipped the article!
I wrote a comment to the same effect a couple minutes ago because I hadn't seen your comment. This headline is hardly the only sign I've seen that the NY Times has apparently liquidated its copy desk.
3
As a a long time patient, I have experienced a lot of really mediocre to downright bad experiences. I find, in my case, that many doctors, ironically females, like to downplay my symptoms. In other words, they pooh pooh all my concerns. I cannot stand that condescending nonsense and it is simply unacceptable in the medical arena.
Stupid questions are also part of the equation.. One time, I was in the E.R as a result of medication side effects, the attending nurse started to ask all kinds of questions like I was have coffee with her. She started to ask me about my personal life - in a crowded E.R. bay with barely a curtain between me and the next patient. When she got to the question of whether or not I had a boyfriend. I said of course not (I was so sick at the time, what I meant was all my energy was going towards getting well, not putting energy and time I did not have into a relationship). She then proceeded to ask me if I was gay! I could not figure out what my sexual orientation had to do with a prescribed drug side effect, but she proceeded to tell me "I looked gay" because of my short hair. I still, to this day, cannot figure out how anyone's sexual orientation - whatever that may be - needs to be discussed anywhere in a medical setting other than in complete privacy.
Stupid questions are also part of the equation.. One time, I was in the E.R as a result of medication side effects, the attending nurse started to ask all kinds of questions like I was have coffee with her. She started to ask me about my personal life - in a crowded E.R. bay with barely a curtain between me and the next patient. When she got to the question of whether or not I had a boyfriend. I said of course not (I was so sick at the time, what I meant was all my energy was going towards getting well, not putting energy and time I did not have into a relationship). She then proceeded to ask me if I was gay! I could not figure out what my sexual orientation had to do with a prescribed drug side effect, but she proceeded to tell me "I looked gay" because of my short hair. I still, to this day, cannot figure out how anyone's sexual orientation - whatever that may be - needs to be discussed anywhere in a medical setting other than in complete privacy.
23
Unless you have symptoms of an STD or HIV, then your sexual orientation is irrelevant.
4
Yale, Harvard ! Stanford, Utah - these are all academic medical centers where predominantly white, educated, and most importantly insured. Studying "inattentiveness" at these research institutions is entirely appropriate, but implying that it should now become a national standard (albeit an unmeasurable one) is yet another example of why the country doesn't take the health care crisis seriously. There are many people who would likely welcome the chance to be treated by inattentive doctors as one of these hospitals, because it is better than what they currently have - no treatment at all. Or patients cared for by doctors who practice just past the margin of acceptable (and who view all this quality stuff including electronic health records as just another nuisance).
I wonder what Kaiser Permanente leaders think about this article - after all they are the largest private health system in the country (more than 9 million members), with a long track record of developing and implementing meaningful quality practices.
I wonder what Kaiser Permanente leaders think about this article - after all they are the largest private health system in the country (more than 9 million members), with a long track record of developing and implementing meaningful quality practices.
2
My brother was in Delray Hospital where the nurses carry cell phones and instruct the patients to use a specific phone number printed on a white board in front of their beds when they need a nurse. They also discourage family member from coming to the nursing station to ask for something. My brother was so weak that he could not lift the phone nor dial the number. Therefore, he received NO care. He was given a PRN medication for a cough but was never told that PRN meant as needed and he was supposed to ask for it so he never got the medication and his cough worsened. I am an RN and was disgusted with the care and practice of this hospital as well as the rudeness of the staff. Unfortunately, I was never given a Press-Ganey survey. My brother is a dialysis patient and required, at that time, a considerable amount of care which was neither offered nor given. Fortunately, we got him home and had nursing care and physical therapy done at home. Within a week's time he was back on his feet and slowly regaining the 17 pounds he lost while hospitalized for one week. I'd call this suffering.
32
Hospitalized for 5 days last year. I found the experience dehumanizing, akin to be sent to prison. They took away my clothes, and gave me rags to wear. I was not permitted to leave my room. And I vomited from an overdose of pain medication, which also left me in a stupor for an entire day. (Funny since I made no complaint that I was ever in pain). I'm a successful business owner who became just a number. Hospitals need to find a way for patients to retain their dignity. Letting us wear scrubs like the doctors and nurses would be a nice start. After all, we are on the same level as they are in our everyday lives.
16
While I sympathize with the feeling of overexposure wearing hospital gowns can cause, the reason for requiring them is to allow the patient to be accessible for exams, procedures, treatments, etc., while allowing him or her to retain at least some minimal coverage of body areas not directly involved in the proceedings.
1
Unfair perhaps, but the caption under the photo should probably be "Dr. Michael Bennick, center, medical director for patient experience at Yale-New Haven Hospital, handles concerns about care, while he and his staff are caught ignoring the patient in the room" In this photo the patient seems a non-person that exists only as an object to be pointed at with a seeming lack of respect. Certainly for the photographer/photo editors, the patient was something to just cut out.
Doctors might have best intentions, but this photo shows a problem so common it is invisible. Everybody talks about the patient, but seldom to the patient, which is depersonalized into a medical problem at best, or a profit center at worst.
Doctors might have best intentions, but this photo shows a problem so common it is invisible. Everybody talks about the patient, but seldom to the patient, which is depersonalized into a medical problem at best, or a profit center at worst.
18
Perhaps. Just as likely that the patient was participating in the conversation, and was left out of the photo for reasons of confidentiality and privacy. Unfair perhaps.
5
Curious, the point about medical journals eschewing the words "suffer" or "suffering." Isn't the prohibition against these words also the policy of media outlets such as The New York Times?
4
Great article. It should be required reading for all hospital personal. Having been a patient in a number of hospitals, I have witnessed all of these things and have long wondered why doctors aren't required to spend 48 hours as a patient to see how it is living with near constant noise, being woken up to be poked and prodded at all hours of the day and night, etc. I think it would go a long way to making hospitals a place more conducive to healing.
9
I am glad to read that physicians are taking an approach that is "standard of care" for advanced practice nurses, like family nurse practitioners. Ask questions. Listen to patients. Respond to patients' suffering. Guaranteed satisfaction.
6
We need more doctors, and we need better doctors. How do I know this? Mistakes and absent-mindedness abound.
One of my doctors attempted to prescribe steroids twice, having forgotten that he had already prescribed them for me. I now believe that those drugs should be prescribed only as a last resort, by the way, but they are inexpensive. Had the doctor bothered to ask, I could have told him that I would be willing to pay for something else, but that is beside the point, since no one should have to suffer the often permanent side effects of steroids simply because the steroids are cheap and effective against the affliction concerned.
Another doctor discussed an unusual medical device with me at length. At my next visit, the doctor's reiterative line of inquiry revealed that that conversation had been completely forgotten.
The most telling thing for me, however, has been that those who did not do as well as my own children (who had no medical aspirations) in school are now nevertheless physicians, sometimes undoubtedly due to hard work, but also apparently because of affirmative action or personal connections. That a person's parent or other relatives or acquaintances are physicians or VIPs does not guarantee that that person has what it takes to manage others' health, and accepting students of dubious merit simply because of their skin color or ethnic background does not make sense either, given what is at stake for their prospective patients of any race or ethnicity.
One of my doctors attempted to prescribe steroids twice, having forgotten that he had already prescribed them for me. I now believe that those drugs should be prescribed only as a last resort, by the way, but they are inexpensive. Had the doctor bothered to ask, I could have told him that I would be willing to pay for something else, but that is beside the point, since no one should have to suffer the often permanent side effects of steroids simply because the steroids are cheap and effective against the affliction concerned.
Another doctor discussed an unusual medical device with me at length. At my next visit, the doctor's reiterative line of inquiry revealed that that conversation had been completely forgotten.
The most telling thing for me, however, has been that those who did not do as well as my own children (who had no medical aspirations) in school are now nevertheless physicians, sometimes undoubtedly due to hard work, but also apparently because of affirmative action or personal connections. That a person's parent or other relatives or acquaintances are physicians or VIPs does not guarantee that that person has what it takes to manage others' health, and accepting students of dubious merit simply because of their skin color or ethnic background does not make sense either, given what is at stake for their prospective patients of any race or ethnicity.
3
Actually we need more African American doctors. They speak ENGLISH. What we don't need are doctors who can't communicate with the patient. Some doctors from foreign countries have trouble speaking English well enough to communicate well. And elderly patients are often hearing impaired, which does not mix well with a heavy accent.
4
Your post reminds me of the old joke:
Q: What do you call a medical student who graduated at the bottom of his/her class?
A: Doctor
Q: What do you call a medical student who graduated at the bottom of his/her class?
A: Doctor
3
Doctors also need to concern themselves with the harm that they do, not through inattention, but through over-treatment, and in particular over-medication. The inattention that occurs after over-medication is the lack of listening and credence given to patient complaints about adverse effects.
Most glaring, because the numbers are so vast, is the prescription of statin drugs to by present "guidelines" over 40% of Americans over 45 years old. Most of these millions of patients are apparently healthy, but are at more than 7.5 risk of heart disease
Statins seem to reduce risk for most "qualifying" patients by 1 or 2%...over a ten year period. The adverse effect rate seems to be over 10%.
The suffering caused by adverse effects is mostly denied. Doctors generally get angry, rather than concerned, when a patient says that the doctor's treatment caused damage. Yet for many people, statins cause horrendous, permanent, untreatable damage and lifetime suffering.
Rare? Last week a technician at my doctor's visit printed out the obituary of a friend--statins, rhabdomyolysis, death late last year. Then to the gym, where a friend's legs have yet to recover at all after 6 months on statins, 4 months off. Then friends for dinner, both on statins, one with severe foot cramps that cause to get up multiple times a night. One day, four new (to me) cases of statin-caused suffering.
Ask around, or perhaps if on a statin, simply think about your own condition. Foot cramps, weakness/pain?
Most glaring, because the numbers are so vast, is the prescription of statin drugs to by present "guidelines" over 40% of Americans over 45 years old. Most of these millions of patients are apparently healthy, but are at more than 7.5 risk of heart disease
Statins seem to reduce risk for most "qualifying" patients by 1 or 2%...over a ten year period. The adverse effect rate seems to be over 10%.
The suffering caused by adverse effects is mostly denied. Doctors generally get angry, rather than concerned, when a patient says that the doctor's treatment caused damage. Yet for many people, statins cause horrendous, permanent, untreatable damage and lifetime suffering.
Rare? Last week a technician at my doctor's visit printed out the obituary of a friend--statins, rhabdomyolysis, death late last year. Then to the gym, where a friend's legs have yet to recover at all after 6 months on statins, 4 months off. Then friends for dinner, both on statins, one with severe foot cramps that cause to get up multiple times a night. One day, four new (to me) cases of statin-caused suffering.
Ask around, or perhaps if on a statin, simply think about your own condition. Foot cramps, weakness/pain?
5
Here's the problem, when physicians don't prescribe medications, they most often get negative ratings by these Press-Ganey surveys mentioned in the article. When physicians get negative ratings, they get penalized by hospital administrators. Patient satisfaction is tied to getting prescriptions -- too often for things patients don't need. So the reason that us doctors get angry is because we are in a no-win situation. When we give you the drugs and we are overtreating. When we don't give you the drugs and we get poor patient satisfaction scores. The use of the quantitative survey scores are part of the problem. The fact that the NY Times is citing them in the article is almost comical.
The truth of the matter is that happy and satisfied patients are not always healthy patients. There has to be a better way.
The truth of the matter is that happy and satisfied patients are not always healthy patients. There has to be a better way.
6
I'm surprised more RNs have not commented here. We are the current monitors to assure patient comfort and quality care and I agree with the comments that point out how difficult it can be sometimes. I've had wives of cancer patients call me to thank me but they add that hey have nothing good to say about their MD. I often felt caught between my advocacy for the patient I cared for and the MD who was making lots of money for corporate institutions. We collected data, we had talks and many nurses left. And nothing changed. Informed consent means just that, and every patient deserves to know ALL of their options. Many people are turning to the internet for evidence based treatments and then searching for the truly caring MD who cares for them more than their own ego or pocketbook.
14
Thank you. My guess is that you don't hear those words as often as you should.
1
Additional reply to A. Stanton, since I am only allowed one reply with limited space:
6. This is just blatantly false. There are many chronic problems. Doctors aren't God and we can't cure autoimmune conditions, for example.
7. Great idea. Who's going to pay for it? Are you willing to work for free? It's not greedy to expect to be paid for working. Consider how doctors are paid (insurance mostly)--where are salaries for office staff coming from? Insurance doesn't cover phone calls like this.
8. I've not heard this myself, but I agree.
9. Once again, re: home visits -- are you willing to work for free?
10. I know more arrogant businessmen and lawyers than doctors. This is a problem for a minority of doctors.
11. Try saying that after you've been sued as a doctor.
6. This is just blatantly false. There are many chronic problems. Doctors aren't God and we can't cure autoimmune conditions, for example.
7. Great idea. Who's going to pay for it? Are you willing to work for free? It's not greedy to expect to be paid for working. Consider how doctors are paid (insurance mostly)--where are salaries for office staff coming from? Insurance doesn't cover phone calls like this.
8. I've not heard this myself, but I agree.
9. Once again, re: home visits -- are you willing to work for free?
10. I know more arrogant businessmen and lawyers than doctors. This is a problem for a minority of doctors.
11. Try saying that after you've been sued as a doctor.
3
Just a mention to the other side of this equation....doctors and nurses need shorter hours and more support, fewer patients and trained auxiliary staff. I don't think that having residents work 18 hr days and catnap in lounges keeps their treatment techniques at optimum levels. Nurses who are dedicated should not work 12 hour shifts that often don't even allow for a lunch or bathroom break because their patients are critical. And the paperwork for all detracts from the medical and human attentions their patients need. We need more intermediate trained positions (medically knowledgable but not necessarily intereacting with patients) that can take care on the non-face-to-face treatment of patients so that doctors and nurses can administer with the skill and compassion that they took years training for.
5
Absolutely. The culture of the institutions causes a lot of suffering for medical staff also. Minimizing their suffering would help with their having enough time and discretion for them to do better on minimizing patient suffering.
2
There is no need to reinvent the wheel: Observe the processes at the Mayo Clinic Hospitals in Rochester, MN, and follow them.
A specially-trained physician's assistant is the information link for the team treating each pstient. At the beginning of rounds s/he briefs the team on the patient's status in a meeting room down the hall, then the *whole team* enters the patient's room, asks their questions, does whatever exam is needed, and the PA writes the key points on a large whiteboard directly in front of the patient's line of sight, including anticipated discharge. There's a place for family to write questions or requests. Nurses and aides focus on patient comfort, and the wellbeing of family accompanying the patient (e.g., food late at night).
If I need to be hospitalized, I want (somehow) to get there.
A specially-trained physician's assistant is the information link for the team treating each pstient. At the beginning of rounds s/he briefs the team on the patient's status in a meeting room down the hall, then the *whole team* enters the patient's room, asks their questions, does whatever exam is needed, and the PA writes the key points on a large whiteboard directly in front of the patient's line of sight, including anticipated discharge. There's a place for family to write questions or requests. Nurses and aides focus on patient comfort, and the wellbeing of family accompanying the patient (e.g., food late at night).
If I need to be hospitalized, I want (somehow) to get there.
5
A lightening bolt must have struct the medical community; their patients are human beings with feelings. Rene Descartes (17th Century) thought otherwise, the body and mind are distinct to themselves, and the continued thinking has brought us five centuries later to where doctors are now recognizing what has been avoided, suffering is a connected body experience. The question becomes, what other antiquated thinking do their practices entail?
3
An important consideration this article omits is the suffering caused by a health care system that puts profit first and patients last. Patients have to deal with an obstacle course of narrow networks, deductibles, copays, coinsurance, step therapy, tiered formularies, prior authorization, and the possibility of being driven into bankruptcy even with adequate insurance. The need for doctors to spend their time negotiating a parallel obstacle course, which includes justifying medical decisions to clerks in Bangalore cubicles, surely detracts from their ability to be attentive to patients.
Avoiding or relieving suffering requires personalized attention to a patient's needs. That includes taking time to listen to the patient's concerns. Unfortunately, that's contrary to the approach dictated by the MBAs who are ultimately in charge of our health care. They seek to maximize shareholder value by efficiently dehumanizing medical care, reducing it to standardized checklists and algorithms that can be implemented by computers and the clerks in Bangalore who read the resulting scripts to doctors. Doctors are subject to "metrics" that penalize them for taking the time to listen to patients, or to treat them as individuals.
If "suffering" could become a "quality metric" that contributes to cost reduction, the MBAs might be persuaded to add it to their checklists. But as long as shareholder value remains the primary focus of health care in this country, patients will suffer.
Avoiding or relieving suffering requires personalized attention to a patient's needs. That includes taking time to listen to the patient's concerns. Unfortunately, that's contrary to the approach dictated by the MBAs who are ultimately in charge of our health care. They seek to maximize shareholder value by efficiently dehumanizing medical care, reducing it to standardized checklists and algorithms that can be implemented by computers and the clerks in Bangalore who read the resulting scripts to doctors. Doctors are subject to "metrics" that penalize them for taking the time to listen to patients, or to treat them as individuals.
If "suffering" could become a "quality metric" that contributes to cost reduction, the MBAs might be persuaded to add it to their checklists. But as long as shareholder value remains the primary focus of health care in this country, patients will suffer.
15
My guess is that those patients who suffer less, recuperate faster. Qualitatively cheaper.
Suffering examples:
Patients asks "Will it hurt?". Doctor replies "It will be a little uncomfortable". Worse pain I have ever felt in my life, felt like someone was stabbing me repeatedly me from the inside. I was shouting and crying in pain. I was only given a Tylenol before and after.
Having a urinary catheter in for HOURS before a PET scan to drain/irrigate the bladder. They were running behind, but wanted to have me 'prepped and ready to go' so they left the catheter for hours in without any numbing anesthetic. Oh, then the computer lost my images and I had to do it again.
First day after surgery - vital signs every 2 hours, and blood draws every 2 hours. The whole night and never coordinated together.
Patients asks "Will it hurt?". Doctor replies "It will be a little uncomfortable". Worse pain I have ever felt in my life, felt like someone was stabbing me repeatedly me from the inside. I was shouting and crying in pain. I was only given a Tylenol before and after.
Having a urinary catheter in for HOURS before a PET scan to drain/irrigate the bladder. They were running behind, but wanted to have me 'prepped and ready to go' so they left the catheter for hours in without any numbing anesthetic. Oh, then the computer lost my images and I had to do it again.
First day after surgery - vital signs every 2 hours, and blood draws every 2 hours. The whole night and never coordinated together.
6
This article could not be more timely. My Brother in law is currently in the hospital and has a difficult condition to explain and predict( acute pancreatitus )
He was admitted to a local hospital in Tucson and because he has been there for over a week already we have been exposed to varying levels of care. What is interesting is my wife and I were instrumental in working with this same institution in helping them improve their patient satisfaction surveys and can see a difference in the doctors and nurses we worked with and the ones we did not. Just the simple act of being willing to listen carefully to what the patients concerns are makes a big difference. Before my wife and I intervened and got the right care for him he was wanting to switch hospitals.
Most hospitals are not designed with patient care or comfort in mind only how can they satisfy legal and monetary concerns.
This initiative could be very helpful to overall patient care.
He was admitted to a local hospital in Tucson and because he has been there for over a week already we have been exposed to varying levels of care. What is interesting is my wife and I were instrumental in working with this same institution in helping them improve their patient satisfaction surveys and can see a difference in the doctors and nurses we worked with and the ones we did not. Just the simple act of being willing to listen carefully to what the patients concerns are makes a big difference. Before my wife and I intervened and got the right care for him he was wanting to switch hospitals.
Most hospitals are not designed with patient care or comfort in mind only how can they satisfy legal and monetary concerns.
This initiative could be very helpful to overall patient care.
2
"Most hospitals are not designed with patient care or comfort in mind only how can they satisfy legal and monetary concerns."
Is it at all possible that hospitals are designed to take care of patients in the best way, to save the most lives, etc??
No, that is not at all possible, is it
Is it at all possible that hospitals are designed to take care of patients in the best way, to save the most lives, etc??
No, that is not at all possible, is it
My daughter was sent to Westchester County Medical Center for evaluation after a sledding accident. She had CT scan, MRI, multiple doctors telling us different things. She was never admitted, but kept two nights for observation. When we were told she had no spine injury and we wanted to take her home before the second night, we were threatened with DCF for removing a child against medical advice, even though they hadn't yet told us why they wanted to keep her for another night.
Yesterday, my insurance company sent an itemized list of expenses related to the claim; included were an "Ancillary Charge" for $3000; "Facility Charges" for $23,000; and three "Service Charges" for $3100, on top of the labs, scans and ER fee - $29,000 worth of vaguely defined charges. Given how much she was ignored during her 48 hour stay in limbo, and how much we had to chase doctors down for information about her condition, how can you not wonder if the medical advice you get is designed to generate revenue rather than treat the patient?
Yesterday, my insurance company sent an itemized list of expenses related to the claim; included were an "Ancillary Charge" for $3000; "Facility Charges" for $23,000; and three "Service Charges" for $3100, on top of the labs, scans and ER fee - $29,000 worth of vaguely defined charges. Given how much she was ignored during her 48 hour stay in limbo, and how much we had to chase doctors down for information about her condition, how can you not wonder if the medical advice you get is designed to generate revenue rather than treat the patient?
30
My doctor is very good. He is retiring, I am looking for one as good as he is.
1
I’m someone who spent 3 long months in a hospital and being woken up every two hours was not the worst of it. The caregivers and the nursing assistants are at the bottom of the pay scale so the patients receive the brunt of their dissatisfaction. The lack of team work and a hierarchical pecking order with doctors at the top is the major problem.
3
Interesting. There is some good information here - It is also true that frequently a doctor taking the time to explain why he made a particular decision regarding a patient's treatment means more to the patient than the decision itself. Some are more concerned whether the decision really was the best decision and the patient is unlikely to be able to judge that. Much of this is good practice though - such as the example of drawing blood at 4:00 AM just in case. Discussing patient care where it can be overhood? I was once treated in an emergency room on the Oregon coast. The emergency room was too small for privacy - we could hear what was going on behind one curtain or the other curtain. A medical facility was doing its best with the size of hospital that could be maintained with the small population in the region. We can't expect medical experts and large partitioned walls in every region of the US.
Consider how great health care would be if all doctors, nurses and other practitioners simply treated their patients as they themselves would like to be treated.
Becoming a patient is the best eye-opener as to how health care should be practiced. Of course, you can't require medical personnel to be sick and admitted to a hospital. But even simulations can be surprisingly enlightening -- for example, having health care practitioners put on patient gowns, lie in hospital beds, and be talked down to by those who hover above them.
A wonderful movie that portrays what it's like to move from practitioner to patient is "The Doctor" from 1991. It's based on a real doctor's experience and shows just about every error that practitioners can make in treating patients insensitively -- as well as portraying better alternatives.
Becoming a patient is the best eye-opener as to how health care should be practiced. Of course, you can't require medical personnel to be sick and admitted to a hospital. But even simulations can be surprisingly enlightening -- for example, having health care practitioners put on patient gowns, lie in hospital beds, and be talked down to by those who hover above them.
A wonderful movie that portrays what it's like to move from practitioner to patient is "The Doctor" from 1991. It's based on a real doctor's experience and shows just about every error that practitioners can make in treating patients insensitively -- as well as portraying better alternatives.
60
Sometimes reducing patient suffering can be as simple as enforcing existing hospital policies, for example, visiting hours and use of television in multipatient rooms.. In one of my 88 yr. old aunt's hospitalizations for a surgical procedure, she was kept awake into the night by the many members of her roommate's family, who were allowed to remain in the room until 10 pm and beyond, in clear violation of visiting hours.
In another instance, a friend recuperating from cancer surgery had to obtain an eyeshade and ear plugs so that she could sleep at night because here roommate insisted on having the television on all night.
Private rooms help this type of suffering, and I understand most new construction recognizes this.
In another instance, a friend recuperating from cancer surgery had to obtain an eyeshade and ear plugs so that she could sleep at night because here roommate insisted on having the television on all night.
Private rooms help this type of suffering, and I understand most new construction recognizes this.
50
Private rooms are not ideal in this era of shortage of nurses. At least in a double room, there is a much better chance of someone getting a nurse or doctor to the bedside should an emergency occur, or the patient be unable to use the call button properly. It is fine in places such as Miami, where a large part of the patient population is of a culture where families take turns ensuring a patient is never left alone, but otherwise - not a great idea except for the very hardy who, presumably, wouldn't be hospitalized at all.
Beth Israel Deaconess supplies ear plugs to in-patients!
1
I totally agree that private rooms will help alleviate unnecessary suffering. Recovering from complicated abdominal surgery, I had to share a room with a dying roommate who was in so much pain and suffering that she cried and kept her TV all night, which I certainly did not begrudge her. I am still haunted by her suffering, which added to my own suffering.
4
Press Ganey surveys are junk science at its worst. They present data as statistics but have no statistical validity. As others have pointed out, any statistical tool that ranks a doctor as the worst in the country one month and the best, two months later, is statistical snake oil.
The whole game of hospitals vying to be in the 90th percentile or above is akin to Garrison Keillor's Lake Wobegon, where all the children are above average.
Worst of all, high patient satisfaction scores have been associated with higher patient mortality! Fenton JJ, et. al. Arch Intern Med. 2012;172(5):405-411. "Adjusting for sociodemographics, insurance status, availability of a usual source of care, chronic disease burden, health status, and year 1 utilization and expenditures, respondents in the highest patient satisfaction quartile (relative to the lowest patient satisfaction quartile) had lower odds of any emergency department visit (adjusted odds ratio [aOR], 0.92; 95% CI, 0.84-1.00), higher odds of any inpatient admission (aOR, 1.12; 95% CI, 1.02-1.23), 8.8% (95% CI, 1.6%-16.6%) greater total expenditures, 9.1% (95% CI, 2.3%-16.4%) greater prescription drug expenditures, and higher mortality (adjusted hazard ratio, 1.26; 95% CI, 1.05-1.53)." Now those are real statistics!
The whole game of hospitals vying to be in the 90th percentile or above is akin to Garrison Keillor's Lake Wobegon, where all the children are above average.
Worst of all, high patient satisfaction scores have been associated with higher patient mortality! Fenton JJ, et. al. Arch Intern Med. 2012;172(5):405-411. "Adjusting for sociodemographics, insurance status, availability of a usual source of care, chronic disease burden, health status, and year 1 utilization and expenditures, respondents in the highest patient satisfaction quartile (relative to the lowest patient satisfaction quartile) had lower odds of any emergency department visit (adjusted odds ratio [aOR], 0.92; 95% CI, 0.84-1.00), higher odds of any inpatient admission (aOR, 1.12; 95% CI, 1.02-1.23), 8.8% (95% CI, 1.6%-16.6%) greater total expenditures, 9.1% (95% CI, 2.3%-16.4%) greater prescription drug expenditures, and higher mortality (adjusted hazard ratio, 1.26; 95% CI, 1.05-1.53)." Now those are real statistics!
8
Doctors are always evaluated and rated, though mechanisms such as patient surveys, computer-based monitoring of productivity, and automated review of medical records. All too frequently this does more harm than good.
This article describes real issues with patient care: excessive wait times, patient feelings of “being lost in the shuffle,” etc.
Too often it’s the physician that bears the brunt of the blame, when the problems may not be his or her fault. Today, most physicians are employees of large hospital corporations. The hospitals often place strict standards on productivity, requiring physicians to see so many patients per hour, and limiting the time available to review a lengthy medical chart. It’s the hospitals, not the doctors or nurses, that control things like scheduling and wait times.
Patient medical outcomes are also measured. But important factors go beyond the quality of care; patients who start off sicker, or may be non-compliant for economic or social reasons, tend to have poorer outcomes. If physicians are judged by outcomes, doctors who see the sickest and poorest patients may be unjustly penalized.
Patients often lack the medical training to judge whether they are receiving good medical advice. Surveying patients on the medical quality of their care may not give meaningful results.
So, keep those surveys coming, but be wise about how the results are interpreted and used. In today’s medicine, it’s often physicians that get lost in the shuffle.
This article describes real issues with patient care: excessive wait times, patient feelings of “being lost in the shuffle,” etc.
Too often it’s the physician that bears the brunt of the blame, when the problems may not be his or her fault. Today, most physicians are employees of large hospital corporations. The hospitals often place strict standards on productivity, requiring physicians to see so many patients per hour, and limiting the time available to review a lengthy medical chart. It’s the hospitals, not the doctors or nurses, that control things like scheduling and wait times.
Patient medical outcomes are also measured. But important factors go beyond the quality of care; patients who start off sicker, or may be non-compliant for economic or social reasons, tend to have poorer outcomes. If physicians are judged by outcomes, doctors who see the sickest and poorest patients may be unjustly penalized.
Patients often lack the medical training to judge whether they are receiving good medical advice. Surveying patients on the medical quality of their care may not give meaningful results.
So, keep those surveys coming, but be wise about how the results are interpreted and used. In today’s medicine, it’s often physicians that get lost in the shuffle.
10
From the article..."The next quarter, he was rated in the upper 90s. The big difference was slowing down and listening to patients, answering their questions."...
My Mother's Family Practitioner just quit the Premier Medical Network in Ohio. Premier lowered the allowed time for appointments to 7 minutes. They used to allow a whopping 15 minutes! Mom's doctor attributes the new policy to the new healthcare system in the US. After being lectured by Premier because he spent more time with his patients and receiving poor reviews from the company, he chose to become an in-house doctor only for one of the hospitals in Dayton.
My Mother's Family Practitioner just quit the Premier Medical Network in Ohio. Premier lowered the allowed time for appointments to 7 minutes. They used to allow a whopping 15 minutes! Mom's doctor attributes the new policy to the new healthcare system in the US. After being lectured by Premier because he spent more time with his patients and receiving poor reviews from the company, he chose to become an in-house doctor only for one of the hospitals in Dayton.
6
In the early fifties I worked as a night laboratory technician in a city hospital while attending college. Whenever I was awakened at three or four in the morning to draw blood from a patient to perform a lab test I always called the Doctor with the test result. It was amazing how soon only true emergency tests were my main workload. No surprise for me to now see the same suggestion for relieving patients from being awakened for a routine blood test for the convenience of the Doctor. Restful sleep is a good therapeutic and should be a high priority in every hospital to the extent possible.
18
My father, recently hospitalised at an NHS hospital in the UK, had a quite different experience from many of those described here. He had fallen and broken his hip (He's 88 yrs old, with an NHS pacemaker). He was taken to hospital and had a new hip two days later.
The hospital stay was in an 8 bed trauma ward. No TV, no doors. The nursing station was opposite the entrance to the ward, and the nurses faced the entrance. They were attentive. The only computer was for administrative work, and used by an administrator. Visiting hours were restricted, and no more than two visitors per patient (not rigidly enforced). As far as I can tell, the routine of the hospital was intended to let people sleep as much as they needed to, and not have it interrupted all the time. Visiting hours were after surgical rounds, but I met the surgeons on a Sunday when they were making what for them was a routine check up on all their patients.
The only hangup on discharge was arranging for follow-up care and proper transport and home modifications.
It was about as different as could be from a US hospital stay, which I and various family members have had the misfortune to experience.
The hospital stay was in an 8 bed trauma ward. No TV, no doors. The nursing station was opposite the entrance to the ward, and the nurses faced the entrance. They were attentive. The only computer was for administrative work, and used by an administrator. Visiting hours were restricted, and no more than two visitors per patient (not rigidly enforced). As far as I can tell, the routine of the hospital was intended to let people sleep as much as they needed to, and not have it interrupted all the time. Visiting hours were after surgical rounds, but I met the surgeons on a Sunday when they were making what for them was a routine check up on all their patients.
The only hangup on discharge was arranging for follow-up care and proper transport and home modifications.
It was about as different as could be from a US hospital stay, which I and various family members have had the misfortune to experience.
8
According to Private Insurance companies and their Wall Street partners Universal Socialized Healthcare in the UK is worst than hell itself. You have to wonder if those benevolent capitalists may have ulterior motives to make such condemnations?
3
I literally learned this axiom at my father's knee(he was an ophthalmologist) : Fix and cure when possible, but give comfort always.
8
Here's how to avoid suffering. Avoid hospitals.
9
I just survived a two-night hospital stay after a major surgery.
I wanted to get out of bed periodically to sit, stand, or walk a bit, but I had a wire attached to every body part. When I would try to get out of bed, an alarm would go off, yet no nurse would come. Ironically, the nurse told me that this was a safety alarm to prevent me from falling out of bed. I asked how this alarm would be helpful if I was laying on the floor and no one responded.
Once, I waited an hour and a half for the nurse to give me my pain medication. My pain was out of control by the time she gave it to me.
Another time, my bladder was getting very full and I repeatedly asked for them to put in a catheter, which my doctor had already approved. Again, it took an hour for this to happen.
I feel like I have PTSD from this hospital stay.
I wanted to get out of bed periodically to sit, stand, or walk a bit, but I had a wire attached to every body part. When I would try to get out of bed, an alarm would go off, yet no nurse would come. Ironically, the nurse told me that this was a safety alarm to prevent me from falling out of bed. I asked how this alarm would be helpful if I was laying on the floor and no one responded.
Once, I waited an hour and a half for the nurse to give me my pain medication. My pain was out of control by the time she gave it to me.
Another time, my bladder was getting very full and I repeatedly asked for them to put in a catheter, which my doctor had already approved. Again, it took an hour for this to happen.
I feel like I have PTSD from this hospital stay.
24
I spent one of my most miserable times one night in a hospital. The staff was talking, joking, ordering coffee all night. I was woken up (although I never slept) all the time for some thing. It was noisy and inconsiderate and thoughtless.
6
Why was it so drastically hard to realize that waking the patient up in the middle of the night is not always necessary and greatly disturbs the patient? Some doctors do often overlook and that causes patients to suffer, sadly.
10
Good to hear about these approaches working for the patients--someone should show this article to the administrators and board members of Lenox Hill hospital in New York-they need it!! Hope they will read it and make the necessary changes to insure their patients come first!
1
I agree with MIMA (an RN ?)--there is no need for an expensive PressGaney survey of patient dissatisfaction. Being decent & attentive should be woven into good practice- esential to getting a sound history or careful monitoring of a patient's status. The clumsy splitting of medical care & bedside manner has made it seem like an MD could be competent but oblivious. Wrong.
Of course, some interpersonally limited MDs are scared of emotional communication and develop defensive disdain. There is also so much time pressure that there is the illusion that paying real attention to a patient's experience will be quicksand or engulf the MD in trivia.
Patients collude--trying to be 'good' or liked- afraid to tell the truth lest they alienate the MD they depend on.
Perhaps ratings that shame an institution can be incentives for improving MD competence, but it is unlikely a hospital administrator or a PR firm can design a truly useful protocol.
Of course, some interpersonally limited MDs are scared of emotional communication and develop defensive disdain. There is also so much time pressure that there is the illusion that paying real attention to a patient's experience will be quicksand or engulf the MD in trivia.
Patients collude--trying to be 'good' or liked- afraid to tell the truth lest they alienate the MD they depend on.
Perhaps ratings that shame an institution can be incentives for improving MD competence, but it is unlikely a hospital administrator or a PR firm can design a truly useful protocol.
2
" Patient " in Latin means " to suffer ". So what's the big deal with using the term suffer?
4
Isn't it amazing that it's taken so many decades to figure out that a hospital can be quiet in the halls at night? and that a 4am blood draw is totally unnecessary? and that drugs don't have to be administered orally when the patient is asleep?
Not only is this amazing, but it is also amazing that a study needed to be done to inform parents that a nap for their toddlers interferes with their sleep. OMG. My tax dollar can be better spent. On better medical care.
Not only is this amazing, but it is also amazing that a study needed to be done to inform parents that a nap for their toddlers interferes with their sleep. OMG. My tax dollar can be better spent. On better medical care.
3
I miss the days when we had GP's as primary physicians who knew or had access to our complete medical history and with whom we had a relationship with. They would explain everything and would listen to our questions or comments. Today you get shuffled from specialists to specialist and sometimes the right hand does not know what the left hand is doing and the resultant cumulative billings are staggering.
4
Recently I was a new patient in a Cardiologist's office. My suggestion is this--now that the Doctor is "prisoner" to his computer and looks at the computer 90% of the time the patient is in the room, and 10 % of the time establishing eye contact with the patient, why not have the desks that the Dr. places his computer on face the patient's chair and force the Dr. to look directly at the patient. As a retired private practice nurse, this could at least make the Doctor actually look at the patient more, and hopefully make the patient feel as though he is something more that just a disease.
19
Irwin Press is an anthropologist.He approaches a hospital setting as a culture of humans.In any successful culture, humans need to interact with respect and understanding.Patients,their families, nurses and doctors need to collaborate with one another--not jockey for power--to make the culture work.When I had my brain tumor,I chose a surgical team that was comfortable being called by their first names.Radical?No.We were collaborative partners-they the doctors and nurses,but it was my tumor.In traditional societies, shamans heal importantly by reinforcing the sense of community and helping the sick feel part of it,not alienated.Everyone benefits during hospital confinement when doctors, nurses and administrators understand that they need to help create a comfortable healing community in hospitals. When patients feel comfortable enough in the hospital community to feel empowered to participate in their own care, on an equal footing instead of feeling like they are enslaved by a system that treats them as pawns, they are happier and heal. Simple changes like those included in this article--respecting needed sleep & privacy--help.Symbolic changes such as providing soothing colors, softer light, quiet music & warm instruments & encouraging doctors and nurses to sit down to look patients in the eye when talking to them rather than standing like stone idols waiting for tribute are essential.During a Mexican hospital stay, doctors and nurses touched me as if I mattered. A revelation.
5
Before entering a hospital I could 1) eat, 2) sleep, 3) change position and location, 4) use a bathroom (elimination/bathing) and 5) initiate conversations and activities. So, I have to continue some of those things - make sense of what happens to me and what I can still do for myself - while in a hospital.
I don't remember anything on all those forms I signed that relinquishes my control of all my activities when I am still able to do some things for myself.
In the ER, the OR, or ICU, I know I will and often need to relinquish most or all control. Everywhere else, and for many activities in my care, give me a chance to retain some autonomy, my dignity, my identity as a person.
Oh, and hire, train and staff with many more nurses - they are there with me 24/7. They are my link to reality and essential part of my recovery.
Teach me something I can and must do for myself throughout my stay and up to the time of discharge. Do NOT put all of that on one nurse for 15 minutes with as many sheets of paper I should "read when at home."
Oh, and try an little experiment when I am able - give me a tablet (electronic) linked to parts of my record, my care, my team. Make me a part of what is happening to me. No "surveys" after, no TV during.
I don't remember anything on all those forms I signed that relinquishes my control of all my activities when I am still able to do some things for myself.
In the ER, the OR, or ICU, I know I will and often need to relinquish most or all control. Everywhere else, and for many activities in my care, give me a chance to retain some autonomy, my dignity, my identity as a person.
Oh, and hire, train and staff with many more nurses - they are there with me 24/7. They are my link to reality and essential part of my recovery.
Teach me something I can and must do for myself throughout my stay and up to the time of discharge. Do NOT put all of that on one nurse for 15 minutes with as many sheets of paper I should "read when at home."
Oh, and try an little experiment when I am able - give me a tablet (electronic) linked to parts of my record, my care, my team. Make me a part of what is happening to me. No "surveys" after, no TV during.
6
When love and compassion overcome the love of money and prestige, we will have more compassionate healthcare. We have "money centered" medicine in this country. The "First do no harm...," has metastasized into "First do no harm to the bottom line."
7
Well, I wouldn't call this "suffering" per se just the medical system as it is currently formatted. Years ago I was in a 23-hr ICU and I kept waking up because staff were having a gab session talking and laughing loudly at the nurses' station. Only the really seriously ill patients got a room of their own. There are many indignities at a hospital. Most of it is because of budget cuts to health care funding (in Canada) or the drive for profit (in the US). These days it is not unusual to see patients in the hallways on stretchers near busy clinics. All of our major hospitals have ongoing campaigns soliciting public donations. I find that after I have been admitted as patient it takes me two days to recover from the experience.
4
As a doctor, my 2 hospitalizations taught me what matters. Sleep, not being treated like an object by doc/nurse/tech/anyone who moved me for any reason post-op. Docs and nurses who don't look you in the eye. I could go on. I think there are good docs/nurses and bad, but I avoid hospitalizations if I can. I don't work in a hospital so perhaps docs are worse than nurses. Or maybe being a doctor in the hospital brings its own kind of treatment. But at least I understand somewhat when my patients tell me about their experiences. The best training is being a patient yourself.
10
I am very leery of surveys and usually refuse to participate. Generally, they seem designed to reinforce positive feelings on the part of the questioners, not to generate information that might lead to improvement. They should be designed carefully, but often they are not.
There also has to be a commitment to acting on the results. Years ago, my company had everybody fill out a survey about management. The outcome was a shocking, universal condemnation. In panic mode, a great program of response was rolled out. Its goal was quite clearly to improve the results of the next survey. The underlying problems were not addressed.
There also has to be a commitment to acting on the results. Years ago, my company had everybody fill out a survey about management. The outcome was a shocking, universal condemnation. In panic mode, a great program of response was rolled out. Its goal was quite clearly to improve the results of the next survey. The underlying problems were not addressed.
4
My husband spent a total of 4 and a half months in the hospital and "rehab" and what the doctors and the staff just refuse to acknowledge is the emotional and mental toll this takes along with the complete physical toll. Imagine no eating or taking a shower for that long. After a while it seemed that we were in prison and would never get out and resume our lives. The constant lack of sleep and privacy and student doctors and nurses interfering and prodding. Physical therapists who did really nothing. Pressing the call button for help and no one responding for 10 or 15 minutes. At shift change, absolutely no nursing care for up to an hour while the nurses discussed patient care. Constant noise and total lack of personal control. When the patient is nearing discharge, vultures from nursing homes lurking around trying to recruit patients for their facilities and invading patient's privacy by reading their medical records without permission. The entire system is not designed for patient care. Rather it is designed for the convenience of the staff and to make as much money as possible. It costs a fortune and is a disgrace. No one can safely be hospitalized without a family member or friend present at all times to monitor care and advocate for the patient. Otherwise you are risking your life.
10
I am sure that the doctors "just refuse to acknowledge is the emotional and mental toll this takes". What a complete misrepresentation of any imaginable situation.
2
Patient satisfaction has actually been a focus of hospital quality improvement efforts all across the country for some years now, partly because the Center for Medicare and Medicaid Services (CMS) has begun linking Medicaid/Medicare reimbursement to various quality measures, including scores on patient satisfaction surveys. Having worked in a large urban hospital that made extensive efforts to improve its patient satisfaction scores, with only moderate success, I've come to believe that truly considerate, attentive patient care can only be achieved in a culture in which healthcare is seen as a basic right and hospitals are not expected to be financially self-sustaining. Many factors contribute to the way physicians and other staff relate to patients, but one of them is the heavy workload, on all clinical and administrative levels, that arises from the current economic model. The constant pressure to be more and more productive, with the same or fewer resources, prevents staff from spending more time with patients, thwarts efforts to implement and maintain constructive change (because it's very time-consuming and may not immediately increase revenue), discourages meaningful performance evaluation (especially in situations where unions are very powerful and/or vacant positions can't be easily filled), keeps the focus on numbers rather than on lived experience, and creates a stressful work environment in which staff typically receive little psychological support.
5
If only we could join the civilized world and have cradle-to-grave healthcare, our costs would go down, our life expectancy would go up, and we would have better outcomes. Is it Unamerican to take the profit motive out of healthcare? To the end of my days, I will never understand why Republicans are so keen to take away their constituents' healthcare. Is it just Schadenfreude, or a desire to sacrifice their constituents' health in order to get at that uppity crossbreed in the White House, the one who got elected twice with the biggest popular majorities since 1980?
15
I have witnessed as staff member how hospitals focus on patient satisfaction or any other measure that may increase their income, but that approach is generally disconnected from providing good care. It is just as it is in politics, if a politician panders to the people with entertainment and support of their hate wars that politician does not have to do work that improves the salaries and working conditions of his/her constituents, and that way he/she will not offend his/hers actual corporate owners who pay for his perks and reelection campaigns.
2
This is such a welcome development. In 1987 I had a bone marrow transplant (BMT) for leukemia and in 1990 a relapse followed by several clinical trials. I’ve long told anyone who would listen that medical care itself is a significant source of suffering. Examples include, “Oh it does not hurt that much,” and innumerable instances of not being given information I asked for. In part to address this suffering (and for other reasons) I started one of the first Internet patient-to-patient resources, BMT-Talk, in 1996. This list and countless others like it have helped patients, family members, and others address “iatrogenic suffering” (my term) with the help of others who have had similar experiences. Here are a couple of reflections for the Dr. Bennick and others leading this promising effort:
- It’s critical to remember that different people are hurt by different aspects of medical professionals’ interaction with them. For me the hot button was not being listened to. For others it is quite different. This knowledge has to be built into training and change efforts..
- Don’t forget that other patients (on the Internet and other forums) can be an enormous source of support to your patients. Not every person wants to talk with other patients but for those who do it can be extraordinarily healing.
Thank you to Dr. Bennick for finally addressing what many patients have been saying for quite a long time and good luck with your efforts.
Laurel Simmons, Founder, BMT-Talk
- It’s critical to remember that different people are hurt by different aspects of medical professionals’ interaction with them. For me the hot button was not being listened to. For others it is quite different. This knowledge has to be built into training and change efforts..
- Don’t forget that other patients (on the Internet and other forums) can be an enormous source of support to your patients. Not every person wants to talk with other patients but for those who do it can be extraordinarily healing.
Thank you to Dr. Bennick for finally addressing what many patients have been saying for quite a long time and good luck with your efforts.
Laurel Simmons, Founder, BMT-Talk
26
My father suffered a "closed-head" brain injury in a car collision. After surgery to remove the subdural hematoma he developed, he developed a post-surgical infection--hospital acquired, that required 2 additional surgeries. The area right next to your brain is a terrible place to suffer an infection, and the months of treatment he endured as a result of this infection amounted to torture. One bad episode involved a an MRI scan before which the technician failed to remove a drain installed at his surgical site. "It was EXCRUCIATING!" he told me.
When he died 5 months after the first surgery, I felt as if he had been tortured to death.
The "best healthcare system in the world," as someclaim we have, should include stringent infection control procedures to reduce hospital-borne infections like the one my father developed, technicians who look carefully at every patient before any procedure to make sure anything that might cause pain--like a surgical drain--has been removed, doctors who don't rush by once a day, deliver bad news to someone with brain damage while they're alone and scared, and then angrily refuse to repeat what they told him because "I already discussed this with your father" (who is suffering from brain damage at this point), meals that aren't awful, a way to relief other patients in a 30-room unit from hours of ceaseless bellowing from a brain-damaged patient in one of the rooms--a truly frightening and heart-rending sound--and basic human consideration.
When he died 5 months after the first surgery, I felt as if he had been tortured to death.
The "best healthcare system in the world," as someclaim we have, should include stringent infection control procedures to reduce hospital-borne infections like the one my father developed, technicians who look carefully at every patient before any procedure to make sure anything that might cause pain--like a surgical drain--has been removed, doctors who don't rush by once a day, deliver bad news to someone with brain damage while they're alone and scared, and then angrily refuse to repeat what they told him because "I already discussed this with your father" (who is suffering from brain damage at this point), meals that aren't awful, a way to relief other patients in a 30-room unit from hours of ceaseless bellowing from a brain-damaged patient in one of the rooms--a truly frightening and heart-rending sound--and basic human consideration.
1
Of course inattentive care cannot be in the best interests of patients, but the headline of the piece, "Doctors Strive to Do Less Harm by Inattentive Care," could be misleading.
3
So true. When I first saw this headline I thought "Hmm, they're saying the less doctoring, the better the patient outcome." Well, I'm sure that's sometimes true.
2
I'm glad for this article, but it is so late in coming. The harm and suffering caused by the medical establishment is huge. I avoid going to the doctor and know others who do as well. Much of these issues have to do with the culture at a certain hospital or doctors office. Some are great, but too many are horrid.
After 20 years I still regret having my babies at a hospital where the culture among the nurses was to be antagonistic to their patients. The nurses treated women going through labor like they were an affront to them, refusing to give normal supplies after labor meant to alleviate suffering, because their first response was to be catty and antagonistic. I fled the hospital 12 hours after giving birth because of the constant disrespect, the 25 visits by staff into the room to change the trash can, etc and after one of the nurses hovered a clip board over my newborn while filling out a form. This was the treatment I received after expressing concerns to the hospital years before.
After 20 years I still regret having my babies at a hospital where the culture among the nurses was to be antagonistic to their patients. The nurses treated women going through labor like they were an affront to them, refusing to give normal supplies after labor meant to alleviate suffering, because their first response was to be catty and antagonistic. I fled the hospital 12 hours after giving birth because of the constant disrespect, the 25 visits by staff into the room to change the trash can, etc and after one of the nurses hovered a clip board over my newborn while filling out a form. This was the treatment I received after expressing concerns to the hospital years before.
43
I had similar experiences when I had a child. The comments here from nurses show what I think is often going on: nurses carry a huge grudge around with them, and they often use this against their patients.
3
This article speaks many truths about suffering. It is a shame we have to pay for such obvious advise. Unfortunately, many people "suffer" from self induced poor diets, lack of excerise, use of intoxicants and other self inflicted ills. My life experiences suggests that people who damage themselves are more concerned than most about other's persevied wrongs towards them.
Let me guess you are a doctor? I got news for ya bub my "apparent" condition is due to doctors and medical staff like yourself who assume in advance and then treat that assumption rather than the patient.
Your perspective lacks perspective. It is much too complex to simplify as you have, suffice it to say that most issues of failure to care for ones self involves some form of self medication or dissociation in order to cope with an issue they cannot solve.
You know the very purpose of medicine, to solve problems people cannot solve on their own.
Your perspective lacks perspective. It is much too complex to simplify as you have, suffice it to say that most issues of failure to care for ones self involves some form of self medication or dissociation in order to cope with an issue they cannot solve.
You know the very purpose of medicine, to solve problems people cannot solve on their own.
3
Patients and the people who care for them suffer unnecessarily through illness, suffer the system, experience it as arbitrary and mean. For twenty-five years, the Arnold P. Gold Foundation has focused on making sure the opportunity for the critical, intimate relationship between clinician and patient is not lost. If we all acknowledge that the core of healthcare is compassion, the relationships that minimize suffering - between doctor and patient, nurse and doctor, patient and trainee, patient and staff - will cure the system and end the suffering induced by it.
4
Michael Bennick has always put his patients first...listens to team members' concerns, answers their questions, and is respectful when trying to expedite a good treatment plan for the patient. It looks like the rest of the medical world is trying to come up to his level of care. Good for all of us and give us the strength and intelligence to make our care more compatible with problem solving and comfortable adherence to , "Do no harm."
The bottom line is that we need to spend more time with patients, which is increasingly impossible. Consider a hospitalist, who is capped at a maximum of 15 patients. Spending an hour with each one would be ideal but it is not feasible.
32
The "hospitalist" is an unnecessary position. Everything necessary to run medicine well and profitably existed in the 1930's. Everything we have today is the construct of folks trying to maximise profit one way or another.
4
I somewhat agree, however medicine is vastly more complicated than it was in the 1930s. That has to be taken into account.
1
I gave you a thumbs up but I do not agree that "complexity" of medicine is a factor. Treatments by the time the doctor is ordering them or applying them pretty much all the complexity is worked out and standardised before a treatment is brought into use.
None of it comes close to justifying the assembly line impersonal and often abusive application of medicine by people supremely uninterested in the patient that has taken place in American Medicine.
None of it comes close to justifying the assembly line impersonal and often abusive application of medicine by people supremely uninterested in the patient that has taken place in American Medicine.
As a nurse practitioner, I have always been taught that treating the person--not just seeing them as their disease--is what true caring is all about. Acknowledging and validating a patient's suffering, however they experience it, is a major part of their care. I am puzzled as to why this seems like a major breakthrough...to alleviate suffering in my view, should be the top concern of all medical workers.
15
You mean to tell me that the triumph of the mellow Boomers' generational mantra--"don't sweat the small stuff, and it's ALL small stuff"--is a national disaster in medicine, too? Who'd have thunk it?
I was having outpatient surgery for a growth on top of my big toe which was making it hard to wear shoes. The nurse called me the day before to give me instructions along with the usual "no makeup" order. Feeling very insecure without makeup, I got out of my clothes and into the hospital gown and settled on the bed to wait for the operation. The anesthesiologist came into the room, looked at me and the first words out of his mouth were "YOU HAVEN'T AGED WELL, HAVE YOU?" Then he proceeds to tell me that he will be taking care of the person in the next room--his assistant would take care of me. I requested not to be knocked out since I was only have a minor operation on my toe. He assured me that I was absolutely ridiculous and I WOULD be asleep during the operation.
I felt humiliated but with shaking hands I settled back on the bed to read my newspaper, dropped the newspaper, grabbed for it and tore the IV out of my arm, blood flowing all over. I made my way to the door, opened it to see eight nurses seated around a table nearby and repeatedly asked for help while they ignored me. Finally the older nurse of the group looked up, came over and assisted me while the rest still pretended I wasn't there.
This was such a surreal experience and I made sure that the hospital administration knew about the incident as well the anesthesiology group and the operating doctor. Their response was this doc was such a "kidder", just likes to joke all the time. Really.
I felt humiliated but with shaking hands I settled back on the bed to read my newspaper, dropped the newspaper, grabbed for it and tore the IV out of my arm, blood flowing all over. I made my way to the door, opened it to see eight nurses seated around a table nearby and repeatedly asked for help while they ignored me. Finally the older nurse of the group looked up, came over and assisted me while the rest still pretended I wasn't there.
This was such a surreal experience and I made sure that the hospital administration knew about the incident as well the anesthesiology group and the operating doctor. Their response was this doc was such a "kidder", just likes to joke all the time. Really.
20
As a daughter caring for a hard-of-hearing and extremely forgetful 83-year-old mother, who also has diabetes requiring self-administered insulin injecttions at night before bed, I can tell you I have had to speak to her physician numerous times over the past few years to follow up on her regular office visits with him. Sher seems to be shy and does not communicate new symptoms or concerns with him until we have to call the emergency line on weekends.
He could be asking lots more questions when she is in the office. I live 180 miles away and find he does not seem to question her much. We had to bring her diabetes to his attention ourselves, after months of increasing dizziness, disorientation, etc. Given her age and his general patient population, I do not know why he did not diagnose her months earlier. Same goes for current conditions.
He could be asking lots more questions when she is in the office. I live 180 miles away and find he does not seem to question her much. We had to bring her diabetes to his attention ourselves, after months of increasing dizziness, disorientation, etc. Given her age and his general patient population, I do not know why he did not diagnose her months earlier. Same goes for current conditions.
3
Maybe because dizziness and disorientation are not classical presenting symptoms of diabetes
As someone who moved to Utah several years ago, I can't say what the University of Utah was like before the change, but since they've been caring for my family they've been nothing short of spectacular. Every encounter with that health system has been a joy. I've never filled out a single form in their office (they do it all for you), my medical records are easy to access, I find the doctors friendly, compassionate and knowledgeable, willing to listen to me but not just giving me any medication I want, up on the latest research, and willing to spend extra time with me. The nurses, admin, and phlebotomists are skilled and kind. Billing has worked with me many times when my insurance was being difficult. My only complaint would also be long waits for routine appointments, but I don't mind if it's because the doctor is spending a lot of time with patients, including me. I've never had a long wait for emergency care. If every hospital/healthcare provider followed this model we'd be a lot better off!
"I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick." The Modern Hippocratic Oath
If your doctor fails to understand your suffering, and is only concerned with the desease, fire him on the spot and make sure you tell him why you're replacing him to his face. The above is the most important part of the doctor's oath, and so many gloss over it in an effort to cure the desease, not the patient.
If your doctor fails to understand your suffering, and is only concerned with the desease, fire him on the spot and make sure you tell him why you're replacing him to his face. The above is the most important part of the doctor's oath, and so many gloss over it in an effort to cure the desease, not the patient.
2
I think just providing a decent explanation regarding what is happening can help a lot. My mom was in the hospital for cataract surgery, and every time someone entered the room they asked her her name and birthday. I could see her stress rising until she finally blurted out "I know when my birthday is!". I think she thought they were giving her (81 years old) a cognitive evaluation. I said "Mom, they just want to be sure they have the right patient for the right surgery". Stress vanished. Anyone could have explained to her that that was going to happen, and why, to her at the start. If I hadn't been there she would have stayed confused and upset. Simple....
9
So many people, not just medical professionals are truly uncomfortable in the presence of suffering. The natural human instinct is to "do something" to "fix it" and when we cannot "make it better" we feel very uncomfortable. What gets lost in this very human reaction is that the very act of caring and listening attentively and with compassion is itself curative.
I witnessed first hand when I worked in a hospital how uncomfortable people are when they feel helpless in the presence of suffering they can't alleviate. I always knew the prognosis when the MD entered the patient's room and I was present listening to the patient's fears and concerns. If the MD expected me to leave they felt they could "do something" but when I was told "It's OK, I can come back latter," I knew the MD felt there was nothing left to be done.
There is no greater gift we can give to a suffering human being than to simply "stay" and listen without trying to "fix it." Just listen, connect and feel the pain.
I witnessed first hand when I worked in a hospital how uncomfortable people are when they feel helpless in the presence of suffering they can't alleviate. I always knew the prognosis when the MD entered the patient's room and I was present listening to the patient's fears and concerns. If the MD expected me to leave they felt they could "do something" but when I was told "It's OK, I can come back latter," I knew the MD felt there was nothing left to be done.
There is no greater gift we can give to a suffering human being than to simply "stay" and listen without trying to "fix it." Just listen, connect and feel the pain.
3
If a doctor is running way behind half the day because he responded with the necessary attention to one patient's unexpected crisis earlier, he will get bad ratings from several patients burying the one good rating from the person that most needed him. Would anyone suggest that he made the wrong decision in allocating his time?
1
KBronson: yes, absolutely, there is a time allocation problem. Many doctors are chronic offenders in this regard. They need to adjust their scheduling and have their practices build in some redundancy. How many patients wait for hours only to have a rushed encounter as that doctor tries to catch up? That's not good care.
7
I have been a member of a large western health cooperative for many years. During those years I have seen it in a general way change from a caring health care provider and a non-profit to one that is intensely interested in profit over care. For example, I waited several weeks to see a hand specialist for hand pain. When I did see him his diagnoses was "old man hands." Then he sent me to an occupational therapist for a device that I couldn't wear but paid for. My primary care physician "retired" at an early age and was replaced by a just minted MD who seemed more interested in telling me what she couldn't do for me than what she could, and this while typing notes and not listening. I now believe that my previous primary care physician left because he didn't like what he was seeing and, perhaps, told how he must change. There is another instance that I won't go into, but it, too, illustrates my point.
Thankfully I am also covered by VA medical. Despite the bad press, mush of it justified, the VA has been nothing but attentive and responsive to my needs.
What's the answer: the article points out some of them, but there is one more very important one. Actually listening and responding appropriately. If there was one paramount thing that I learned over the years as a police officer in a major city it was that my most important took wasn't my weapon, it was my ears and a willingness to use them. The medical profession could take a lesson from that.
Thankfully I am also covered by VA medical. Despite the bad press, mush of it justified, the VA has been nothing but attentive and responsive to my needs.
What's the answer: the article points out some of them, but there is one more very important one. Actually listening and responding appropriately. If there was one paramount thing that I learned over the years as a police officer in a major city it was that my most important took wasn't my weapon, it was my ears and a willingness to use them. The medical profession could take a lesson from that.
4
As a physician, I agree with the general message of this article. Suffering and quality of life should be primary endpoints in any patient interaction.
I would advocate caution, however, in how these are quantified. Some of the greatest physicians I've ever trained with were experts at motivating their patients toward life changes. Their counsel was often a tough nugget to swallow, but ultimately in their patients' best interests.
Case in point. A friend of mine recently confided that she chose her primary care physician because he had received a negative review on an online survey. This at first seemed counterintuitive. However, she explained to me that the negative review was because a physician told her patient that the best treatment for her chronic back pain would be to lose weight. The patient was offended. My friend thought this was great counsel, and I agreed.
There is a place for tough love in medicine. I have never encountered a patient satisfaction survey that accommodates for this approach. There is room for more than one style of good doctoring, and not all styles conform to surveys.
I would advocate caution, however, in how these are quantified. Some of the greatest physicians I've ever trained with were experts at motivating their patients toward life changes. Their counsel was often a tough nugget to swallow, but ultimately in their patients' best interests.
Case in point. A friend of mine recently confided that she chose her primary care physician because he had received a negative review on an online survey. This at first seemed counterintuitive. However, she explained to me that the negative review was because a physician told her patient that the best treatment for her chronic back pain would be to lose weight. The patient was offended. My friend thought this was great counsel, and I agreed.
There is a place for tough love in medicine. I have never encountered a patient satisfaction survey that accommodates for this approach. There is room for more than one style of good doctoring, and not all styles conform to surveys.
9
I was wondering how long it would take for a doctor to blame the patients. Well done.
3
When I was hospitalized after surgery a couple of years ago, I noticed quite quickly that nurses wear soft-soled shoes and young residents wear fancy shoes with hard soles and heels that clatter down the early morning hallways. I always knew when a herd of residents was about to descend on my bed and start yelling questions at me as if I was deaf.
Check your footwear, doc!
Check your footwear, doc!
6
Several weeks ago this paper ran an article in which an academic physician(I forget his name) related that he asked medical students what the role of a doctor was. Most were puzzled at the question and replied with answers like "save lives" or "cure disease". The doctor replied that in his opinion the role of a physician was to reduce suffering. In reality, medicine can cure very few diseases, but as this article shows, it can-and should- reduce human suffering.
3
If I were suffering from pneumococcal pneumonia I would much rather prefer to be treated by a doctor versed in the use of antibiotics than one who can only hold my hand and tell me how much he can relate to my suffering. This "we know nothing and can do nothing" argument is simply wrong. We know a heck of a lot and have done a great deal. Just ask your grandma how effective touchy feely care was for Consumption (tuberculosis)in her day.
1
This is a good start. However, as long as we don't take this to heart and truly start training doctors differently, it will be just that. Presently, Medicare spends $10 billion a year subsidizing the training of physicians, and has the ability to require that they become competent in areas such as geriatrics and palliative care. Yet, we are not even close. Surveys are one thing. Let's start by focusing on teaching doctors how to interact with patients.
3
How about we start screening out doctors driven to the profession by avarice?
3
It is worrying, but apparently true, that doctors and hospitals feel the need to regroup and reconsider their pledge to "first do no harm." My Gawd! Patients should reconsider where they place their trust and, themselves, pay closer attention. What can we expect in a "for profit" environment? We are all expendable cash cows, until we die of neglect.
4
It would be helpful to see if these problems are persistent in countries that a national health care plan.
5
The hospital lawyer once told us at a physician's meeting, that spending more time with patients and addressing their concerns in an uncrushed manner, resulted in a dramatic reduction in malpractice claims.
When I suggested to the CEO, that perhaps seeing fewer patients and spending more time with them might be a good idea, after all, (something I'd mentioned to him before), he declared that it was "not an option". He seemed more at ease during discussions about increasing physician productivity.
When I suggested to the CEO, that perhaps seeing fewer patients and spending more time with them might be a good idea, after all, (something I'd mentioned to him before), he declared that it was "not an option". He seemed more at ease during discussions about increasing physician productivity.
6
He was right. Even employed physicians are on their own when it comes to malpractice, so why should he care?
. . . a doctor blurting out, “Oh, it looks like you have cancer.”
The article makes it sound as if that act alone is more grave than having the disease itself. Have we gotten to become such a weak and frail society, both in body and mind, that simply having to hear of bad news becomes the source of more suffering than the actual malady? If so, then what is to become of us for we're psychologically disabling ourselves to such a pathetic condition where the slightest insult will be the thing that kills us, and not some more realistic mortal blow.
The headstones will read: They died as a result of poor bedside manner, the epidemic of which raged in 2015 . . .
The article makes it sound as if that act alone is more grave than having the disease itself. Have we gotten to become such a weak and frail society, both in body and mind, that simply having to hear of bad news becomes the source of more suffering than the actual malady? If so, then what is to become of us for we're psychologically disabling ourselves to such a pathetic condition where the slightest insult will be the thing that kills us, and not some more realistic mortal blow.
The headstones will read: They died as a result of poor bedside manner, the epidemic of which raged in 2015 . . .
10
As a doctor the past 35 years, I can tell you the most damaging cause inattentive care has been the introduction of the electronic medical record.
8
Can you please explain why?
Please elaborate. If I end up seriously injured or ill (ie, unable to communicate with my care providers) in an ER while on vacation out of state, and that ER has zero knowledge of my medical history because that history is chicken-scratched in a manila folder by my doctor at home and exists nowhere else, how does that help provide more attentive care?
1
gmg22,
That is the wrong question as it really isn't a problem. Electronic records are an invention of insurance companies that want to claim they will detect and prevent fraud. They know they won't the intent is to find plausible excuses to deny payment.
Doctoring started before electronic records were invented and they have proper methods and procedures for dealing with "new" patients. A simple phone call would solve any of the "known issues" problem. If you are in an ER they don't need to know your history they need to solve the "Emergency" medical issue. If there is another problem you are already in the ER.
Electronic records can be accessed from anywhere and if you did not know even the best records have holes in them. In my case they are currently mostly fraudulent. Filled with lies and made up accounts and lacking in most of what I have reported to medical staff. It is very clearly intended to make sure I do not get proper care anywhere I go that uses the network of records. Another reason possibly the source of my problem, is
People with iatrogenic injury can't go to a new locale and start anew with a new doctor to get the problem fixed anymore since all records follow us.
And there is the fact that there are a lot of bad actors, even evil people in medicine because they get to have such power over the lives of people with little or no danger of being held to account for it.
http://www.patient-safety.com/index.html
That is the wrong question as it really isn't a problem. Electronic records are an invention of insurance companies that want to claim they will detect and prevent fraud. They know they won't the intent is to find plausible excuses to deny payment.
Doctoring started before electronic records were invented and they have proper methods and procedures for dealing with "new" patients. A simple phone call would solve any of the "known issues" problem. If you are in an ER they don't need to know your history they need to solve the "Emergency" medical issue. If there is another problem you are already in the ER.
Electronic records can be accessed from anywhere and if you did not know even the best records have holes in them. In my case they are currently mostly fraudulent. Filled with lies and made up accounts and lacking in most of what I have reported to medical staff. It is very clearly intended to make sure I do not get proper care anywhere I go that uses the network of records. Another reason possibly the source of my problem, is
People with iatrogenic injury can't go to a new locale and start anew with a new doctor to get the problem fixed anymore since all records follow us.
And there is the fact that there are a lot of bad actors, even evil people in medicine because they get to have such power over the lives of people with little or no danger of being held to account for it.
http://www.patient-safety.com/index.html
2
If we are really to look at the whole medical experience, we also need to look at billing and whether or not a doctor/provider is in network or not. There is a lot of room for improvement. Trying to match bills to services is extremely difficult. Sometimes bills can show up a year after the service was provided. Trying to figure out the bills is an enormous source of stress.
5
A word of caution on putting all your eggs into one basket like patient surveys. Of course I want to alleviate suffering, but I question if popularity votes are the best way to achieve it. Remember that health care is still not ((or rather should not be) a commercial endeavor. Hospitals should not turn into spas competing with each other by offering patients whatever they want. An unwanted outcome of this could be hospitals and doctors catering to the surveys themselves instead of truly doing what's best for the patient. Can you imagine what would happen if a doctor's style of practice, choice of treatment and exams were based overwhelmingly on patient satisfaction? It would turn into a popularity contest. I interned at a primary care office for a year and it was just shocking to me how often the doctor gave antibiotic shots to patients who had no bacterial infection. (Which contributes to antibiotic resistance.) He sheepishly admitted to me that if he didn't give them what they wanted they wouldn't feel as if he had done anything. Reviewing and critiquing a doctor's performance as it relates to patient care is good. But beware the possibility of doctor's becoming "yes-men"
2
This has to be my all time favorite ambiguous headline.
7
Unintelligible actually.
If at all possible, stay out of the hospital. It is a dangerous place. And if you are in the hospital, try to get discharged quickly. Ask questions, be polite but firm, and realize that the vast majority of healthcare providers are trying their best to help you.
7
My father was struck with a sarcoma, a devastating form of cancer. He was treated at, what is considered by many, to be the leading cancer treatment center in New York. While we understood that his prognosis was not good, our family was initially hopeful that this particular hospital and the doctors treating him would at least provide us assurances that he would be cared for in a respectful and dignified manner.
Unfortunately, we found none of this to be true until the very end when we demanded a palliative care team to intervene on Dad's behalf. The palliative care team was unbelievable. Throughout his short battle with cancer, they were the only doctors in the hospital who seemed to care.
While his main doctors treating him were experienced and knowledgeable, there seemed to be a discerning lack of bedside manners. Especially with the attending doctors. One of the attending doctors casually said to my father, "Well, if the chemo fails to work, then death comes pretty quickly." I appreciate the candor, but isn't there a better way of saying this?
The hospital began to feel like a factory. Especially in the urgent care facility they ran. I remember my Dad checking in at 4PM one afternoon and not leaving until 2AM. The waiting room and treatment rooms were packed. People lying on gurneys in the hall waiting to be seen by a doctor. Not that it's enough these people are battling cancer but they also have to endure an inefficient and sometimes callous health care system.
Unfortunately, we found none of this to be true until the very end when we demanded a palliative care team to intervene on Dad's behalf. The palliative care team was unbelievable. Throughout his short battle with cancer, they were the only doctors in the hospital who seemed to care.
While his main doctors treating him were experienced and knowledgeable, there seemed to be a discerning lack of bedside manners. Especially with the attending doctors. One of the attending doctors casually said to my father, "Well, if the chemo fails to work, then death comes pretty quickly." I appreciate the candor, but isn't there a better way of saying this?
The hospital began to feel like a factory. Especially in the urgent care facility they ran. I remember my Dad checking in at 4PM one afternoon and not leaving until 2AM. The waiting room and treatment rooms were packed. People lying on gurneys in the hall waiting to be seen by a doctor. Not that it's enough these people are battling cancer but they also have to endure an inefficient and sometimes callous health care system.
2
Years ago I chased a vampire out of my father's room when she came to draw blood and couldn't find a good vein. He moaned and she kept poking him. It caused quite an uproar, but I made my point! My father was dying and sticking him with needles every two hours was painful and useless. Glad some doctors are starting to question their way of doing business.
6
The main problem has been the "maximising of profit" in medicine in all its forms, from the education doctors need to every aspect of every item used in medicine. It is wrong. It is a perversion of our controlled capitalism model.
In doctor patient relations I'd advocate for ending the "pre" interview before one sees a doctor.
At first glance it seems smart but in practice it works out as abusive and things important to the patient get overlooked. The relaying of that info is not done well or the doctor is choosing to pretend they have not heard it so they do not have to explain themselves and the patient as a matter of how the mind works (see exposure therapy for PTSD) does not recount the entirety of the list of reasons for being there again when the doc comes in having said them once in the "pre" interview it has left the "Say this to the doc" memory stack. The mind, trusting it has been dealt with by saying it to the first person (possibly assuming it had been relayed and dismissed byu the doctor) moves on to focus on the new. It also creates confusion when the patient calls back to settle the issue.
A different wrinkle in this way of doing medicine, is that the doctor becomes too familiar with the pre interviewer and over time that person starts having undue influence over the doctors view of the patients they have interviewed. Even without familiarity, the trust implicit in such a situation lends itself to this problem.http://www.patient-safety.com/index.html
In doctor patient relations I'd advocate for ending the "pre" interview before one sees a doctor.
At first glance it seems smart but in practice it works out as abusive and things important to the patient get overlooked. The relaying of that info is not done well or the doctor is choosing to pretend they have not heard it so they do not have to explain themselves and the patient as a matter of how the mind works (see exposure therapy for PTSD) does not recount the entirety of the list of reasons for being there again when the doc comes in having said them once in the "pre" interview it has left the "Say this to the doc" memory stack. The mind, trusting it has been dealt with by saying it to the first person (possibly assuming it had been relayed and dismissed byu the doctor) moves on to focus on the new. It also creates confusion when the patient calls back to settle the issue.
A different wrinkle in this way of doing medicine, is that the doctor becomes too familiar with the pre interviewer and over time that person starts having undue influence over the doctors view of the patients they have interviewed. Even without familiarity, the trust implicit in such a situation lends itself to this problem.http://www.patient-safety.com/index.html
1
The term "first do no harm" does not exist in any medical oath. It is a worthy goal, and many doctors try their best.
1
Recently I had retina surgery. My primary eye doctor misdiagnosed me and told me there was no hope to save my vision. I went home and googled a new eye doctor. After three operations my vision was restored to almost where it was. My new doctor is always on time always explain what ever questions I have and will always be my Doctor from now on. Being a guy most Doctor visits is like listening to chalk dragged across a blackboard. My doctor is not trying to be my buddy but he does a great job at being my doctor. That means the world to a really nervous but acting macho guy.
15
There is an important element missing from this story: cost. The companies that perform these surveys for hospitals charge by the survey. Hospitals cannot afford a large sample size. So when a doctor receives a "summary" based on 3 patients, it's hard to know what to make of a sub-par evaluation or a perfect 100% review. Did they sample that one disgruntled patient who is never happy? Or did they get three long-time patients who love me? The bigger question is: who will pay for all this surveying of patients in a system already stressed to make a profit?
1
Regrettably, medicine has simply become a business, more concerned with profit margins than patient care. Several recent and ongoing personal experiences have convinced me that our medical system is a large, and largely unregulated, business. When hospitals are allowed to charge for services and tests not performed, and insurance companies simply pay the bill without question, something is seriously wrong. There is far too much money changing hands to believe that the system is not corrupt.
“Patient care? Why would we worry about the patients? There are always more patients to bill.”
It is not surprising that studies continue to show that the United States has the most expensive health care system in the world, and patient outcomes are among the lowest. The system has to be fixed before it bankrupts the country.
See:
http://www.pbs.org/newshour/rundown/health-costs-how-the-us-compares-wit...
http://www.washingtonpost.com/news/to-your-health/wp/2014/06/16/once-aga...
“Patient care? Why would we worry about the patients? There are always more patients to bill.”
It is not surprising that studies continue to show that the United States has the most expensive health care system in the world, and patient outcomes are among the lowest. The system has to be fixed before it bankrupts the country.
See:
http://www.pbs.org/newshour/rundown/health-costs-how-the-us-compares-wit...
http://www.washingtonpost.com/news/to-your-health/wp/2014/06/16/once-aga...
7
Press Ganey, and their surveys do more to hinder compassionate patient care and actually facilitate suffering. Here's an example of what happens:
Dr. has a sick pediatric patient --> pediatric patient has a long wait because Dr. is spending sufficient time with another pediatric patient to provide good care --> pediatric patient is seen but mom is upset at long wait time and because the doctor did not prescribe antibiotics (Dr. ruled out bacterial infection because they believed it was viral) --> mom fills out negative review on Press Ganey survey --> hospital administrators give bonus incentive to Dr. who has better Press Ganey survey scores, and penalize those with bad Press Ganey score --> in the future Dr. feels pressured to give out antibiotics (or in adults painkillers) even when they are not warranted and shorten visit time with patients --> patient gets shorter visit and worse care --> NY Times writes article about how Dr.'s are to blame for growing antibiotic resistance, substance abuse due to painkillers, and lack of compassion and well visit times --> Tenet, HCA etc. line their pockets.
Dr. has a sick pediatric patient --> pediatric patient has a long wait because Dr. is spending sufficient time with another pediatric patient to provide good care --> pediatric patient is seen but mom is upset at long wait time and because the doctor did not prescribe antibiotics (Dr. ruled out bacterial infection because they believed it was viral) --> mom fills out negative review on Press Ganey survey --> hospital administrators give bonus incentive to Dr. who has better Press Ganey survey scores, and penalize those with bad Press Ganey score --> in the future Dr. feels pressured to give out antibiotics (or in adults painkillers) even when they are not warranted and shorten visit time with patients --> patient gets shorter visit and worse care --> NY Times writes article about how Dr.'s are to blame for growing antibiotic resistance, substance abuse due to painkillers, and lack of compassion and well visit times --> Tenet, HCA etc. line their pockets.
20
This is exactly correct. Doctors have become pawns for the profit-driven health care system.
4
How about doctor fully informs mother about risks of antibiotic overuse including higher risk of MRSA? I know of two 13 yo's in my extended social circle who have died quickly of MRSA in the past 5 years. If the mother fully understood she might thank the doctor for not prescribing antibiotics. Also this is an excellent time to prescribe a placebo like peppermint tea because the real need of the mother is to feel she is doing something. The result? Good survey score, lower health costs and better outcome.
I agree that there are times when blood tests are ordered excessively in patients who are hospitalized. However, one of the reasons that blood tests are drawn in the morning is for the providers to have information so that appropriate plans can be formulated in the morning, especially at teaching hospitals. Would it be preferrable to have the blood tests done after 9am so the results would be available around noon for diagnostic tests or interventions to be scheduled for the following day? I'm sure the hospital administration will be pleased with the length of stay.
It is interesting to see Press Ganey described under such a positive light.
It is interesting to see Press Ganey described under such a positive light.
3
I doubt that most people think of 4 AM as being "in the morning" -- it is effectively the middle of the night, and sleep interrupted may be difficult to regain. Why not draw the blood at bedtime? Will the sample be so different from one taken in the wee hours?
This article doesn't tell quite the whole story. The ACA now ties hospital reimbursement to "patient satisfaction," as determined by surveys. This has had the result of reinforcing the drive towards turning hospitals into hotels, which is massively contributing to our expanding healthcare costs.
Yes, feedback is great, and I think doctors can learn a lot from some of this data. But we also have to note that patients' priorities (especially in a post-care survey) are not always in line with the best, evidence-based medical care. Public hospital system docs will get slammed if they don't prescribe painkillers enough. A patient with back pain demands an unnecessary MRI. What do you mean I'm fit to go back to work already?! Extend my worker's comp!
This article points out some glaring problems that are indeed ripe targets for improvement, and it's great to see them being implemented! But naming "suffering" as the chief outcome in these surveys is quite a liberal use of the word in many cases...
Yes, feedback is great, and I think doctors can learn a lot from some of this data. But we also have to note that patients' priorities (especially in a post-care survey) are not always in line with the best, evidence-based medical care. Public hospital system docs will get slammed if they don't prescribe painkillers enough. A patient with back pain demands an unnecessary MRI. What do you mean I'm fit to go back to work already?! Extend my worker's comp!
This article points out some glaring problems that are indeed ripe targets for improvement, and it's great to see them being implemented! But naming "suffering" as the chief outcome in these surveys is quite a liberal use of the word in many cases...
66
Read the comments, Dr.
6
I question whether the issue of "public hospital system" docs getting slammed for not prescribing enough painkillers is just an expression of poorly disguised contempt for those patients in a "public hospital system" rather than private care patients who Dr.DR in Texas seems to think tolerate pain better (or answer surveys with more compliments). Perhaps private care patients simply get listened to and believed about their pain levels. I also point out that a patient with back pain returning to a very physical job may have a legitimate issue that a patient with back pain going back to a sedentary CEO position doesn't. Mindfulness from medical personnel sometimes requires more than attentiveness; it requires overcoming barriers of class, sex and race bias.
1
You are right - what the patient wants and what is medically correct are not always the same things.
2
Before a doctor orders a test he should stop and think it over more than once if the results will advance the patient's care. Does he really need a daily blood test for a hospitalized patient? Is that MRI or CAT scan really necessary/ Could he just actually examine the patient instead? Is he ordering the test to keep his hospital's equipment in constant use? Would he treat his own family members the way he treats his patients?
Nurses should consider when they yell down the hall in the hospital that patients may be trying to rest. I'm not talking about an emergency, but when they are going to lunch. Buzzers from equipment blast for fifteen minutes before they bother to check.
There are supposed to be strict rules about privacy. Does the medical profession actually think that a flimsy curtain between beds prevents the next patient from hearing a person's private medical information? What about asking from the doorway if you've passed a stool today? All these inconsiderate behaviors add to the suffering of the patients.
Last but not least is expecting a person to share a room with a sick stranger. My mother has experienced a roommate who slept with the lights on, one who had hepatitis, one who called "nurse nurse" all night and one admitted at 5am very noisily.
One hospital in the midwest gives out pagers in the emergency room because just calling your name is a violation of privacy. That is my idea of a hospital that is beginning to understand how a patient may feel.
Nurses should consider when they yell down the hall in the hospital that patients may be trying to rest. I'm not talking about an emergency, but when they are going to lunch. Buzzers from equipment blast for fifteen minutes before they bother to check.
There are supposed to be strict rules about privacy. Does the medical profession actually think that a flimsy curtain between beds prevents the next patient from hearing a person's private medical information? What about asking from the doorway if you've passed a stool today? All these inconsiderate behaviors add to the suffering of the patients.
Last but not least is expecting a person to share a room with a sick stranger. My mother has experienced a roommate who slept with the lights on, one who had hepatitis, one who called "nurse nurse" all night and one admitted at 5am very noisily.
One hospital in the midwest gives out pagers in the emergency room because just calling your name is a violation of privacy. That is my idea of a hospital that is beginning to understand how a patient may feel.
7
Doctors are at the top of a pyramid that includes physicians assistants, nurses and hospitals. When someone becomes sick either temporarily or chronically they are no longer in the care of their physician they are in the care of a large institution.
Institutions are in fierce competition for chronic patients. Cancer Center of America, Sloan Kettering and others advertise on prime time shows and sporting events because a chronic cancer patient is going to be billed for multiple Chemo therapies, multiple surgeries, and all kinds of imaging tests on a regular basis.
These patients will spend a good deal of their lives at this institutions in waiting rooms, getting tests, chemo, recovering from surgery and killing time that could otherwise be spent with family and friends.
We view doctors as bright, empathetic human beings who have science based knowledge to help us. The reality is once chronically ill we choose an institution to care for us. Institutions aren't empathetic even if they employ people who may be.
Institutions are in fierce competition for chronic patients. Cancer Center of America, Sloan Kettering and others advertise on prime time shows and sporting events because a chronic cancer patient is going to be billed for multiple Chemo therapies, multiple surgeries, and all kinds of imaging tests on a regular basis.
These patients will spend a good deal of their lives at this institutions in waiting rooms, getting tests, chemo, recovering from surgery and killing time that could otherwise be spent with family and friends.
We view doctors as bright, empathetic human beings who have science based knowledge to help us. The reality is once chronically ill we choose an institution to care for us. Institutions aren't empathetic even if they employ people who may be.
3
This is the misconception that is the main problem in articles such as this. Doctors are in no way at the top of the pyramid. Hospitals, CMS, insurance companies, device makers, etc are at the top of the pyramid as they control the money. They have figured out how to line their own pockets from the healthcare system while keeping all responsibility for bad outcomes on the shoulders of the doctors. Similar to the financial crisis where the banks privatized the gains and publicized the risk.
The public still believes that doctors call the shots and are at the top of the pyramid as it was before the 1990s- and those benefiting from the current system have a strong incentive to continue that appearance.
It's all money and smoke and mirrors- just like politics, finance, law, or any other business
The public still believes that doctors call the shots and are at the top of the pyramid as it was before the 1990s- and those benefiting from the current system have a strong incentive to continue that appearance.
It's all money and smoke and mirrors- just like politics, finance, law, or any other business
5
I have never had a drug prescribed, surgery scheduled, admitted to a hospital or a procedure done without a doctor initiating it. I have no doubt many doctors have pressure on them to prescribe medications and procedures from their employers, drug companies and in many cases their patients influenced by ads and hearsay.
Nothing happens without a doctor initiating the treatment. There are many fine none-profit institutions that dispense health care for patients but even those none profits are institutions that run on money.
If anything those benefiting financially have been trying to take more power from doctors by denying care rather than giving it including the federal government.
Nothing happens without a doctor initiating the treatment. There are many fine none-profit institutions that dispense health care for patients but even those none profits are institutions that run on money.
If anything those benefiting financially have been trying to take more power from doctors by denying care rather than giving it including the federal government.
Your comment proves my point exactly. Thank you.
1
Aside from these problems, there is the delicate issue of bad doctors, who cause incredible suffering because of arrogance, poor judgment, rushing through the patient load, or a combination of all three.
The last time I saw a doctor, 5 years ago, was an otolaryngologist clinic at a major teaching hospital here. The diagnosis was laryngitis/strep infection. With the camera the doctor could see that my throat was so swollen that it was beginning to block the airways. I was sent home without any anti-inflammatory prescriptions, just antibiotics. She said if it was still swollen tomorrow she would give me a prednizone prescription. I called the next morning, explaining I was in extreme pain, and unable to even swallow saliva, but had to call the clinic back 5 more times to get hold of her; she finally answered, and when I got there she gave me a prescription for prednizone.
In the end, it is all for the good, because I will only visit medical doctors for catastrophic illnesses or car accidents now. I have been studying homeopathy intensely and can resolve conditions like this easily by home prescribing, and much more efficiently. The medical profession is leaving itself in the dust with their medieval ideas of healing and medicine.
The last time I saw a doctor, 5 years ago, was an otolaryngologist clinic at a major teaching hospital here. The diagnosis was laryngitis/strep infection. With the camera the doctor could see that my throat was so swollen that it was beginning to block the airways. I was sent home without any anti-inflammatory prescriptions, just antibiotics. She said if it was still swollen tomorrow she would give me a prednizone prescription. I called the next morning, explaining I was in extreme pain, and unable to even swallow saliva, but had to call the clinic back 5 more times to get hold of her; she finally answered, and when I got there she gave me a prescription for prednizone.
In the end, it is all for the good, because I will only visit medical doctors for catastrophic illnesses or car accidents now. I have been studying homeopathy intensely and can resolve conditions like this easily by home prescribing, and much more efficiently. The medical profession is leaving itself in the dust with their medieval ideas of healing and medicine.
3
Comments are mixing quality of doctor-patient interaction with systemic problems about how a hospital is run overall (such as waking patients all hours of the night).
What we need is a patient-hospital committee or at least a "survey" about patient in-hospital experience, since these are situations where an individual physician can do little.
What we need is a patient-hospital committee or at least a "survey" about patient in-hospital experience, since these are situations where an individual physician can do little.
5
Tests indeed. I recently had out patient hand surgery and was asked by a nurse whether or not I had a tubal ligation. I reminded her that it was my hand I was having surgery on. She advised that if I had not had a tubal ligation, they would do a pregnancy test. I advised that, as I was 60 years old, it really was not necessary. Shockingly, she said that my age did not matter, if I had not had a tubal ligation, they would do a pregnancy test: and I'm sure bill my insurance company for it. Truly absurd!
21
I would've just said "yes, my tubes were tied 30 years ago"
1
That practice is not new, unfortunately. When I was inpatient on a mental ward, staff routinely ordered pregnancy tests for every single female, even if they were 80 years old. Worse than that, they also ordered tests based on gender neutral names. In other words, someone like a Pat, Chris or Shawn, etc. could be male or female. A man on the ward one time was very puzzled by the fact that he was given a pregnancy test (he questioned lab billing). It turns out other male patients with gender neutral names had also been given a pregnancy test. It was no mistake.
1
Bohemienne, Adding to the level of deceit in society does not hekp.
I find yelp helpful in terms of open-ended comments and assuming there are no 'plants'.
I know it's a classic, but it really happened to me. I was sleeping peacefully the night after hernia surgery when a nurse woke me to give me a sleeping pill. I declined. She said it was doctor's orders. I told her to go away, which she did after a long argument. I went back to sleep without the pill.
7
And the flip side of that story is the doctor who is awakened in the middle of the night by the house physician who wants to know if it is Okay to write an order for a sleeping pill for the awakened doctor's patient
1
It's amazing when simple common sense is front-page news, but here it is. Anyone who has spent any time in a hospital has experienced some or all of these scenarios. At least the medical establishment is starting to get the message that they are treating people and not just diseases & symptoms.
6
There are two reasons for "inattentive care". The first making attention to the patient's experience a priority is addressed by this article. The second is that physicians and all other caregivers work in a world where they are constantly bombarded by information and conflicting demands. They need training to be able to be present with and focused on the patient, to systematically assess options, and to be compassionate. Without this training the new emphasis on taking the patient's perspective may well backfire. Leading health systems [e.g. Mass General] have long provided mindfulness training to patients to enable them to manage their wellness more effectively. It is time training in mindfulness, positive psychology and hardiness is integrated into medical education. Caregivers who are trained to be resilient will not only be more attentive to patients they will provide better clinical care. Equally important they will once again find medicine a fulfilling career.
56
As this article notes, one problem with surveys is that people often don't tell the truth. I just spent time with my elderly mother in a rehab/nursing home. People came by frequently to ask how things were going. I found it very instructive to watch what happened. Mom would complain to me about various problems (some of them significant), but then when someone came in to do a survey, she would say "Oh everything's fine!" She didn't want to appear to be complaining.
73
Because who wants to be the victim of worker revenge for a poor survey?
My cousin and his wife had to admit cousin's mom to a nursing home for a while after she fell ill. They are not touchy-feely people but, savvily, went into overdrive bringing food baskets for the nurses and aides, paying gushing compliments, making sure hardly a day went by without a treat or gift for the staff (they themselves were at the nursing home several times a day) and said it was criminal how much better treatment my aunt received compared to people who had no visitors or whose family weren't doling out these thinly disguised bribes.
My cousin and his wife had to admit cousin's mom to a nursing home for a while after she fell ill. They are not touchy-feely people but, savvily, went into overdrive bringing food baskets for the nurses and aides, paying gushing compliments, making sure hardly a day went by without a treat or gift for the staff (they themselves were at the nursing home several times a day) and said it was criminal how much better treatment my aunt received compared to people who had no visitors or whose family weren't doling out these thinly disguised bribes.
1
Maybe she thought that telling you would get it addressed?
One reason you're there is to speak for your mother or other patient. Relating your concerns is imperative. If "everything's fine" when it really is not, how does any situation get corrected?
Or be the kind of physician/nurse that you would like to have taking care of you!
1
"No more routinely awakening patients for vital signs."
-- also no more janitor entering the room 20 times every day,
one time for the garbage, one time for the sink, one time for the window, one time for the toilet, one time more for the garbage, one time for the floor, one time for the bed, one time more for ...
-- also no more janitor entering the room 20 times every day,
one time for the garbage, one time for the sink, one time for the window, one time for the toilet, one time more for the garbage, one time for the floor, one time for the bed, one time more for ...
4
I'm surprised there are currently only 88 comments given that anybody who has ever been a patient probably has stories to tell on this subject. But I'll just suggest that in the name of reducing patient suffering, how about turning off those alarms in the patient's room that are so unimportant that even when a doctor or nurse hears them going off, they don't feel the need do anything about them? If alarms don't require immediate attention, surely a digital readout would serve just as well as constant beeps that wake the patient up, freak them out, and/or drive them slowly insane?
2
The solution to our broken medical system is to give back all control to the physicians. Doctors can not perform their best with pressure from the government to check off box after box of nonsense called meaningful use, from the insurance companies to document ridiculous coding schemes in order to get paid and from the administration to perform quickly and efficiently to maximize profits. It is up to the patients to organize and take back medicine. Doctors have already been divided and conquered.
7
"Thinking not from our perspective but from the patients perspective"
"I wondered whether it (reducing suffering) was a tad sensational, a bit too emotional"
Glad a few doctors out there are working on this in addition to their main preoccupation, which seems to maximizing their income and self esteem.
"I wondered whether it (reducing suffering) was a tad sensational, a bit too emotional"
Glad a few doctors out there are working on this in addition to their main preoccupation, which seems to maximizing their income and self esteem.
All I can think of is doctors I represented in malpractice suits, telling me they had followed standards of care and that the lawsuit "is about hurt feelings."
Example: actions for lack of informed consent, when the patient would have had the surgery in any case, had they been informed about the possibility of a colostomy or suprapubic catheter.
"No one told me this might happen!!" is a cri de coeur. It's idle to say, "But she has no damages."
Example: actions for lack of informed consent, when the patient would have had the surgery in any case, had they been informed about the possibility of a colostomy or suprapubic catheter.
"No one told me this might happen!!" is a cri de coeur. It's idle to say, "But she has no damages."
1
I would think there would have to be some cost savings in reducing patient suffering. During a recent stay in the hospital because of a "cardiac event," a test was performed on me right after I returned from recovery from an angiogram. It was a "corticol test," I later found out. Neither my cardiologist nor my primary care doc nor the attending at the hospital had ordered it. The doctor who had ordered it never showed up to explain why he was doing it, nor did he inform the nurses. When I asked what it was, they couldn't answer. Literally--they'd never heard of it.
A nurse I'd never seen before barged into my room, told the day nurse that I needed to have blood drawn once every half hour for a total of three draws, and she hooked up a bag of some sort of fluid to my IV catheter. Whatever it was, it burned going in. The blood draws were exceptionally uncomfortable as they were from the back of my hand and from a muscle in my arm.
I've informed the hospital of this incident and my displeasure at having this test forced upon me by a bullying nurse.
A nurse I'd never seen before barged into my room, told the day nurse that I needed to have blood drawn once every half hour for a total of three draws, and she hooked up a bag of some sort of fluid to my IV catheter. Whatever it was, it burned going in. The blood draws were exceptionally uncomfortable as they were from the back of my hand and from a muscle in my arm.
I've informed the hospital of this incident and my displeasure at having this test forced upon me by a bullying nurse.
7
I found that this article had great merit. While in a hospital recetnly, the loud and incessant beeping of my IV line was very annoying and upsetting. Had the fluid in the line run out and was this a warning to staff to put in more medication etc? I complained to the nurse assistant and nurse on duty each time the constant loud beeping noise returned. I received quick brief and cold resposnes such as that is the way the machine womrked and everything was ok. The staff had adjusted to the normative noise levels of hospital noise and they had not even a superficial understanding of how noise may afffect the anxiety level of a perspn (me) who already feels vulnerable in a hospital bed. There are certainly necesssary emergency audio signals, but I came to find out that these routine and annoying beeps were unecessary and did not improve patient care, but rather diminished it. This article accurately hones in on a dynamic that is often overlooked by caregivers.
6
Suffering may be a unique human condition, beyond what can be explained by inflicting pain, discomfort and anguish, in the process of rendering medical/nursing care, surgical and otherwise. It might help when the professional doing a procedure, with potential harm, to have 'suffered' him/herself a similar fate, so there is 'skin in the game', and we pay particular attention to the nuances of what we are doing, all the while explaining things and taking as much time as necessary to make patients comfortable. This, in an environment and circumstances not always amenable to do it comfortably, given an excessive load we impart on ourselves and others. Still, an honest effort must be made with each and all 'cases', to minimize pain and suffering. Now, all this compassionate care must be balanced, so we physicians remain effective and efficient, namely, objective. So, allow me to quote Bruce Brown, M.D.'s "The good physician" poem: 'You and I cannot be friends, for now; I must coldly probe, pain and score you. If I care too much, Yours, and all the other's pains will drain, weaken, and kill me. My love must be shallow enough for both of us to survive'.
1
I had an infection that the doctor treated with Cipro antibiotic. Two weeks later I ran for a subway and tore my Achilles tendon, which required surgery and 10 weeks on crutches. Then I looked on Wikipedia and learned that torn Achilles are a well-known side-effect of Cipro.
Now, my MD knew that I was a marathon runner and his practice is built around sports. It seems like a no-brainer for the doc to have warned me about the dangers of Cipro. But I guess he was too busy.
10 weeks on crutches. Thanks, Doc.
Now, my MD knew that I was a marathon runner and his practice is built around sports. It seems like a no-brainer for the doc to have warned me about the dangers of Cipro. But I guess he was too busy.
10 weeks on crutches. Thanks, Doc.
8
Running for a subway train is by itself a risk factor for Achilles tendon rupture so who knows????
1
When my father was dying of Pancreatic Cancer he was hospitalized a few times before dying at a renowned NYC hospital. For the first time I witnessed the care given at such a place firsthand, and heard from him a bit too about occurrences such as buzzing during the night for help to the bathroom, and when no one ever came, losing bowel control. (In the morning he managed to remove the dirty sheet and throw it out; the nurse made a face when she saw this.)
Aside from the Palliative Care team, who were wonderful - but also couldn't really stay to talk - the only kind person there was a surgeon who put in his stent. I witnessed him several times with my father; he was caring, looked into his eyes, in short, he was what you'd expect. Every other person from nurses to aids to his own cancer specialist was cold as ice. It was very depressing.
Aside from the Palliative Care team, who were wonderful - but also couldn't really stay to talk - the only kind person there was a surgeon who put in his stent. I witnessed him several times with my father; he was caring, looked into his eyes, in short, he was what you'd expect. Every other person from nurses to aids to his own cancer specialist was cold as ice. It was very depressing.
120
Why not say what "renowned NYC hospital"? Though, it could be any of them.
Practiced for 30 yrs.; retired a couple of years ago, because of my own health issues...and the enervating experience of having to fight with ins companies.
What I miss most is the sitting down and talking to my patients, in a simple, non- medicalese filled, conversation. If one takes the time to listen, and then f/u with questions based on training and experience, the patient will tell you what their diagnosis is ...95+% of the time...before any 'tests' or imaging studies are reviewed or ordered.
More than a few were a p.i.a.; but then again, often so am I. I miss the feeling of helping someone; or at least being there for them when I could not....
What I miss most is the sitting down and talking to my patients, in a simple, non- medicalese filled, conversation. If one takes the time to listen, and then f/u with questions based on training and experience, the patient will tell you what their diagnosis is ...95+% of the time...before any 'tests' or imaging studies are reviewed or ordered.
More than a few were a p.i.a.; but then again, often so am I. I miss the feeling of helping someone; or at least being there for them when I could not....
Reading the comments echo's everything I experience working in a Trauma center/teaching hospital. The place is run by bureaucrats that wreck the place in an attempt to justify their enormous salaries. And then over privileged brainy children run around trying to learn what a human being is after years of studying. These geniuses then strive to isolate themselves economically from most of those 'human beings'. I won't discuss keeping people alive after their expiration date. It is essentially an insane asylum if you have a slightly absurd POV.
6
Frankly, it's called common sense... and most physicians have no clue.
The profession has gone south with the flow of government money, strangulation with 3rd party involvement, patient and physician obesity, addiction drive disease, and enabling.
Inattentive care will just be another excuse to ignore...
When what's needed is common sense.
The profession has gone south with the flow of government money, strangulation with 3rd party involvement, patient and physician obesity, addiction drive disease, and enabling.
Inattentive care will just be another excuse to ignore...
When what's needed is common sense.
2
NONE OF THIS IS NEW!!!
This is basic doctoring 101. I have ben doing this for over 20 years as have others I know. Its about empathy and treating people the way you want to be treated. This is basic stuff. Many doctors do this, many do not. If you need to be told then thats a shame but the bottom line is some people do need to be told.
How much of this is addressed in Medical Education in Obamacare...zippo.
This is basic doctoring 101. I have ben doing this for over 20 years as have others I know. Its about empathy and treating people the way you want to be treated. This is basic stuff. Many doctors do this, many do not. If you need to be told then thats a shame but the bottom line is some people do need to be told.
How much of this is addressed in Medical Education in Obamacare...zippo.
4
This has been going on for a long time. Obamacare, or the ACA, has nothing to do with the sorry state of physician compassion.
15
I find it very irritating when I pay 140-180 bucks for an office visit and the doctor spends 5-10 minutes with me and seems to want to get to the next 140-180 bucks.
Because of their rushed state they find it easier to write a prescription than review side effects of medications I am currently on. If the side effects only happens 4 percent of the time they act like it never happens.
It is also frustrating to get a doc driven by ego and full of themselves rather than being humbled by what they don't know.
For me the doctors attitudes and lack of care produce the suffering.
Because of their rushed state they find it easier to write a prescription than review side effects of medications I am currently on. If the side effects only happens 4 percent of the time they act like it never happens.
It is also frustrating to get a doc driven by ego and full of themselves rather than being humbled by what they don't know.
For me the doctors attitudes and lack of care produce the suffering.
1
Compassion has morphed into arrogance at many medical practices, particularly in specialist offices.
These practices have become largely insurance-driven factories, where the goal is to process as many patients as possible in the shortest possible time, and collect the largest amount of reimbursement. You get a ten-minute visit for which you have to wait up to an hour in the waiting room, and the practice charges for a much longer visit. It's particularly bad for Medicare patients.
I can talk authoritatively about this because in the last couple of years I have experienced it first hand.
These practices have become largely insurance-driven factories, where the goal is to process as many patients as possible in the shortest possible time, and collect the largest amount of reimbursement. You get a ten-minute visit for which you have to wait up to an hour in the waiting room, and the practice charges for a much longer visit. It's particularly bad for Medicare patients.
I can talk authoritatively about this because in the last couple of years I have experienced it first hand.
2
Ironically, digitization of medical records and office/exam room practices have reduced meaningful patient-doctor interaction. Now my dr mostly stares at his computer screen and clicks thru a series of mindless, mostly wasteful questions that consume valuable clinical time. The time he spends looking at me and speaking to me, the person, patient and customer, is less and of lower quality.
These systems need more tweaking to be useful in the exam room.
These systems need more tweaking to be useful in the exam room.
3
Buying into stocks that only make money if a person is ill seems to me to be counterproductive to the idea of good medical care. The higher the bill the bigger the payoff. My health should not be put up for speculation on the stockmarket.
1
A few years ago I had back surgery at the UNC-CH hospital.The surgeon who treated me in the months leading up to my decision to have back surgery and who performed the surgery was an interesting ,personable person who was really in the moment when he was discussing my condition and how we might proceed.
In the months subsequent to the surgery I had begun to experience bilateral knee pain. I asked my back surgeon who he would recommend to check out my knees. He was happy to recommend a colleague in the Ortho. department . I assumed the old adage :birds of a feather etc., etc. WRONG! The referral turned out to be an arrogant jerk. He manifested every negative stereotype that has bee that has been hung around the medical profession's neck. I was more than happy to fill out the evaluation that I was given when I checked out of his office.
In the months subsequent to the surgery I had begun to experience bilateral knee pain. I asked my back surgeon who he would recommend to check out my knees. He was happy to recommend a colleague in the Ortho. department . I assumed the old adage :birds of a feather etc., etc. WRONG! The referral turned out to be an arrogant jerk. He manifested every negative stereotype that has bee that has been hung around the medical profession's neck. I was more than happy to fill out the evaluation that I was given when I checked out of his office.
2
I had a dr like that. He was our family dr for 7 years and he was awesome. Then he moved to Utah. :( Haven't found a good one like him since. It's been about 5-6 years now. I'm sure our insurance company will be glad when I finally settle on one.
many years ago, in a book called megatrends, the authors described the natural state of any institution. that is, if left alone, all institutions will grow to serve not their clients, but rather the people that work there. This is how hospitals (and the medical system) have lost their way in serving their patients. blood draws at 4 am serve the staff, as do bps at shift change, long waits in clinics and offices etc... The cure is for leadership to actively and constantly restore the balance between workforce demands and consumer demands,while reminding the staff of who the institution is supposed to care for.
3
Many, many hospitals view physicians as revenue sources, with nurses and every other employee (excepting the executive suite, of course) as "cost units," as interchangeable as beans in pot of soup. Entice the doctor to practice their medicine here with generous 6-figure guarantees of income; pay the staff what you can get away with. This attitude does not engender attentive, quality patient care.
3
I've reached a point where I no longer respect doctors. As someone once told me there are good doctors and bad doctors, but no poor doctors. They have allowed our medical system to become a greed motivated dysfunctional killing machine that empties our pockets and gives us poor care in return.
I'd like to see us no longer give them the unique distinction of being addressed with a prefix. It's nonsense.
I'd like to see us no longer give them the unique distinction of being addressed with a prefix. It's nonsense.
5
225,000 deaths per year from iatrogenic causes. That's the third cause of death in the US.
And how many are saved by medical treatment? Any idea?
Dear Physicians, there is nothing more important to us patients than knowing we've been seen, listened to, heard, and our concerns validated. That experience not only tells us you care it also indicates that our treatment will be more informed and appropriate. Thus it's a huge first step in the healing process. And, as we age, please don't simply write off our concerns as "just age." Those are fighting words. So, if there were only a couple of major changes that would result from your new interest in reducing suffering and doing less harm, I would vote for those couple of factors. They would decidedly produce the greatest benefits with the least effort and costs.
3
"Although half the nation’s hospitals use Press Ganey surveys, it is not clear what many do with the data." I will tell you what the hospital I worked for as an RN did with the survey data: relentlessly hammered us with it. "Your unit's numbers are down this month. You have to work harder to bring them up". "Your unit's numbers are up this month. Don't let them slip!". The numbers, the numbers, the numbers. That's all we heard. We weren't told much about how to improve our performance, or even why it mattered. And of course, come time to get a raise, "the numbers" would be trotted out and used as an excuse to give a paltry raise or none at all. I began to think "Press Ganey" was a concept invented by someone who enjoyed torturing nurses and other hospital staff. While I am glad to see some hospital systems use the data in a positive way, I suspect there is a fair percentage of hospitals who use it the way my employer did: something to beat their employees over the head with. This is one reason why I am glad I left bedside nursing and became an NP.
3
So is a low percentile score good or bad?
Start in the ER waiting rooms, most often the first point of contact for a patient. Hospitals need to staff them appropriately so that people needing urgent care are tended to in a timely manner. Some of the worst care comes from the triage nurses who misdiagnose and then send people in pain back to the waiting room. My teenage daughter was suffering a severe pain in her side and triage chalked it up to female issues/cramps. We sat for longer than an hour while my daughter suffered in pain before she got to see a real doctor who immediately diagnosed acute appendicitis and set her up for surgery within a couple of hours. I get that triage nurses see their share of hypochondriacs and drug addicts looking their next hit, but they need to be better trained to differentiate the fakes from people in real need of medical help.
2
Press Ganey surveys are not necessarily accurate indicators of professional care quality and the patient's degree of suffering, but used thoughtfully, they can be one plank of data to push hospital administrators to support professionals instead of tightening staffing (registered nurses are almost always the first to be cut).
Hospital and institutional "patient advocates" are paid by the organization and are truly just legal risk reporters. Hire/use your own independent advocates.
Look for "Magnet" designations for professional nursing. This is a voluntary accreditation for hospitals which are rough indicators of professional nursing expertise, adequate staffing and nurse autonomy to provide care.
Get on hospital boards of directors. Attend their meetings. Volunteer for your hospital. Hold board directors and hospital executives accountable for the care and treatments they provide.
Use social media and community support to hold hospitals accountable. Form a hospital patient experience support group, and invite hospital administrators and clinicians to explain their operating plans, how they are meeting their mission and what they are doing to provide safe, humane and compassionate care. Blog.
All bets are off for patients in psychiatric units - they aren't surveyed routinely, civil rights are routinely stripped, units are prison-like, locked & closed to family visitation excepting for 1-2 hour daily tightly staff controlled allowance. Shameful standard of "care".
Hospital and institutional "patient advocates" are paid by the organization and are truly just legal risk reporters. Hire/use your own independent advocates.
Look for "Magnet" designations for professional nursing. This is a voluntary accreditation for hospitals which are rough indicators of professional nursing expertise, adequate staffing and nurse autonomy to provide care.
Get on hospital boards of directors. Attend their meetings. Volunteer for your hospital. Hold board directors and hospital executives accountable for the care and treatments they provide.
Use social media and community support to hold hospitals accountable. Form a hospital patient experience support group, and invite hospital administrators and clinicians to explain their operating plans, how they are meeting their mission and what they are doing to provide safe, humane and compassionate care. Blog.
All bets are off for patients in psychiatric units - they aren't surveyed routinely, civil rights are routinely stripped, units are prison-like, locked & closed to family visitation excepting for 1-2 hour daily tightly staff controlled allowance. Shameful standard of "care".
2
Is anyone really surprised by this article? We've seen versions of this lack of sympathy by those in power forever. The Bible is full of them, the Times must have published scores of similar pieces. Not a happy side of our human nature - the more power or prestige, the less empathy for others below us. The lower on the power spectrum, the more empathy. That's why nurses are, generally, better at this than the M.D.s.
The "Golden Rule" is the basis of all our moral and ethical beliefs. Do unto others as you would have them do to you - or your parents, or your children, or your friends. It's not hard to understand it, but it needs constant awareness and repetition. Those "others" are actually your mom and dad, kids, grandparents. If you have to trick yourself in order to accomplish this, there's no shame. When I made believe that the slow driver ahead of me was my aged dad, I instantly became more patient and less angry. It was a simple and effective way to become a better person. Doctors, please think this way, about EVERY patient you see. It's easy and it works.
The "Golden Rule" is the basis of all our moral and ethical beliefs. Do unto others as you would have them do to you - or your parents, or your children, or your friends. It's not hard to understand it, but it needs constant awareness and repetition. Those "others" are actually your mom and dad, kids, grandparents. If you have to trick yourself in order to accomplish this, there's no shame. When I made believe that the slow driver ahead of me was my aged dad, I instantly became more patient and less angry. It was a simple and effective way to become a better person. Doctors, please think this way, about EVERY patient you see. It's easy and it works.
4
As an academic who teaches Research Methods to social work students and health care majors, I am continually amazed at the faulty logic which leads to faulty methodology in medical studies. Students with even basic research training know that qualitative methods are indicated when investigators want to explore a phenomenon they know little about, and want to avoid biasing the results by assuming they do know all the possible aspects of that phenomenon [an epistemological assumption of quantitative research]. If doctors truly want to understand the dimensions of "suffering" from the patient's perspective, then sound research logic indicates that they should spend some time with patients in their environments, observing and interviewing patients through open-ended questions that allow patients to name and frame categories of suffering from their own perspective. The article mentions that patient comments were the most helpful. Surely, this should indicate that the way to go, at least initially, is not with survey research which reduces all phenomena to numbers, always the gold standard in medicine. Yes, qualitative research is more time consuming and costly, but certainly well worth it in the long run if you want valid results. After patients inductively identify their categories of suffering, then survey items can be developed and quantitative methods can proceed.
3
Thank you Professor. Unfortunately very few people understand research design and statistics; they are unduly impressed with numbers and "data" without having the slightest idea where the numbers come from and what they mean (or don't mean).
1
I find it so sad that the Medical Establishment is only now beginning to figure out (of, course with the help of a paid corporate- designed system) that patients are at the center of their work. Why is the fact the medicine must address the entire person, not just an illness, so revolutionary?
In saying this I do not mean to demean the many compassionate doctors, nurses,and medical workers of all kinds who provide wonderful, life affirming care.
In saying this I do not mean to demean the many compassionate doctors, nurses,and medical workers of all kinds who provide wonderful, life affirming care.
2
On the other hand, Dr. Ramsey said, the suffering issues are real, and if survey answers can get doctors and hospitals to change their ways, “that is great.”
I'm being treated by two different systems. One for Ovarian Cancer, which I I was told was cervical cancer. I've had four physicians thus far, none of whom has ever had much concern, in my opinion.
Seeing as I should have at least a PAP smear my last visit, I don't believe there are. Many physicians who care. I'm sorry to say this now includess my PCP. At 62 years if age I consider this neglect.
What I won't tell them, now, after 12 years of surgery, chemo, and radiation, is I go to a Family Planning Center to get my PAPs. I at cash so I can know exactly where my health is headed.
Complacency and inattentiom are now synonymous!
I'm being treated by two different systems. One for Ovarian Cancer, which I I was told was cervical cancer. I've had four physicians thus far, none of whom has ever had much concern, in my opinion.
Seeing as I should have at least a PAP smear my last visit, I don't believe there are. Many physicians who care. I'm sorry to say this now includess my PCP. At 62 years if age I consider this neglect.
What I won't tell them, now, after 12 years of surgery, chemo, and radiation, is I go to a Family Planning Center to get my PAPs. I at cash so I can know exactly where my health is headed.
Complacency and inattentiom are now synonymous!
1
Every week there is a new survey, study, etc. confirming that doctors and other health care providers are shocked to learn that their patients are human beings that they are treating like livestock and who react better when they are treated like actual people. What is wrong with this profession? I continue to believe that because they are treated like royalty when they or their families get sick or even get routine care and/or they are by definition better informed about their treatments, they don't get that everyone else's experience is different. In other words, they lack empathy on a pretty grand scale. Hospitals are run entirely for the staff's convenience. People don't like being woken at 4 am for a blood draw for no clinical reason? No kidding. They needed a study to tell them that people don't like being ignored, waiting inordinate amounts of time to get information or a call back? The new thing seems to be hospital systems creating patient portals. You can get your test results, schedule an appointment, send an email to your doctor. Sounds like a great idea. What it's really about in my experience is giving you another opportunity to pay your bill. Try using one of those portals and see how long you wait for a response -- hint, don't hold your breath.
2
I had a colon resection in the last year. What I loved about my doctor mainly
Was his ability to be a wonderful surgeon. His kind bedside manner
Was just an extra plus.
Was his ability to be a wonderful surgeon. His kind bedside manner
Was just an extra plus.
1
A lot of my "suffering" could be relieved by transparency, i.e., good clear detailed communications. It really irritates me that although I am subscribed to what Partners calls "Patient Gateway", the only reports available are the barest of bare bones. If I want details, I have to jump through hoops to get my doctors' reports — and when I am able to do so, I get the sanitized version because, don't you know, patients are too stupid and/or too excitable to understand "doc speak". I worry a lot more about my health problems when I don't have all the facts than when I do. For those of us who have to cope with a chronic disease, full transparency is devoutly to be wished.
4
Thanks to so many that I do not have many experiences myself or with my immediate family members waiting to be discharged in the hospitals. But the few experiences I have had were "suffering". Just like one of the readers revealed, the time you were told to be discharged by a doctor or a nurse and the time you actually can leave the hospital is MANY HOURS apart! To be released from the hospital every time, we kept waiting and waiting, afraid to leave the room in case someone finally stopped by to try to sign me or my family members off and we could have missed that only opportunity. It is always a mystery to me why the process of discharge can possibly take such a long duration in the hospitals we have been to. Don't they want the patients to vacant the room as soon as they are good to be discharged so they can accommodate still more patients who are strapped in the cot in the hallway. Are there not doctors available making rounds all over in the hospital and all the nurses who take turns waking you up in the middle of night to collect your body data around to sign off your release from the hospital in a more "urgent and speedy" fashion?
4
This article reinforces why I retired from nursing; inattentive self-aggrandizing doctors (not all of course, but many) paying more attention to their own agenda than to input from BOTH nurses and their own patients.
1
The biggest problem, as I see it, is that physicians, most notably those who are members of general practice groups, is that, because many of them are under constant pressure to turn patients over quickly, they don't have enough time to properly listen to and adequately treat patients. At the root of this, of course, is the need for profit, as much of it as possible.
1
The general trend in major metropolitan areas has been the buying-up of small private and group practices by larger organizations, such that the physicians are salaried employees. The pressure to see many patients- giving each only a smidgen of time- isn't driven by physicians, but by the larger corporate organizations that aim to have physicians delivering health care as if they were assembly line workers in a factory. You might want a car produced on an assembly line, but probably you would not want to be placed on an assembly line yourself.
5
I was an RN in a teaching hospital on a med-surg floor. My time spent with the patient consisted of utilizing a care plan, administering meds., observing progress or worsening condition, and communicating with the patient, time permitting. The doc came, with residents, saw patient for a few minutes, and usually prescribed or decreased meds, possibly recommended another specialist, wrote some notes to cover the unmentionable part of his body, and left, a trail of residents following. This icon of the system might or might not take recommendations from the nurse, the major care-giver of the patient.
Another poster spoke of auxiliary personnel and their attitudes, considering them a major problem. These people work physically close with the patient, caring for the constant bodily needs and functions of the patients, and ofttimes, they are dissatisfied with salaries, the work they do, their position in the hierarchy, and their anger at society in general, They can be wonderful, adequate, or they can be hostile, and at times, actually, mean. This dynamic, the doc, RN, and the aides, can sometimes be a difficult mix for the patient. Teamwork may consist of keeping the team happy and productive, rather than addressing the needs of patients. The pre-dawn awakenings are mostly for staff convenience, except in the ICU, and should end. And after all is said, the best medicine is the loved ones advocate , who should be a constant 24-hr. presence, .
Another poster spoke of auxiliary personnel and their attitudes, considering them a major problem. These people work physically close with the patient, caring for the constant bodily needs and functions of the patients, and ofttimes, they are dissatisfied with salaries, the work they do, their position in the hierarchy, and their anger at society in general, They can be wonderful, adequate, or they can be hostile, and at times, actually, mean. This dynamic, the doc, RN, and the aides, can sometimes be a difficult mix for the patient. Teamwork may consist of keeping the team happy and productive, rather than addressing the needs of patients. The pre-dawn awakenings are mostly for staff convenience, except in the ICU, and should end. And after all is said, the best medicine is the loved ones advocate , who should be a constant 24-hr. presence, .
4
Dr. Michael Koch told me that I probably had cancer and should have an immediate biopsy and see him as soon as possible to see which treatments, if any are appropriate. He did so spey on the basis of elevated spa. He was negligent in performing the biopsy and I fainted and fell of the table incurring an injury that required surgery. He ultimately told me that he may not be able to explain the possible causes of my condition because he works fifteen hours a day. Dr. Koch is the chairman of the Urology Department at INdiana University Medical
school.
school.
1
I had a knee replacement and the whole experience was much less stressful than I had thought, since all the medical personnel and the hospital made being there as pleasant as possible. One of the features was a white board on the wall in my room, where times for the procedures/medications was noted, so I knew what to expect. Each change of shift, the nurse wrote his/her name on the board so I knew who was taking care of me. Just having that information available to me helped. It's the little things, sometimes.
7
an acquaintance had his left knee replaced, ended up becoming infected with an incurable form of bacteria. He needed to get 2 months of I.V. antibiotics just to bring it under control and then remain on powerful antibiotics for the rest of his life.. i'll take knee pain any day over knee replacement surgery, thank you.
The hospital I am affiliated with uses Press-Ganey surveys. Unfortunately, at times patients/families leave unsatisfied because they don't receive antibiotics/narcotics/work excuses that are inappropriate for their condition. The survey allows them a convenient place for retribution.
6
I believe in positive feed back right on the spot to doctors, nurses, p.a.s With four operations in 18 months and visits to myriad specialists, I tell them right away what I like: the results of an operation, seeing me promptly.
With two doctors in my family, I'm acutely aware of how tough it is for the doctor who's dealing with me: little time off, being chased into rural India by cell phone when on vacation; colleagues who may not meet their responsibilities.
But as a Buddhist, I'm very aware of suffering, something Buddhists are encouraged to be conscious of in all sentient beings and to vow to end.
So I applaud Beth Israel and other hospitals' leadership. I personally benefitted from B.I.'s progressive attitude during and after a recent surgery.
Thank you for this article.
With two doctors in my family, I'm acutely aware of how tough it is for the doctor who's dealing with me: little time off, being chased into rural India by cell phone when on vacation; colleagues who may not meet their responsibilities.
But as a Buddhist, I'm very aware of suffering, something Buddhists are encouraged to be conscious of in all sentient beings and to vow to end.
So I applaud Beth Israel and other hospitals' leadership. I personally benefitted from B.I.'s progressive attitude during and after a recent surgery.
Thank you for this article.
All you have to do is be the kind of physician you are hoping to have take care of you, Doctor.
3
Many years ago, 1942 to be exact, the law of comparative advantage was explained to me. One has lots of alternatives but none of them are good— all are bad. So you pick the one that is the least bad.
2
it appears that when a patient is not in d1rect contact with a medical staff member, the patient does not exist. i.e., loud talking and laughing just outside patient's room at night, and much, much more.
I wonder if you would do the same thing at home outside your guests' bedroom?
In the hospital the pt. does not exist unless s/he is in direct contact with the doctor/med. professional. thank you for this validating article. I never thought of suffering in this way before. how disrespectful and dehumanizing to be treated this way. no wonder I broke down at home after spending Friday night in the ER.
pls forgive poor typing. have fractured shoulder.
I wonder if you would do the same thing at home outside your guests' bedroom?
In the hospital the pt. does not exist unless s/he is in direct contact with the doctor/med. professional. thank you for this validating article. I never thought of suffering in this way before. how disrespectful and dehumanizing to be treated this way. no wonder I broke down at home after spending Friday night in the ER.
pls forgive poor typing. have fractured shoulder.
2
Several recent long and short-term hospitalizations of family members as well as my own have made me aware of the dramatic decrease in the quality of care for patients over the past few decades. Being in an American hospital today has become a nightmare experience for most patients unless they can afford private care. The norm today is for patients to suffer and sacrifice their own comfort, welfare and health to bureaucratic "efficiency." Understaffing is standard everywhere so that meeting the needs of patients is routinely ignored or delayed. To meet the needs of insurance companies and avoid legal liability, nurses must spend most of their time in a patient's room entering data into computers instead of caring for their patients. Hospital schedules that create disturbing noise levels and disrupt patient sleep are obviously maintained for the convenience of the staff and institution, not the patients. Of course, patients and nurses already know all of this all too well. Doctors just haven't been paying attention.
6
Sickness is stressful on both patients and physicians. Critical illness is one of the most difficult experiences a person has to live through (hopefully) and, even if emotionally detached, it also takes its toll on physicians.
The hospital is not the Cheesecake factory. Anyone who tells you differently is selling something.
Also, please investigate Press Ganey before lauding them. Their motives are profit-centered not patient-centered. I doubt their executive experts on patient care and "suffering" have ever debrided a homeless person's purulent bone infection for bascially free. Treating "suffering" involves more than a suit and a survey.
The hospital is not the Cheesecake factory. Anyone who tells you differently is selling something.
Also, please investigate Press Ganey before lauding them. Their motives are profit-centered not patient-centered. I doubt their executive experts on patient care and "suffering" have ever debrided a homeless person's purulent bone infection for bascially free. Treating "suffering" involves more than a suit and a survey.
11
Just touches the surface of the entire situation in health care today.
Hospitals need to be aware of the need for the improvement in physical design and use of floor space and square footage to create private rooms for all patients rather than continue to function "ward style" with shared rooms.
As for blood work, staff needs to be trained to take patient's blood on first draw
without using the patient like a human pin cushion resulting in terrible bruising for patients that takes weeks to heal. Some nurses have no technique when it comes to taking blood so they page for help from those who do this better. Sometimes a doctor has to be called in.
This is a basic skill that should be mastered by nurses or left to the skilled blood takers on staff at the hospital.
Most doctors and the nurses working in hospitals today are insensitive "pigs" for lack of a better term. They are nasty and abusive to patients. They are unable to control their frustrations, act like they are too busy to be bothered with a patient who has the "nerve" to ask a question or dare to challenge a medical opinion or diagnosis.
Hidden cameras or not hidden cameras used by the police to monitor traffic violations should be installed. Many doctors and nurses would be appalled if they saw themselves on camera acting the way they do-for lack of high term language-stupid,rude, lacking in sensitivity and basic manners and just plain and simply unprepared when they speak to patients.
Hospitals need to be aware of the need for the improvement in physical design and use of floor space and square footage to create private rooms for all patients rather than continue to function "ward style" with shared rooms.
As for blood work, staff needs to be trained to take patient's blood on first draw
without using the patient like a human pin cushion resulting in terrible bruising for patients that takes weeks to heal. Some nurses have no technique when it comes to taking blood so they page for help from those who do this better. Sometimes a doctor has to be called in.
This is a basic skill that should be mastered by nurses or left to the skilled blood takers on staff at the hospital.
Most doctors and the nurses working in hospitals today are insensitive "pigs" for lack of a better term. They are nasty and abusive to patients. They are unable to control their frustrations, act like they are too busy to be bothered with a patient who has the "nerve" to ask a question or dare to challenge a medical opinion or diagnosis.
Hidden cameras or not hidden cameras used by the police to monitor traffic violations should be installed. Many doctors and nurses would be appalled if they saw themselves on camera acting the way they do-for lack of high term language-stupid,rude, lacking in sensitivity and basic manners and just plain and simply unprepared when they speak to patients.
2
Hosptial routines are designed for the hospital, not the patient. And it isn't just inpatient either. When my kid was a toddler, he was in treatment at Sloan-Kettering for 2 years. Much of their treatment is in the outpatient clinic, which is great in many ways, but the kids only get an outpatient bed if they are getting chemo. There is a waiting room, where the families and kids often spend up to 12 hours waiting on things, and a big glitzy playroom. The playroom is wonderful, but why didn't they design a rest area in it, with nap mats??? Virtualy their entire clientele is small kids, really sick kids, kids who need some rest during a 12 hour day at clinic. My kid, and all the other kids, would end up trying to rest in the waiting room. No one designs a nursery school without a rest area - it would have been such a simple way to improve things at Sloan.
And inpatient, don't even get me started. I was the mean mom who insisted the nurses could bring the meds BEFORE my kid's bedtime, because if they woke him up at midnight, he wouldn't get back to sleep (and he was just 2). And there were the nurses who would stand at the intercom at midnight and place their takeout food orders!!!! While Sloan tries, it still seems like the routines are for the convenience of the doctors and nurses, not the patients
And inpatient, don't even get me started. I was the mean mom who insisted the nurses could bring the meds BEFORE my kid's bedtime, because if they woke him up at midnight, he wouldn't get back to sleep (and he was just 2). And there were the nurses who would stand at the intercom at midnight and place their takeout food orders!!!! While Sloan tries, it still seems like the routines are for the convenience of the doctors and nurses, not the patients
135
Good for you, mean mom! I was one of those too, long ago - had a child diagnosed with leukemia in 1969 when he was 20 months old. Our clinic experience was overall pretty good, but inpatient!? When our kids were hospitalized, the "mean moms" took turns (so some could sleep) actually guarding our kids' rooms at night to be sure kids were not awakened unnecessarily, that dying children were NOT resuscitated when there were orders not to, that correct meds were given, etc. But ah! I so remember the nurses who suddenly were blind when we would sneak siblings and dogs in for prohibited visits! And THOSE visits truly eased a small child's suffering!
1
Yes, I don't want to dump on Sloan too much. We also had the nurses who turned the blind eye when there was a real need for a sib to visit. And their policy was to allow parents to sleep with their little kids. Not kid-in-crib, parent-in-sleeperette. No, we could sleep together, and the nurses would arrange all the tubes to allow that to happen. That is priceless when your toddler is so sick.
I just couldn't figure out why, when they obviously wanted to make things better, that they couldn't see the obvious - things that any nursery school teacher could have taught them about the needs of very small children.
I also think the effort in this article is wrong headed. Focusing on physicians is doomed. They actually do not have that much power in the way a hospital is run. It is the overall design of hospital systems that is to blame.
I just couldn't figure out why, when they obviously wanted to make things better, that they couldn't see the obvious - things that any nursery school teacher could have taught them about the needs of very small children.
I also think the effort in this article is wrong headed. Focusing on physicians is doomed. They actually do not have that much power in the way a hospital is run. It is the overall design of hospital systems that is to blame.
4
Hear, hear. Why do facilities and providers not seem to recognize that lack of sleep can negatively affect health? Parents all over the world tell their children to be sure to get plenty of sleep so that they won't get sick -- but go into the hospital or rehab facility, however, and for the most part a good night's sleep is actively prevented. How can that not be bad for someone's recovery?
1
A lot of what this article calls suffering is not suffering. An inconvenience or a frustration but hardly suffering or at best a first world definition of suffering. Waiting a few hours in a busy EMERGENCY department waiting room with an obvious non-emgergency condition is not suffering. I certainly understand the frustration but let's not inflate that into suffering.
I've been an ER physician for many years and we've poured over our Press-Gainy scores monthly. In all this time I've never heard the word suffering come up. Preventing suffering would obviously be important but Press-Gainey is all about customer satisfaction, not preventing suffering. The customer might always be right but few are suffering.
Your inconvenience does not equate to the stroke or trauma patient's suffering.
I've been an ER physician for many years and we've poured over our Press-Gainy scores monthly. In all this time I've never heard the word suffering come up. Preventing suffering would obviously be important but Press-Gainey is all about customer satisfaction, not preventing suffering. The customer might always be right but few are suffering.
Your inconvenience does not equate to the stroke or trauma patient's suffering.
113
I absolutely agree! I almost thought I was reading The Onion when I saw Press Ganey cited in article on "inattentive care." Satisfied patients are usually not healthy patients. Here's an article that sums it up.
http://www.medscape.com/viewarticle/821288
"Satisfied patients are not healthy patients. In a paper published in 2012, researchers at the University of California, Davis, using data from nearly 52,000 adults, found that the most satisfied patients spent the most on healthcare and prescription drugs.[2] They were 12% more likely to be admitted to the hospital and accounted for 9% more in total healthcare costs. Strikingly, they were also the ones more likely to die."
http://www.medscape.com/viewarticle/821288
"Satisfied patients are not healthy patients. In a paper published in 2012, researchers at the University of California, Davis, using data from nearly 52,000 adults, found that the most satisfied patients spent the most on healthcare and prescription drugs.[2] They were 12% more likely to be admitted to the hospital and accounted for 9% more in total healthcare costs. Strikingly, they were also the ones more likely to die."
1
Good point.
One of the problems with customer satisfaction surveys is that sometimes customers don't want to hear bad news. Such pressures on physicians cannot possibly be good for patient care.
One of the problems with customer satisfaction surveys is that sometimes customers don't want to hear bad news. Such pressures on physicians cannot possibly be good for patient care.
2
Boy oh boy -- the arrogance that impedes this kind of progress. Nobody said don't take care of the stroke case first and every example provided worked! This is why people don't talk to their doctors or care personnel...my god I only had a heart attack I can't tell them I'm still sick I might interfere with a stroke patient getting their care.
2
This is all fine and good and yet I would really hesitate to reveal some of my complaints about doctors because if they are in the same system with all the readily available electronic records they know everything that is said in an exam. If a patient get labeled as "difficult" they could make it hard for them to find another physician if change is needed. The last time I had an overnight procedure at a hospital the next morning I wanted the person in the room to assist me with a bath and they brought me all the stuff for the bath but then told me they did not do that. I don't know if they were an aide or nurse but I have never forgotten that and never told my doctor.
1
"Greater patient satisfaction with physicians was associated with increased hospitalization, higher health care expenditures, and a higher mortality risk within a few years, according to a survey of over 36,000 patients."
Arch Intern Med. 2012;172(5):405-411. doi:10.1001/archinternmed.2011.1662
Arch Intern Med. 2012;172(5):405-411. doi:10.1001/archinternmed.2011.1662
5
This is less about satisfaction with the physician, which is often because the doctor offers lots is tests, than satisfaction with a hospital system because the patient has increased comfort while in the hospital. The former depends on a specific survey question,"how satisfied are you?" The latter is based on a number of indirect questions.
Thus it follows that greater patient dissatisfaction is associated with decreased health care utilization, lower costs, and longer lives.
Unless one wants to reexamine the validity of the interpretation of these numbers -- something that statistical experts have long been claiming as the weakest link in medical science -- the docs in this story are moving in precisely the wrong direction.
Unless one wants to reexamine the validity of the interpretation of these numbers -- something that statistical experts have long been claiming as the weakest link in medical science -- the docs in this story are moving in precisely the wrong direction.
I was in Chestnut Hill hospital for 6 days several years ago for severe infection. They saved my leg and they saved my life and woke me up every few house to change the IV antibiotic. Thank you Chestnut Hill Hospital!
2
Amazing what ivory tower institutions are discovering. First a senior editor of the New England Journal Of Medicine is hospitalized in his 80s and is amazed to discover how hard nurses work. Then a prestigious surgeon has to deal with a family members cancer and discovers the emotional turmoil the patient and family goes through. Then patients start complaining their doctor is only looking at the computer and not them. Nurses are spending more and more time checking boxes on their computer than with the patient. Wht next in the bussiness of medicine?
7
The real question is whether it is any different in the ivory tower or the community hospital. These issues are real, both in the ivory tower and elsewhere. But let's give credit to those who call attention to these issues, and hopefully are able to effectuate some improvement in what doctors and nurses do.
A review of the academic literature in Nursing will reveal nursing's interest in and examination of the concept of suffering. Late to this awareness, this would be a wonderful time for MDs to admit that the awareness and knowledge they seek related to suffering lies within a different discipline. Many concepts related to patients and their experience of health and care do not reside in medicine's domain - such as holism, patient-centered, health promotion, anticipatory guidance, suffering - but have been key concepts in Nursing for decades. During This era of transformation of our health care priorities and delivery systems, now may be a good time to share evidence and insights rather than medicine providers and academics assuming that they need to develop expertise already well established as core nursing knowledge.
2
The most useful rule at "The House of God": Do as much nothing as possible.
2
We seem to require regular “reminders” of patients’ essential personhood. In 1926 Francis Peabody delivered a speech to Harvard Medical School students in which he warned about the depersonalization of the practice of medicine and the degradation of the doctor-patient relationship. As he famously cautioned, "The good physician knows his patients through and through, and his knowledge is bought dearly. […] One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient."
The seeming tautology of Peabody’s dictum invites us to consider the scope of care itself beyond laboratory science and disease processes. Similarly, in Eric Cassel’s influential 1982 article in The New England Journal of Medicine, “The Nature of Suffering and the Goals of Medicine”, he address suffering as the experience of illness or injury that is not limited to physical pain, but is an anguish at threats to one’s personhood—threats which often include medical intervention itself. As he explained, "It is not possible to treat sickness as something that happens solely to the body without thereby risking damage to the person."
As Cassel describes, the dissociation of illness from personhood is itself a form of injury, still sadly endemic in our healthcare system today. The message about suffering isn’t new, but it founders in the face of a system which effectively objectifies and dehumanizes patients and clinicians alike.
The seeming tautology of Peabody’s dictum invites us to consider the scope of care itself beyond laboratory science and disease processes. Similarly, in Eric Cassel’s influential 1982 article in The New England Journal of Medicine, “The Nature of Suffering and the Goals of Medicine”, he address suffering as the experience of illness or injury that is not limited to physical pain, but is an anguish at threats to one’s personhood—threats which often include medical intervention itself. As he explained, "It is not possible to treat sickness as something that happens solely to the body without thereby risking damage to the person."
As Cassel describes, the dissociation of illness from personhood is itself a form of injury, still sadly endemic in our healthcare system today. The message about suffering isn’t new, but it founders in the face of a system which effectively objectifies and dehumanizes patients and clinicians alike.
3
Would be very instructive to see a survey of how nurses feel they are treated by the doctors they work with.
7
I don't understand all the negative comments. This is a positive development and I applaud it!
If you want to really reduce patient suffering, provide physicians and hospitals with an insurance code they can charge labeled "suffering reduction efforts".
4
While applaud the customer satisfaction strategy, the larger question is what is driving the "care" problem. Thankfully, I have limited experience/stays in a hospital for routine procedures, but what I noticed was a systems like approach to the visits, questions, and tests that I was ask to respond to. In conversations with several doctors, they claim that insurance and liability are driving that systems like approach to human pain and suffering. Even my family doctor, who I have known for many years, now looks at a computer screen more than he looks at me. The care and medical expertise I am receiving is excellent, what is missing is that interpersonal connection which is a large ingredient in the care formula. Should add, I see the same thing happening in schools where teachers spend more time looking at computerized spread sheets then looking me in the eye and giving me some feeling they know my child beyond a number on a test.
1
When the third leading cause of death is medical mistake, Attention should first be there.
8
The first rule to follow in order to avoid becoming another medical mistake is never, ever take any prescription drug. If your doctor gives you a prescription, throw it in the trash. One of the leading causes of death in this country is prescrpition drugs.
1
Don't throw out the baby with the bath water. I'm alive today, more than 15 years after a cancer diagnosis, thanks in part to prescription medications. You do fellow patients a disservice by supporting this point of view.
2
Thank god there is someone here who recognizes that perhaps medical care might save a life or two once in a while, instead of only "dehumanizing" everyone and causing "suffering".
Was anyone else struck by the posture of the resident in blue, with his arm flung up on the bedrail? By treating the patient's personal space with complete disregard, this guy conveys a message that the patient is only part of the background, not the reason for the whole enterprise of medicine. Why is it so hard to view patients as people deserving simple courtesy?
6
Perhaps. Or maybe he and the patient have developed a relationship in which the patient enjoys the closeness and the resident recognizes the honor that this imparts. There is enough discourtesy out there that we need to make sure that it has not blinded us to the possibility of decency.
No, I did not interpret the resident's posture as dismissive or insulting. His arm isn't "flung" up on the bed rail. He's leaning up against it in a crowded room. I'd rather have my physician appear relaxed and attentive rather than rushed and robotic. The person to whom they're listening appears to be a family member. What's the problem?
1
I'm old enough to remember when my doctor came to the house. He knew everything about us, as a family unit, as individuals. We knew him and his family, socialized with them too. Healthcare is so anonymous today that it's no wonder doctors feel they need to give their patients a survey.
6
Comments loading on doctors here. Sorta unfair. The real issue in my opinion is the entire medical delivery system where "who is going to pay" becomes number one issue, or if anyone will pay. Then, add to, the dis incentive of becomng a doctor, financial, debt. So, keep on loading on them. Sorta like the folks that dislike attorneys until you need one.
3
1. Stop hiding behind your computer. Start talking to your patients and looking directly at them. Do this today.
2. Get rid of all the stupid and ridiculous forms that
you are asking people to fill out.
3. Be far less concerned with keeping detailed health records. No one is really looking at them anyway.
4. Cut all your patient's drug prescriptions back by half. The chances are good that they'll feel better
immediately.
5. Start telling people straight out that you don't know what their problem is. Stop telling them, it's all in your head.
6. Always keep in mind that there are no "chronic"
problems. There are only problems that you and your colleagues don't know how to fix.
7. Assign people in your office to periodically call
patients on the telephone to find out how they are doing. Or much better yet, do it yourself.
8. Stop telling people that marvelous new cures for diseases like Alzheimer's are "right around the corner" when you know perfectly well they are not.
9. Make a home visit from time to time. Attend
the funerals of some of your patients. You may
actually learn something.
10. Be far, far less impressed with yourselves. Be ever mindful of the fact that your own obituary will be appearing in a newspaper someday soon, notwithstanding the marvelous advances of modern medical science.
11. If you are really afraid of being sued by one of your patients, consider becoming a lawyer.
2. Get rid of all the stupid and ridiculous forms that
you are asking people to fill out.
3. Be far less concerned with keeping detailed health records. No one is really looking at them anyway.
4. Cut all your patient's drug prescriptions back by half. The chances are good that they'll feel better
immediately.
5. Start telling people straight out that you don't know what their problem is. Stop telling them, it's all in your head.
6. Always keep in mind that there are no "chronic"
problems. There are only problems that you and your colleagues don't know how to fix.
7. Assign people in your office to periodically call
patients on the telephone to find out how they are doing. Or much better yet, do it yourself.
8. Stop telling people that marvelous new cures for diseases like Alzheimer's are "right around the corner" when you know perfectly well they are not.
9. Make a home visit from time to time. Attend
the funerals of some of your patients. You may
actually learn something.
10. Be far, far less impressed with yourselves. Be ever mindful of the fact that your own obituary will be appearing in a newspaper someday soon, notwithstanding the marvelous advances of modern medical science.
11. If you are really afraid of being sued by one of your patients, consider becoming a lawyer.
18
12. Permit them, nay encourage them, to bring their very good dogs into your office.
1
Your post reminded me of something I had noticed at my sister's funeral. She had the same GP for 30 years and a specialist for 20+ due to suffering from what is now call COPD. All those years, yet neither doctor showed at her funeral or sent condolences. Yet my cat's Vet sent a card and flowers when he died after a long illness. Disgraceful
1
Most doctors would agree with you on 1-4. However they are now requirements if you want to be paid, and also for malpractice insurance. Insurance companies are now doing routine 'audits' of medical records kept by doctors with a view to recovering whatever they paid for treatment of every one of their requirements isn't met. Medications are 'recommended' by the EMR or the insurance company formulary. Defy them at your peril.
Phone-based contact is discouraged and not paid for at all, but it still takes time and costs money. If you are an employed doctor this, and all the form filling and documentation, is something you get to do on your own time, after you meet your quota of 'patient encounters.'
Phone-based contact is discouraged and not paid for at all, but it still takes time and costs money. If you are an employed doctor this, and all the form filling and documentation, is something you get to do on your own time, after you meet your quota of 'patient encounters.'
2
I am currently caught up in the medical system at a local hospital. I keep getting these patient satisfaction surveys in the mail to fill out, but they are worthless
Each one asks a lot about how "your doctor" did with regard to a lot of items that follow. Problem: I am seen by a team of doctors, and go in on a weekly or 2-week basis where I see a variety of doctors Yet the survey does not specify which doctor they want the survey to refer to.
The survey is long--hello, we are patients undergoing procedures that leave you with little energy and not much concentration--a number of items are not applicable. Time is not money for patients but is it energy loss. How do we want to spend our time?
Given the emphasis on marketing hospitals in our town, why do I have the cynical feeling that these surveys are:
1. Supposed to make us think the hospital actually cares about what we think.
2. How do we know anyone reads and analyzes these and gives feedback to the doctors (as if doctors have time and interest, given how they are pushed to see max. patients in small amounts of time)?
3. You can't get reliable, valid information out of poorly constructive surveys.
4. My guess is these surveys came from a commercial company, and those who chose to use this survey at my hospital never tried taking the survey themselves--which gets back to #1 above.
Bad surveys do more harm than good. Better just to interview patients by phone; ask open-ended reactions to & suggestions about their care
Each one asks a lot about how "your doctor" did with regard to a lot of items that follow. Problem: I am seen by a team of doctors, and go in on a weekly or 2-week basis where I see a variety of doctors Yet the survey does not specify which doctor they want the survey to refer to.
The survey is long--hello, we are patients undergoing procedures that leave you with little energy and not much concentration--a number of items are not applicable. Time is not money for patients but is it energy loss. How do we want to spend our time?
Given the emphasis on marketing hospitals in our town, why do I have the cynical feeling that these surveys are:
1. Supposed to make us think the hospital actually cares about what we think.
2. How do we know anyone reads and analyzes these and gives feedback to the doctors (as if doctors have time and interest, given how they are pushed to see max. patients in small amounts of time)?
3. You can't get reliable, valid information out of poorly constructive surveys.
4. My guess is these surveys came from a commercial company, and those who chose to use this survey at my hospital never tried taking the survey themselves--which gets back to #1 above.
Bad surveys do more harm than good. Better just to interview patients by phone; ask open-ended reactions to & suggestions about their care
19
A number of studies of communications between medical professionals and patients at admission and during treatment have been found to reduce hospital re-admissions, improve patient compliance with discharge instructions, etc. By asking the patient a few simple questions, a patient can be typed by mind-set. Some patients want the doctor to be the source of all information, others want to share in decisions, some people decline to accept any information, while still others defer to figures of authority, like clergy.
In studies performed by Saratoga Springs, NY-based iNovum.com, hospital re-admissions for diseases such as heart failure and others decreased exponentially, potentially saving a regional hospital thousands of dollars of Medicare reimbursements. Improved communication with patients benefits everyone.
In studies performed by Saratoga Springs, NY-based iNovum.com, hospital re-admissions for diseases such as heart failure and others decreased exponentially, potentially saving a regional hospital thousands of dollars of Medicare reimbursements. Improved communication with patients benefits everyone.
1
A significant source of "suffering" is the long trail of bills that follow anything more than the most basic doctor office visit -- sticker price shock (often with the first bill or two indicating this is "your responsibility", bills for tests and scans that you never heard directly the results of -- no news is good news, right?
20
I have a number of health issues, see physicians regularly, and receive both outpatient and inpatient care. My experience is varied with regard to personal care.
My experience with ER and ICU care has been excellent.
In general communication with physicians and professional staff during office visits is very good. In general I have received attentive care from professional staff during office visits. Initial contact with non-professional staff (receptionists) varies significantly in quality. At one medical center based practice, communication with receptionists is exceptionally difficult. I suspect that this variation can be attributed to hiring practice and salaries of non-professional personnel.
My inpatient communications experience with physicians is often short, and is frequently done by physicians who are harried. One of the things not mentioned in this article is hospitals' cost cutting by reducing professional staff. Nurses in particular are fewer in number and overworked. Over the course of 10 years I have experienced a very significant decline in quality of patient care in one hospital due significant reduction in the nursing staff.
My experience with ER and ICU care has been excellent.
In general communication with physicians and professional staff during office visits is very good. In general I have received attentive care from professional staff during office visits. Initial contact with non-professional staff (receptionists) varies significantly in quality. At one medical center based practice, communication with receptionists is exceptionally difficult. I suspect that this variation can be attributed to hiring practice and salaries of non-professional personnel.
My inpatient communications experience with physicians is often short, and is frequently done by physicians who are harried. One of the things not mentioned in this article is hospitals' cost cutting by reducing professional staff. Nurses in particular are fewer in number and overworked. Over the course of 10 years I have experienced a very significant decline in quality of patient care in one hospital due significant reduction in the nursing staff.
84
While it is important to listen to patients and to make them as comfortable as possible, nothing in this article points to the real goal of medicine: to cure or at the very least make patients better. I'm not berating the new focus, which has a lot to do with Medicare/Medicaid and insurance reimbursement (don't let anyone fool you), but sometimes the patient isn't always right. Sometimes the patient needs to be sternly told what to do.
I fully think it is a good idea and compassionate to actually let inpatients sleep through the night. But there are instances when the patient is not right. Clearly not every patient should simply be given pain medications or antibiotics for the most frivolous complaints. Occasionally when a patient has the flu, cold, or sinus infection they simply should be sent home with no medications. When this happens some patients may really take that survey to heart...
I fully think it is a good idea and compassionate to actually let inpatients sleep through the night. But there are instances when the patient is not right. Clearly not every patient should simply be given pain medications or antibiotics for the most frivolous complaints. Occasionally when a patient has the flu, cold, or sinus infection they simply should be sent home with no medications. When this happens some patients may really take that survey to heart...
55
Amen. All of this supposed "patient centered focus" has more to do with money than with true compassion or concern for alleviation of patient suffering.
The patient often knows what s/he wants, but not always what s/he needs. The physician's views are "skewed" by years or decades of education and experience.
Sadly, the patient who is not given antibiotics for a viral infection will often vent his or her frustration in a Press Ganey survey. This is not taken into account in the process of evaluating the physician's care via these instruments.
The patient often knows what s/he wants, but not always what s/he needs. The physician's views are "skewed" by years or decades of education and experience.
Sadly, the patient who is not given antibiotics for a viral infection will often vent his or her frustration in a Press Ganey survey. This is not taken into account in the process of evaluating the physician's care via these instruments.
1
I certainly hope you are not a physician, and if you are I hope I am not compelled to be your patient.
Explanations and education help a patient comply with orders.
Not bullying!
Explanations and education help a patient comply with orders.
Not bullying!
You're missing a good bit in your response. Compassion and caring are linked to patient engagement and improved outcomes. Patients are not always right. What's important is how you communicate with care and concern why certain things need to be done and why certain actions are not appropriate. There are a number of good frameworks for such. There are also excellent, patient centered frameworks for negotiating when there are differences in patient and provider perspectives.
The way hospitals fail to recognize the health benefits of A GOOD NIGHT'S SLEEP has always bewildered me. I'm sure the same medical personnel, if they had a family member at home with flu, say, would put them to bed, tell other people in he house to be quiet, give them something to help them sleep,and not dream of waking them up in the middle of the night or at 6 in the morning just to see how they were doing or tot take their temperature. It's just common sense. Let's hope all other hospitals follow this lead.
3
When you find your patient dead in the morning because no one checked their vitals overnight or when you go in to check on them and they are on the floor because the sleeping medication that you gave them made them confused, you'll see that "common sense" to the layperson is not common sense to people who man hospitals overnight. Nursing a cold at home is not the same as an illness that warrants you to be in the hospital overnight. There are many instances where it is fine to leave patients alone, but for patients on floors without monitors, it is not unusual to hear the code calls overhead in the early morning, because as patients are being woken up, that is when the problems are discovered. How would you feel if your relative was found dead in the morning - I am quite sure the term "negligence" wouldn't be far from someone's mouth.
1
Therese, when we say "don't wake us up unnecessarily" we don't mean "go out clubbing"!
Check up on patients periodically and QUIETLY.
And where do you find hospitals without beeping monitors? Does not exist.
Check up on patients periodically and QUIETLY.
And where do you find hospitals without beeping monitors? Does not exist.
It's amazing how many professions never ask for written feedback from their clients. You have to assume they don't want to know what their clients think about them.
7
Would it have been so hard to solicit some input from people that aren't paid by Press-Ganey to comment on the validity of their surveys and the increasing utilization of them by both hospitals and payors? Or the amount of money we're spending as a nation on these surveys, and what we're getting out of them? This reads like a PR piece written by PG.
6
There is hardly a profession more noble than that of medical doctor. Like the James Taylor song, "Fire and Rain," some of these have literally seen it all. Mr. Taylor dedicated this song on his legendary, "Story Tellers," album to his childhood friends who had encountered an early death. In the second line of the song F&R he sings, "Suzanne the plans they made put an end to you," which referred to Suzanne Schnerr, a childhood friend who committed suicide.
Taylor fell into a deep and dark depression after her death and the failure of his band, and wrote, "sweet dreams and Flying Machines in pieces on the ground" which was about the deaths of his band in an airplane accident. He spent alot of time in hospitals and noted the brilliance of the staff and their empathy for the patients. Doctors who take the time and effort to understand the personal stories of each patient as well as the emotional states that effect their ability to get well are the most remarkable. Just like the uncanny ability of dogs to intuitively detect the exact illness of a human w/o advanced technology, highly sensitive doctors are able to incorporate their incredible brain power with the emotional intelligence to assist people recover from an array of suffering. Just like "Fire & Rain," the more that doctors rely on both gut intuition as well as technology and training, the greater the ability to heal people from the wreckage of their pain & suffering.
Taylor fell into a deep and dark depression after her death and the failure of his band, and wrote, "sweet dreams and Flying Machines in pieces on the ground" which was about the deaths of his band in an airplane accident. He spent alot of time in hospitals and noted the brilliance of the staff and their empathy for the patients. Doctors who take the time and effort to understand the personal stories of each patient as well as the emotional states that effect their ability to get well are the most remarkable. Just like the uncanny ability of dogs to intuitively detect the exact illness of a human w/o advanced technology, highly sensitive doctors are able to incorporate their incredible brain power with the emotional intelligence to assist people recover from an array of suffering. Just like "Fire & Rain," the more that doctors rely on both gut intuition as well as technology and training, the greater the ability to heal people from the wreckage of their pain & suffering.
1
Carla, his band didn't die in an airlplane accident. An early band was called The Flying Machines, they broke up, hence the line.
The article would have us think the medical profession just made a major medical breakthrough. Treating the person, called patient, with respect through common sense. Sounds like part of the curriculum for Bedside Manners 101, not a scientific breakthrough.
Doctors have a really tough job and our whole social system based on medical care as a function of money makes it tougher yet. Having to address numerous patients within the constraints of time make it tougher.
The physician's acknowledgement of the patient as a person first and foremost lends a great deal to the person's attitude if not the eventual medical outcome.i
Doctors have a really tough job and our whole social system based on medical care as a function of money makes it tougher yet. Having to address numerous patients within the constraints of time make it tougher.
The physician's acknowledgement of the patient as a person first and foremost lends a great deal to the person's attitude if not the eventual medical outcome.i
5
Well what a surprise. The NYT writing about the miserable conditions in our awful archaic third world health care system. Thank God the NYT is there to help save us from the big bad uncaring doctors. Here is a perfect example of the law of unintended consequences. If you set up a payment scheme and a malpractice system that mandates documentation of meaningless things then this is the result. Examples: 1) A doctor cannot bill without doing a physical exam. 2) A nurse must check on a patient's pain status, even if he is sound asleep 3) A teaching physician cannot have a trainee's physical exam count for billing purposes - even if that trainee is a fully licensed physician and the exam is not critical for the continued care of the patient. The result is a string of doctors mandated by the silly medicare rules to listen to the patients heart and lungs 10 times a day for documentation purposes. The nurses have to wake patients to finish their mandatory stupid documention. All of this impacts patient comfort .. not to mention infection control issues with so many needless patient contacts in the face of resistant infections. Senior docs should have discretion to trust or not trust the value of a trainees evaluation and they should be paid for the expertise they bring to analyzing the data and taking all the malpractice risk involved with supervision. But needless reexamining of the same patient hour after hour and day after day is the result our stupid laws
7
In the era when malpractice was more fearsome than now, medical care was better, because healthcare institutions focussed upon risk management practices to mitigate their potential losses from bad outcomes. That all changed with conservative Republican "tort reform" and malpractice caps to protect insurance companies.
In this brave new world of unintended consequences, it is so hard for anyone to win a malpractice case that insurance companies are focussed strongly on decreasing patient unhappiness -- which produces a need for out-of-court settlements to avoid the threat of expensive litigation.
Because of that legal change, healthcare institutions now minimize risk management practices (i.e., good medical care), and instead focus on "Quality" -- meaning that everyone plays touchy-feely games and takes endless surveys in hopes of avoiding unhappy patients who might threaten a suit.
If your doctor smiles at you longer, it's because his evaluation depends on it. Improving healthcare has nothing to do with it.
In this brave new world of unintended consequences, it is so hard for anyone to win a malpractice case that insurance companies are focussed strongly on decreasing patient unhappiness -- which produces a need for out-of-court settlements to avoid the threat of expensive litigation.
Because of that legal change, healthcare institutions now minimize risk management practices (i.e., good medical care), and instead focus on "Quality" -- meaning that everyone plays touchy-feely games and takes endless surveys in hopes of avoiding unhappy patients who might threaten a suit.
If your doctor smiles at you longer, it's because his evaluation depends on it. Improving healthcare has nothing to do with it.
1
If only they actually *made* morning rounds. When my mother was in the hospital, we had to keep watch around the clock and snag a doctor in person. They came at all hours, or not at all, and they never called or consulted us, nor could we ever reach them. If every doctor spent a week in the hospital feeling bad enough to want to be left alone but good enough to pay attention to what happened there, and kept a journal about the experience, healthcare might turn back into care for health.
13
When my time comes I'm going to skip the hospital and go directly to hospice care. It's the quality of my life that matters, not the length.
I am sure that the doctors are really sorry for inconveniencing you. Why don't you have some gratitude for the work they did for your mother? Disgusting
Last year I had a short stay in a major New York City hospital. After an overnight in the emergency room I was assigned a hospital bed. My roommate was on a machine that made it impossible for me to sleep because of the noise. When I informed the nurses they said that there were no other rooms available.
I gave them three choices. 1) Let me sleep in the visitors lounge. 2) Put me up in the hall away from my noisy room. 3) I would check myself out in the middle of the night.
I ended up sleeping in the hallway on one of those beds with wheels they roll patients around on. I was discharged the next day (lucky for me). I'm only 80 years old.
I gave them three choices. 1) Let me sleep in the visitors lounge. 2) Put me up in the hall away from my noisy room. 3) I would check myself out in the middle of the night.
I ended up sleeping in the hallway on one of those beds with wheels they roll patients around on. I was discharged the next day (lucky for me). I'm only 80 years old.
17
Also, not wearing private clothing, removing jewelry and watches would probably decrease the in-hospital spread of resistant bacteria... Just saying.
3
As a fourth-year medical student applying for residency, I actually wrote an essay discussing how all doctors should have to spend time in the hospital as a patient. hospitalized twice, I vividly remember the horrible experience of being an impatient. I've described it to friends and colleagues as "the worst place in the world to be when you feel sick." Impressively, I cited all the reasons listed in this article: being woken up constantly, feeling uninformed, and frankly, boredom. I remember several doctors standing around my bed in the wee hours of the morning discussing my case without even looking at me and feeling profoundly ignored and annoyed. I now know this was surgery rounds.
As a medical student I have tried to make up for these deficiencies, but I am concerned as I move to residency I will have so little time that this will no longer be possible.
As a medical student I have tried to make up for these deficiencies, but I am concerned as I move to residency I will have so little time that this will no longer be possible.
259
"[B]eing woken up constantly, feeling uninformed, and frankly, boredom."
You might have added -- although I guess it wasn't one of your experiences, Zack -- the terror of a resident's entering your room determined to give you a medication that you shouldn't be given and that -- oops! -- was meant to go to the patient in the neighboring bed. A lot of fierce hand-waving was involved in that one.
Or being asked what medications you're on and having one of them written down incorrectly. Always ask young doctors (particularly, who haven't yet been chastened by mistakes) to read lists back to you.
Whenever I've had to deal with careless people and then to follow up in order to get errors rectified, I always sigh, "Well, it could be a doctor, and the mistake could be on a kidney." But when the careless person is a doctor . . . .
You might have added -- although I guess it wasn't one of your experiences, Zack -- the terror of a resident's entering your room determined to give you a medication that you shouldn't be given and that -- oops! -- was meant to go to the patient in the neighboring bed. A lot of fierce hand-waving was involved in that one.
Or being asked what medications you're on and having one of them written down incorrectly. Always ask young doctors (particularly, who haven't yet been chastened by mistakes) to read lists back to you.
Whenever I've had to deal with careless people and then to follow up in order to get errors rectified, I always sigh, "Well, it could be a doctor, and the mistake could be on a kidney." But when the careless person is a doctor . . . .
1
Compassion, empathy and "getting" patients' communications are not mystical they are learned skills and behaviors, the more you practice them the more refined and expeditious they become. But it takes discipline,,,,the same kind of discipline you have applied to learning all the technical skills you are being taught. You're on the right track and as a repeat hospital patient I too wish that doctors would have to spend 2 days or so in a hospital but the real answer is a commitment such as you have expressed and practice, practice, practice in connecting with the patient...and no generally your "culture" does not support you in this practice.
3
Surgery rounds! I fought my way through the fog of anesthesia at 8PM to hear a young man, whom I thought might be my surgeon, say that the plastic surgeon wanted me to go home "tomorrow afternoon." To the shock of the med students gathered at the foot of my bed, I said "Plastic Surgeon has never had this surgery, is not my age and doesn't live alone. I'm staying at least one more night." I could barely walk, even with assistance, the next day. Plastic Surgeon subsequently agreed with my decision.
In recent history many hospitals in the US have implemented 'Hospitalists" service 24X7. Hospitalists are internists that are responsible for the inpatients during their hospitalization. They work closely with the primary care physician or surgrgeon who has admitted the patient. This should improve care and reduce suffering. In the former model the patient was usually limited to physican attention in the early morning or dinner hours. Essentially at the mercy of how much time the physician wanted to add to their day.
In my experience with two aged parents in two different hospitals, hospitalists were the worst.
2
You'll never see the hospitalist. Or hear of him/her, until a bill arrives months later from some doctor whose name will be a complete mystery. What do they do, hospitalists? How can they "work closely with the primary care physician or surgrgeon who has admitted the patient" when they never meet the patient? Does "work closely with" come out to "golfs with"?
They do they orders for medications and treatments that save your life. As well as consults, discharge planning etc. To be honest, you don't deserve to be treated by a doctor. Just stay home next time you're really sick, please
Surveys, shmurveys. How about asking a few simple questions every time you round on a patient: "Is there anything I can do to make you feel more comfortable?" "Do you have any questions about your care that I can try and answer?" If your body language gives the patient permission to answer honestly, meaning you are fully present for them and prepared to spend some time listening, there would be less demerits on the surveys. And better outcomes.
24
All the unnecessary tests! Doctors prefer tests and quantified results. Almost every patient is given a cat scan when they are admitted. I appeared with an obvious infection that I could point to, but it took almost 24 hours of complaining to get a senior doctor to look it and deal with the problem rather than tell me there was no obvious lump on the cat scan.
It was the largest item on the bill, too. I had insurance, but that's no excuse for performing tests that are rote rather than justified. Others I know have also be forced to have a cat scan to be admitted and had to pay for it. 5,000 smackeroos to get a doctor to look at you? pfui!
It turned out I had MRSA, and they even put me in a room with a patient on dialysis. Why did I have to holler for somebody who would look at me rather than the paperwork to get a proper diagnosis. It was a good hospital too!
It was the largest item on the bill, too. I had insurance, but that's no excuse for performing tests that are rote rather than justified. Others I know have also be forced to have a cat scan to be admitted and had to pay for it. 5,000 smackeroos to get a doctor to look at you? pfui!
It turned out I had MRSA, and they even put me in a room with a patient on dialysis. Why did I have to holler for somebody who would look at me rather than the paperwork to get a proper diagnosis. It was a good hospital too!
24
As Lewis Thomas noted in "The Youngest Science," medicine is a hands-on procedure, not a system of charts and algorithms.
5
Agreed. Two weeks in the hospital recently only confirmed that charts and algorithms, while very useful in some respects, are no replacement for actually sitting down with a patient and talking, and more importantly, listening.
A loved one had a serious illness and shuttled between a rural hospital and a rehab for months. He was on a slow decline, but everyone at the hospital insisted he was getting the best possible treatment.
Finally, a nurse friend from out of town told us that some people who are disatisfied with treatment check their loved one out ADA (against doctor's orders) and drive him or her right to the emergency room of a better hospital. None of our crowd of educated people (including many professors and corporate execs) had ever heard of doing that.
We did that - drove our friend six hours to a celebrated urban hospital - and his health started improving immediately. The move undoubtedly saved his life.
Oh, and while we were signing him out from the original hospital, one of the initial boosters whspered to us, in great secrecy, "You're absolutely doing the right thing. He can't get the care he needs here."
Hippocratic oath, indeed.
Finally, a nurse friend from out of town told us that some people who are disatisfied with treatment check their loved one out ADA (against doctor's orders) and drive him or her right to the emergency room of a better hospital. None of our crowd of educated people (including many professors and corporate execs) had ever heard of doing that.
We did that - drove our friend six hours to a celebrated urban hospital - and his health started improving immediately. The move undoubtedly saved his life.
Oh, and while we were signing him out from the original hospital, one of the initial boosters whspered to us, in great secrecy, "You're absolutely doing the right thing. He can't get the care he needs here."
Hippocratic oath, indeed.
42
Being of a certain age is incredibly liberating--I simply take nothing lying down anymore; regardless of what medical personnel believe, it is not my job to be nice. I am the customer, and more importantly, my health or the health of my loved one is at stake. I demand courtesy, answers, and decent service, and if they make me wait too long, the hell with it--I walk out AMA (you can do that) and find a better doctor or facility. Bonus: it embarrasses my children.
3
We have been doing this for years at kaiser Permanente. Glad everyone else has finally realized it.
1
I still remember the time a doctor blithely said, "Well, it could be a brain tumor" when I presented with some hearing loss in one ear. This was after he had given me the "stink eye" after removing a bit of deeply embedded wax. At the end of the day, and after two MRIs (only one of which my insurance paid for) it was neither the wax nor a brain tumor that had caused the problem, but I will never forget his arrogance, and how he completely ignored me and chatted with his staff as I left his office.
I'm guessing that anyone who has had medical care probably has a similar story, and in that lies the problem. Attempts like these to fix this problem are decades overdue. The lack of concern begins in med school and is thoroughly inculcated by graduation...
I'm guessing that anyone who has had medical care probably has a similar story, and in that lies the problem. Attempts like these to fix this problem are decades overdue. The lack of concern begins in med school and is thoroughly inculcated by graduation...
44
Did you go to medical school? How do you know that " The lack of concern begins in med school and is thoroughly inculcated by graduation"?
You have no idea what you are talking about. Keep your ideas to yourself.
You have no idea what you are talking about. Keep your ideas to yourself.
Sounds to me like you DID go to med school, based simply on your "Keep your ideas to yourself" statement. That's perfect "Doctor speak."
What if the doctor hadn't gotten the MRI, and it turned out you did have a brain tumor. Would you be happy then??
The reason that the doctor got the MRI was cause he didn't KNOW if you had a brain tumor, and the MRI was to rule it out.
Why is that do difficult to understand?!? You should be happy that he got an MRI and you didn't have a brain tumor instead of complaining!!!
The reason that the doctor got the MRI was cause he didn't KNOW if you had a brain tumor, and the MRI was to rule it out.
Why is that do difficult to understand?!? You should be happy that he got an MRI and you didn't have a brain tumor instead of complaining!!!
1
The real cause of most of the suffering described in this article is that health care in this country is a for-profit industry.
Insurance companies are money-making businesses that skim off a significant portion of our health care dollars while providing no really useful services to doctors or patients.
Instead physicians have to hire thousands of persons just to complete a plethora of different forms from different insurance company, each with its own requirements.
All medical professionals are forced to take the least amount of money for their services that the insurance company can get away with paying. And while the U.S. Congress has trillions to spend for foreign wars and drone strikes that create new enemies for us every day, it continues to put the squeeze on Medicare. This means less money for those actually providing medical care.
A friend who analyzes medical practices to help build morale among patients and employees while at the same time keeping the practices solvent, says insurance firms are slowing bleeding the health care system to death. Many physicians are struggling to keep their offices open because of added costs and diminishing revenues.
Thus doctors must see more patients. At the same time large cartels that serve shareholders rather than the sick have gobbled up the nation's hospitals and cut staff right and left to increase profits.
So while the changes delineated here can do some good, they are like putting a bandaid on a hemorrhage.
Insurance companies are money-making businesses that skim off a significant portion of our health care dollars while providing no really useful services to doctors or patients.
Instead physicians have to hire thousands of persons just to complete a plethora of different forms from different insurance company, each with its own requirements.
All medical professionals are forced to take the least amount of money for their services that the insurance company can get away with paying. And while the U.S. Congress has trillions to spend for foreign wars and drone strikes that create new enemies for us every day, it continues to put the squeeze on Medicare. This means less money for those actually providing medical care.
A friend who analyzes medical practices to help build morale among patients and employees while at the same time keeping the practices solvent, says insurance firms are slowing bleeding the health care system to death. Many physicians are struggling to keep their offices open because of added costs and diminishing revenues.
Thus doctors must see more patients. At the same time large cartels that serve shareholders rather than the sick have gobbled up the nation's hospitals and cut staff right and left to increase profits.
So while the changes delineated here can do some good, they are like putting a bandaid on a hemorrhage.
53
Exactly! More nurses, doctors, PAs, Nurse Practitioners, PTs and OTs and fewer administrators and clerks would make the health care system better.
1
As a representative of the families who suffer needless loss of their loved ones, brothers, sisters, mothers. fathers, etc. and the families who have their loved ones returned to them from hospital care crippled for life, all because of preventable medical errors. (We are talking about 1,000 needless deaths, many more crippled for life every single day of the year)
The patients who do survive catastrophic "hospital acquired harm" are almost always left to live out their lives in some parallel universe where no provider wants them. Society dos not want them, seen as a burden on society.
I am glad the medical community are accepting the fact "yes" they are causing a lot of needles human suffering.
At least starting with the insignificant things is a start in the right direction..
Thank you for pausing to ponder the idea of preventable human suffering .......acquired in hospitals.
The patients who do survive catastrophic "hospital acquired harm" are almost always left to live out their lives in some parallel universe where no provider wants them. Society dos not want them, seen as a burden on society.
I am glad the medical community are accepting the fact "yes" they are causing a lot of needles human suffering.
At least starting with the insignificant things is a start in the right direction..
Thank you for pausing to ponder the idea of preventable human suffering .......acquired in hospitals.
6
I've had many bad experiences as an out-patient. I have a rarely diagnosed genetic disorder called Ehlers-Danlos syndrome. All my joints are deteriorating. It's painful & exhausting. Many doctors have never heard of it. They assume I'm a hypochondriac, without taking the time to Google it. I quit seeing any doctors because I'm not getting any help.
3
How can we find out the suffering indexes in our local hospitals?
10
Doctors should be reminded that the M.D. after their names does not mean "Medical Deity."
6
About twenty years ago, I was hit by a car and in the hospital with serious injuries. I couldn't get out of bed, and could only sleep on my back. After nurses would come in to check vitals in the middle of the night, most of the time, they left the light on--the lightswitch was by the door; I couldn't reach it. so this overhead light would be glaring till a could get someone to answer the call button and turn it off--which they'd finally do, resentfully. I sure hope things have changed from the better since then.
8
What concept: considering the patient's perspective!
3
Every single one of us, no matter our jobs or life circumstances, can do better at what we do. Not every improvement has to be a new discovery. It's a discovery of "how can I personally use known techniques to be better at what I do?" If the medical community wants to spend time thinking of ways for themselves as individuals to do their jobs better, more power to them. I'm not a doctor or a nurse, but I'm often a patient. I choose, when I can, to be treated by those who listen to me, answer my questions, and consider my ideas. It makes all the difference in the world!
1
The general environment at Beth Israel is like something out of Kafka. It has always surprised me that its reputation for highly educated doctors is totally undone by a soviet-style staff who routinely make errors that call into question all assumptions about quality and accuracy.
5
Those monitoring machines! Turn off the noise in the patients' room...monitor with sounds & flashes at the nurses' desk or central station.
Have 'NO TV' rooms, like we formerly had No Smoking rooms.
Have 'NO TV' rooms, like we formerly had No Smoking rooms.
7
Having written about the "quality in healthcare" movement since the 90s, I found this article really interesting in terms of how surveys had changed.
Several decades ago, health plans themselves conducted the surveys and they were mainly about such customer service issues as phone responsiveness, networks and access, claims resolution, and amount of extra services provided. This was the age of managed care, and every plan used the NCQA ratings to tout their plans, back when competition was tough.
In the past decade, the movement sure has moved to these incessant surveys--partly as a result of the ACA and its' "accountable care organization" scores that affect mainly hospitals (and their bottom lines). But the move to respond to actual patient experience--and the responsiveness of institutions like Beth Israel to make basic changes in say, sleeping conditions--is really great.
Surveys can be illuminating but analyses need to factor in the "disgruntled" patient factor--that some folks will complain no matter how good the care and treatment received is. But doctors are finally facing what most of us who worked in business learned a long time ago: you never get a chance to make a first impression, and as long as patients have choices, in doctor and hospital selection, they get to act on them.
Maybe surveys will finally get physicians to realize the humanity of the people they are treating--something not taught enough, or taken seriously enough--in medical school.
Several decades ago, health plans themselves conducted the surveys and they were mainly about such customer service issues as phone responsiveness, networks and access, claims resolution, and amount of extra services provided. This was the age of managed care, and every plan used the NCQA ratings to tout their plans, back when competition was tough.
In the past decade, the movement sure has moved to these incessant surveys--partly as a result of the ACA and its' "accountable care organization" scores that affect mainly hospitals (and their bottom lines). But the move to respond to actual patient experience--and the responsiveness of institutions like Beth Israel to make basic changes in say, sleeping conditions--is really great.
Surveys can be illuminating but analyses need to factor in the "disgruntled" patient factor--that some folks will complain no matter how good the care and treatment received is. But doctors are finally facing what most of us who worked in business learned a long time ago: you never get a chance to make a first impression, and as long as patients have choices, in doctor and hospital selection, they get to act on them.
Maybe surveys will finally get physicians to realize the humanity of the people they are treating--something not taught enough, or taken seriously enough--in medical school.
6
The real challenge will be to reduce patient "suffering" in nursing homes, most of which are operated for profit and NOT for patient quality of life.
19
Thinking of the middle of the night wakenings, I remember a time when my 80 year old father was in the hospital with c diff, caused by antibiotic treatment for pneumonia. His condition was exasperated by advanced Parkinsons and advanced multi-infarct dementia. I also believe that no one should be in the hospital without an advocate, so my mom spent all day with dad and I spent all night. Because of the c diff caused diarrhea, dad needed changing on a regular basis.
But, one night (about 4 a.m.), when a nurse came in to move dad to a different position (to prevent bed sores), I told her that I had changed him about 45 minutes early and moved him to his other side, and he had just gotten back to sleep, so it was necessary to wake him so soon to move him again. The nurse insisted, I insisted, and wound up standing between the nurse and dad's bed until she left. Later that morning I read on dad's chart "daughter uncooperative". I complained and explained to our family doc, who visited very morning around 7:00 a.m., and he immediately crossed out the nurse's comment, noting on the chart that he had removed it. Fortunately, our family doc was and is a really great doc who treats the whole person, not just the disease (or the chart).
But, one night (about 4 a.m.), when a nurse came in to move dad to a different position (to prevent bed sores), I told her that I had changed him about 45 minutes early and moved him to his other side, and he had just gotten back to sleep, so it was necessary to wake him so soon to move him again. The nurse insisted, I insisted, and wound up standing between the nurse and dad's bed until she left. Later that morning I read on dad's chart "daughter uncooperative". I complained and explained to our family doc, who visited very morning around 7:00 a.m., and he immediately crossed out the nurse's comment, noting on the chart that he had removed it. Fortunately, our family doc was and is a really great doc who treats the whole person, not just the disease (or the chart).
39
Correction - should be it was NOT necessary to wake him so soon to move him again.
“I wondered whether it was a tad sensational, a bit too emotional,” he wrote in The New England Journal of Medicine. Then he realized reducing suffering was one of the most important challenges in health care."
As a doctor, this quote makes me ineffably sad. Medicine (with the help of the big business interests which now control it and a large shove in the wrong direction from too many technologies) has lost its way. This article is about one fact: doctors rarely have relationships with their patients anymore. If we did, we would think of them as we do other people we care about, as human beings who need care and protection from hurt. www.refusetoregain.com
As a doctor, this quote makes me ineffably sad. Medicine (with the help of the big business interests which now control it and a large shove in the wrong direction from too many technologies) has lost its way. This article is about one fact: doctors rarely have relationships with their patients anymore. If we did, we would think of them as we do other people we care about, as human beings who need care and protection from hurt. www.refusetoregain.com
20
What about brusque and unfriendly receptionists? I have a number of older family members and friends who have cancer - one of their chief complaints is receptionists who lose their appointments, reschedule for no apparent reason after you have shown up for your appointment, forget or lose your blood draw appointment etc etc. We undertand that the receptionists have no control over this - but what is going on behind the scenes that is causing this encounter to be so chaotic and inhumane?
13
The doctor in charge of the office is responsible for the behavior of the receptionists. If they are careless it's because he/she is also. Time to find another doctor.
It just seems that hospitals are uncoordinated in so many ways. The patient is neve sure who is in charge of his/her case and never quite gets a straight story from any one. This sounds like a petty complaint. But, studies have shown that a high percentage of patients leave hospitals without knowing their diagnosis.
Also, there doesn't appear to be much communications between departments. As an example, it was clearly communicated in the ER that a patient I know had a history of blood clots. When the patient developed a bold clot, the doctors in ICU were at a loss as to what was causing the patient's leg pains. When a family member told the ICU Doctor of her history, his response was that no one told him.
I personally have many more examples. But, what bothers me the most is that doctors don't appear willing to really learn about the patient. When family members try to convey a medical history about the patient, the doctors appear annoyed. This is a particular problem for elderly patients who are sometimes confused or unaccepting of their medical history.
Also, there doesn't appear to be much communications between departments. As an example, it was clearly communicated in the ER that a patient I know had a history of blood clots. When the patient developed a bold clot, the doctors in ICU were at a loss as to what was causing the patient's leg pains. When a family member told the ICU Doctor of her history, his response was that no one told him.
I personally have many more examples. But, what bothers me the most is that doctors don't appear willing to really learn about the patient. When family members try to convey a medical history about the patient, the doctors appear annoyed. This is a particular problem for elderly patients who are sometimes confused or unaccepting of their medical history.
32
How about directly asking patients about hospital gowns, which are inherently humiliating, degrading and infantilizing?
The typical hospital gown comes with lumpy ties at the neck and back, the whole thing always rides up while one is lying in bed or trying to sleep, and everyone looks pathetic when out of bed groping around the back to try to cover the exposed bottom.
If you're made to dress in a sack, you'll feel like a sack.
The typical hospital gown comes with lumpy ties at the neck and back, the whole thing always rides up while one is lying in bed or trying to sleep, and everyone looks pathetic when out of bed groping around the back to try to cover the exposed bottom.
If you're made to dress in a sack, you'll feel like a sack.
42
Bring your own pajamas and a robe. Yeah, the hosp robes are disgusting.
For my most recent well woman's exam, I was put in a tiny gown that I couldn't pull shut - left a foot across my belly uncovered. In a country where the average female size is 16 (I'm a 20), this is ridiculous and degrading.
3
This article really hits home. My elderly mother is resisting going to the hospital now for the very reasons you mention. Her first reason was she doesn't want to have her arms even more scarred up from all the blood tests. She gets awoken every night for testing and medications and the noise in the hallways makes it nearly impossible to sleep.
13
what about suffering caused by exorbitant bills from greedy doctors and hospitals?
16
When I entered medical school 46 years ago, I thought medicine was an applied science—a view that was reinforced throughout my medical training. Had I and other young medical students and physicians been told that there was no little of no evidence to support much of what was done in the name of medicine at that time, that many interventions did not yield a significant clinical benefit and that medicine was often, if not generally, more art than science, I would hope that I would have taken a more critical look at contemporary medical practice and done what I could to improve it. And, knowing that I frequently had little else to offer, I believe I would have taken more time to explore my patient’s concerns and wishes, shown more empathy and compassion and been a better physician because of it. I’m glad to see times changing.
160
Maybe your comment might have been appropriate 146 years ago but if you truly believe that Medicine as practiced today is more art than science then you should retire because you obviously have not had a very good education or have given up on learning. Unfortunately what we have here is a highly competent medical profession hobbled by having to work under the constraints of a corporate for profit structure. All this suffering mumbo jumbo is simply a euphemism for CUSTOMER SATISFACTION. I expect all these poor whiny folks are looking forward to the day they can just drive up to a window like at McDonald s and get there Healthcare in less than five minutes waiting time but they will not lift a finger to get single payer Healthcare in this country.
1
i recently had a two-week stay at Hackensack Medical Center followed by two weeks of rehab at Kessler Institute.
In both places i suffered some of the problems this article mentions. I think they somehow drew more blood than i had in my body. sometimes doctors visited at ungodly hours. etc.
but the overall care was excellent in both places, and i got well! sure, i could nitpick about certain inconveniences. sure, it would have been nice if the hospital staff's world revolved around me. but i asked the right questions and got good answers.
not every employee of those institutions had a personality that i liked, but the great majority of them were super competent. they helped me get well.
as an adult, i don't expect to be catered to in all hospital situations, but a little stoicism goes a long way when one is in a great hospital/rehab.
In both places i suffered some of the problems this article mentions. I think they somehow drew more blood than i had in my body. sometimes doctors visited at ungodly hours. etc.
but the overall care was excellent in both places, and i got well! sure, i could nitpick about certain inconveniences. sure, it would have been nice if the hospital staff's world revolved around me. but i asked the right questions and got good answers.
not every employee of those institutions had a personality that i liked, but the great majority of them were super competent. they helped me get well.
as an adult, i don't expect to be catered to in all hospital situations, but a little stoicism goes a long way when one is in a great hospital/rehab.
71
For what you probably paid, you shouldn't need to have any stoicism.
2
I do assume that you are neither old nor frail? Confused, frightened, lonely or nearly destitute? Good that you could ask the right questions, etc.
A lot of doctors now have blaring television sets in their waiting rooms. That is very stressful and annoying, especially if they (a) tune to the Food Channel when a lot of people have diet issues or (b) have nonstop advertising for their services, such as eye doctors who relentlessly promote vision surgery. I seem to be the only person who speaks up. Next time I'm in an office that does this I'm wearing earplugs and they can figure out how to "call" me!
15
Hospitals are designed to make money and therefore streamline processes to be more efficient. As caregivers and patients -- we want/demand personalized care. Those two different missions create friction. As long as medicine is for-profit nothing will change.
4
Minnesota statutes mandate nonprofit healthcare providers and insurers. It's an excellent model. I wish it was a more widespread practice.
1
I think that posting comments online is taking it too far. Be aware too that some patients rate doctors highly who do more, whether that "more" is helping: e.g. unnecessary pain medications and procedures.
2
Doctors don't enter the profession to torment their patients and hospitals uniformly profess the goal of "caring" for patients. And yet all of the offenses described in the article are so common that family members are advised to spend as much time as possuble at the bedside of their loved one in order to protect them from the dangers posed by inattentive or oblivious medical providers.
The best physicians have always learned effective bedside manners at the as apprentices of respected elders. The worst learned to treat the disease but not the patient. All of them were treated as lords of the manor by hospital staff trained to imbue them in the eyes of their patients with magical if sometimes imaginary power.
Patient mistreatment is learned behavior adapted to an era when doctors strode upon the earth as gods. Medical communities that fail to adapt to the needs of today's more educated and assertive patient and more powerful payers may find better and higher uses as condominiums.
The best physicians have always learned effective bedside manners at the as apprentices of respected elders. The worst learned to treat the disease but not the patient. All of them were treated as lords of the manor by hospital staff trained to imbue them in the eyes of their patients with magical if sometimes imaginary power.
Patient mistreatment is learned behavior adapted to an era when doctors strode upon the earth as gods. Medical communities that fail to adapt to the needs of today's more educated and assertive patient and more powerful payers may find better and higher uses as condominiums.
6
Scary to hear at two different offices 1) doctors talking casually about the benefits of getting X number of patients through in an hour 2) the nurse taking your vitals complaining that the practice wants only 20 minutes per patient. Let's guess what's more important to them?
6
I hope suffering in terms of unnecessary psychological stress is being tracked. In 2005 I had symptoms that led my doctor to have me scanned for a possible brain tumor. The lab told me my doctor's office would have the results that day. I called the next day and wad promised a call back, but despite calling once a day, increasingly stressed, the doctor never called back. I and my husband tried to play past it, but we had an incredibly stressful 8 days. Then, at my appt the next week, she walked in and said, "Good news! Your blood pressure meds are working!" I don't have high blood pressure. Or a brain tumor, thank goodness.
37
Gosh. Imagine that. Health care providers working to reduce suffering. What a concept. Look up the word "patient" in the dictionary: one who suffers. So many things crowd out attention to care: reimbursements, professional control, practice standards, liability 'loss prevention.' That is why we are surprised to learn that those who suffer want their care providers to genuinely communicate. Chief among these issues is the driving concern to limit costs via administrative mechanisms that limit care. And why do we want to limit costs? To preserve a system that rewards an UNCARING profit motive. Telling doctors to take more time with a patient is folly when we know that the system will not work unless they push the patient out the door to make way for the next one.
14
That next patient also needs the doctor, and has been waiting.
Notice a common thread; improvement comes from making the patient your priority, not profits, not the convenience of doctors, not administrative billing. Patients get labs at 4:00 am because docs want results before rounds at 7:00. Routine daily orders are easier and faster than making individual decisions, and their aren't enough nurses to do that. All hospital electronic medical record systems are primarily billing systems, not patient record systems, so getting discharged still takes forever. Make the patient your priority, and the world is your oyster.
286
If the data aren't available during morning rounds, the doctors won't be able to make necessary decisions then. Does the whole schedule get pushed back a few hours, or must they act on incomplete information?
2
The problem arising from truly making patients the priority (a radical notion) is that nurses are considered expensive by hospital administrators who tend to be penny wise and pound foolish. Optimal nursing staffing costs more but it buys something of profound valuable----the trust, affection, and grateful recommendations of their patients.
1
When my husband and I walk into his urologist's treatment room, I tell him welcome to the showroom. We'll see what he is selling today. So yesterday he was selling a rectal digital exam. Then he pretended to remember how his prostate felt a year ago. Though the hormone treatment is continuing to work, the doctor was selling chemotherapy last month. The month before that he was selling the most expensive bone strengthener. Something his bones don't yet need and is prohibited because of gum disease. As you might suppose, we have very good insurance.
3
Physicians, once hospitalized, learn first-hand what "suffering" is and can bring about changes in their own behavior very quickly. Perhaps medical schools should require that students spend 24 hours in a hospital bed getting poked as a pre-requisite for graduation.
26
You can read this headline to mean the opposite without much trouble.
8
Yes, indeed. Fix the ambiguous syntax in the headline, please. I had to read the article to understand what the headline means.
2
One problem, not addressed here, is the way doctors view a patient because of their age. As an 83 year old, I am acquiring all the maladies of aging: BPH, kidney stones and atrial fibrillation. For each of these problems, doctors do not essentially want to anything because of age can't handle it as well as a younger person. For example, my hospital doesn't want to do ablations for any one over 80. For the kidney stones along with the BPH, the urologist doesn't want to do any invasive procedures because of possible consequences. Only my local nonspecialist doctor treats my problems with respect. He treats me as a friend. I wish the others would do likewise.
23
I know this may be frustrating, but perhaps there is some wisdom in their reticence. Every procedure carries risk, and the risks increase greatly with age.
1
Suffering from disease or injury is nothing compared to afterwards dealing with the insurance company that decides a service is not medically necessary, not a covered service, out of network, or won't count toward the deductible.
34
Here's a suggestion to eliminate some suffering in surgery. Have a strict protocol for removing patients' rings. My mother endured five minutes of excruciating pain while a nurse at Brigham and Women's insisted it was possible to pull a 92-year old's wedding bands over arthritic knuckles that were bigger. Screams did not deter her. Finally a doctor intervened to cut the rings - which was another painful and too-long process. This must be a common procedure. Jewelers do it all the time. Get a better tool, numb the finger, sedate the patient if necessary. Why kick off a frightening, painful surgery and recovery with a scene out of 24?
25
As a life-long jeweler, still find myself feeing rude in certain situations when I give my "dental floss" lecture. ( Mom always said only floss the teeth you want to keep.)
I say," That ring is so tight, if it were anywhere else on your body you would call it a tourniquet." It really does impede blood flow and when a hand swells it is so bad.
Yes , jewelers have a little tool that slips under the ring and saws it off without any extra risk . Every hospital should have one.
And before that crisis which will require expensive reworking the ring, WINDEX will remove almost any ring better than string, ice water, grease, etc,
I say," That ring is so tight, if it were anywhere else on your body you would call it a tourniquet." It really does impede blood flow and when a hand swells it is so bad.
Yes , jewelers have a little tool that slips under the ring and saws it off without any extra risk . Every hospital should have one.
And before that crisis which will require expensive reworking the ring, WINDEX will remove almost any ring better than string, ice water, grease, etc,
6
Why not just cover over the ring(s) with surgical tape instead of removing it/them?
Hospitals usually DO have one of those. It's just hard to find sometimes, because believe it or not, administering appropriate medical care in a timely manner is usually more important than saving people's precious rings in a doctor's mind.
Hmm. Did the physician executive "join" Press Ganey in order to "reduce patient suffering" or to explore the more profitable frontier of the medical industrial complex? After all, in today's bizarro universe, those who can't are often the ones instructing and supervising the efforts of those who can.
5
This is really unfair. I used to work with the guy and have seen him in action. He is thoughtful, compassionate and was esteemed by his colleagues and loved by his patients.
3
My elderly, handicapped Mother woke one morning and began the 30 minute process of putting on her braces. She was born with spina bifida myelomeningocele on September 6, 1928 in the bedroom of her mother who had birthed 3 children prior to my Mom. After several surgeries and therapies in the Mason's Children's Hospital in Dallas she was able to move herself through space via bilateral leg braces that acted like a scaffoling to support the pelvic support portion of her body. Combined with this and two pair of crutches she was able to move a bit without the aid of a wheelchair. That, and she, as her mother before her, refused to have a rods inserted into her spine to make it straight. But on this morning she called me into her room and said her arm hurt so badly that she needed me to help her with her braces. Her arm was cold and I couldn't find the pulse. I called an ambulance. The doctor in the ER dismissed her as a elderly drug seeking woman and told me to take her home. Her arm was in the stages of becoming blue. I placed a low heating pad on it and assured her it would pass. The next day found us in another hospital ER. The doctor ordered a doppler and other tests. She was in surgery inside of 2 hours. ICU for about a week. They had found a clot that extended from well below her elbow and in the process of forming to her heart. She lost the use of her right arm and her ability to move and care for herself. ER docs are in the ER because they do not care about the patients.
7
You described two ER doctors, one incompetent and one who promptly diagnosed the problem and dealt with it expeditiously. Don't generalize from one bad apple.
1
@ Jonathan Katz, It was my fault. You see, I worked in hospitals for over 20 years at that point. I had just moved to be nearer my mother when this occurred. The hospital the ambulance took her to was the first hospital to which I applied. It was near. Like all people, when not familiar with the setting one tries not to make too many waves. The hospital I paid the ambulance to take her to was a medical center about 45 minutes away. At this hospital I chose only because of it's rating in surgeries of the type I speculated she was going to need. I'm not a doctor but when her arm continued to pain her and would not warm I am the one that thought it was a diminished blood flow, probably a clot. I called the ER, talked to the Physician in charge and told him I was bringing her in, what I thought, and to notify the surgeon. That's why they had the doppler waiting for her arrival. How many ordinary citizens are going to have the background I have and make the demands I did?
If the first doctor had been motivated by patient presentation my mother's arm might have been saved and it would have saved medicare many thousands of dollars. She had surgery, ICU, 3 week hospital stay, nursing home for 2 months, rehab for 2 more months. After that a home health care nurse 2 times a week, an aid every other day, meals on wheels, and several more hospital stays during the last 5 years of her life.
And no, I didn't accept the job I was offered at that first hospital but yes, I did the second.
If the first doctor had been motivated by patient presentation my mother's arm might have been saved and it would have saved medicare many thousands of dollars. She had surgery, ICU, 3 week hospital stay, nursing home for 2 months, rehab for 2 more months. After that a home health care nurse 2 times a week, an aid every other day, meals on wheels, and several more hospital stays during the last 5 years of her life.
And no, I didn't accept the job I was offered at that first hospital but yes, I did the second.
Do you actually think that you can be sure the first ER doctor was "incompetent" based on this description? What a joke
As soon as I joined medical residency and subsequent fellowship in Gastro, I realized how much suffering we doctors are causing to our patients by simply stamping a century old knee jerk order: NPO: nothing by mouth for any abdominal condition. Present yourself in any hospital emergency or hospital floor, the first thing you will be slapped is NPO. No question asked, order from a military dictator, in this case a doctor. There is evidence, NPO is overused and is abused and lead to no better outcome. So I decided to wage a lonely jihad; as soon as I am called as a consultant, the first thing I do is to allow my patients to have the right to eat: "Its their basic human rights" I preach to the nurses and my colleagues. In very few circumstances NPO is needed and when needed it is very important. In those cases, I personally communicate to my patients and explain them why it is needed. A frequent abuse of NPO is also during routine or Screening Colonoscopies. Only two hours of NPO is more than safe and sufficient, although I frequently see patients being tortured with NPO after Mid-night! A mindless medical dictum gone wild due to our paternalistic attitude.
253
Fasting for a day is not torture.
Until one of your patients aspirated during the procedure and you have to spend the next three years of your life explaining why your patient was not NPO, which is "accepted practice" for most procedures. Good luck on that!
2
Yes, as a physician and sometimes patient with migraines related to dehydration, I routinely ignore this advice before almost any procedure. It is almost always unnecessary, yet, as you say, has become dictum.
Having taught at an academic medical center 35+ years & now receiving ongoing outpatient care, yes, many doctors do not deal well with patient suffering. If you want to see how uncomfortable & anxious they are, see Frontline's "Being Mortal" with Atul Gawande.
There are lots of reasons too many doctors are not attuned to and do not deal well with patient/family suffering.
Some of the advice in this article was helpful: the need to take the perspective of the patient, and slow down and listen to [I would say "hear] patients. But as health care is structured in this country, there is no time, and many MDs no longer know their patients as people. Why?
Overall, it's the domination of the business-money model of medicine, our medical training (it's not education) of students, hospital administration & boards, and the culture of American medicine do not value patient care
Quality: Instead of being patient-centered, American medicine is business & money-centered for lots of reasons (see NYT 2/16/15 http://www.nytimes.com/2015/02/17/upshot/in-hospitals-board-rooms-are-as.... Follow the money: many administrators are paid more than doctors, & top insurance CEOs make multiple millions each year.
Medicine is science: There are now communication and ethics course in medical schools, but these are given low priority and status, and the role-modeling students see in their clinical years can be dreadful.
Awareness is step 1
There are lots of reasons too many doctors are not attuned to and do not deal well with patient/family suffering.
Some of the advice in this article was helpful: the need to take the perspective of the patient, and slow down and listen to [I would say "hear] patients. But as health care is structured in this country, there is no time, and many MDs no longer know their patients as people. Why?
Overall, it's the domination of the business-money model of medicine, our medical training (it's not education) of students, hospital administration & boards, and the culture of American medicine do not value patient care
Quality: Instead of being patient-centered, American medicine is business & money-centered for lots of reasons (see NYT 2/16/15 http://www.nytimes.com/2015/02/17/upshot/in-hospitals-board-rooms-are-as.... Follow the money: many administrators are paid more than doctors, & top insurance CEOs make multiple millions each year.
Medicine is science: There are now communication and ethics course in medical schools, but these are given low priority and status, and the role-modeling students see in their clinical years can be dreadful.
Awareness is step 1
32
Thank you so much for this comment; it is hard to concentrate on the other worthwhile and important issues around this without first addressing the critical points you made.
1
Yes, I was awake but breastfeeding my newborn son in my hospital bed in the dark, having a lovely moment alone with him when a medical student barged in and asked if I had experienced flatus.
4
Resolving the causes of suffering enumerated here is a wonderful idea.
Unfortunately this will be just another 'fad', or idea that gets buried and will never be resuscitated. And if, perchance, this one hospital retains these improved and enlightened measures, it will take another 75 years for the rest of the hospitals in the country to adopt them.
Unfortunately this will be just another 'fad', or idea that gets buried and will never be resuscitated. And if, perchance, this one hospital retains these improved and enlightened measures, it will take another 75 years for the rest of the hospitals in the country to adopt them.
Inattentive Care sadly appears to reach it's peak with the oldest of patients--It is not just that too many do not pay enough attention, too many do not really listen to what their patients want! We, who have been tireless advocates for our parents through their final stage of their lives howl in frustration at being ignored, patronized and otherwise discounted. Even when one of us is a physician as soon as it you are on the patient's side, you become irrelevant! And HIPPA regulations are a joke especially in ERs where staff all too often shout the most intimate details and confidentialities to anyone within earshot.
I recognize way too many hospitals remain overwhelmed and understaffed but spending my mom's last 18 month's on this earth in and out of several in our area...there are NONE I feel safe or truly cared for in.
I recognize way too many hospitals remain overwhelmed and understaffed but spending my mom's last 18 month's on this earth in and out of several in our area...there are NONE I feel safe or truly cared for in.
14
I tried to talk to our hospital administrators about noise in the nursing stations at night, coordinating overnight care to provide rest for patients, having bedside nurses accompany doctors on rounds to hear what was said and so they could help patients understand the plan. The response was to accuse me of being disruptive and threaten me. So I get high scores on Press-Gainey surveys and the hospital routinely gets lowest quartile.
23
One of the things that would improve care, especially for elderly people, is for doctors to realize that old people often have more than one condition that needs to be taken into consideration. And elderly man may have a heart condition, prostate cancer and a history of stroke. The urologist does not understand why he must repeat what was said. The urologist often is impatient and treats the patient as if he is not intelligent. The cardiologist may prescribe medicine that interacts with medicine given by other physicians. And often they are more interested in saving the life of an 88 year-old person than making sure that life is worth living.
230
I have atrial fib and am in it all the time. I have had eight cardiologists. Now I have zero. The amiodarone to control heart rate almost killed me--they said we didn't know if you would get out of the hosp alive. The blood thinner warfarin (which kills rats on the side) resulted in such a bad detached retina that 4 surgs could not fix it--right eye blind. Still, they try to send me to cardios. The last one wanted to stress me with horrible symptoms, which would then be removed by an antidote. No--that did not sound good. I take a regular aspirin for a slap at thinning and hope for the best. Taking my BP meds made me so nauseated I was buying morning sickness candy--then I dropped one, bit a second in half and space it through the day--sickness gone, BP OK, actually as of yesterday--the best ever. The latest was Vitamin D--every woman I know was told she was "dangerously low" in Vit D. No more sick-making pills. I found out "they" had doubled the acceptable levels of this fat-stored vitamin. Well, of COURSE, people are low now. You see where I am going...
3
Not to mention the side effects of all the pharma drugs he or she might have been prescribed.
1
Which is why elderly patients need a gerontologist who acts as a case manager, coordinating the various carers. I discovered this when one was assigned to my mother, & I questioned it. Mum wasn't senile, & I was somewhat affronted that she was automatically given this kind of doctor.
1
Maybe hospitals will now consider eliminating the Chargemaster billing software from their systems, which charges astronomical arbitrary amounts for each and every intervention. ($500 per suture?)
Now that would relieve some serious suffering.
Now that would relieve some serious suffering.
32
It all stems from our profit-driven system. Listening, reassurance, and basically being human use up a lot of time when dealing with sick, scared and stressed out. These are not "billable" entities so they are the first to get tossed.
26
Oh, there will be a way to bill for them- don't worry!
So interesting that there are so many docs out there that actually have to work hard at doing less harm. My sense is that there's a growing geographic as well as generational overlay at play here, with physicians in less populated areas way from the coastline states and younger more likely to be doing this proactively for quite sometime. The potential irony here is that not far down the road I suspect we will learn that consumers with access to the "best" a.k.a. most expensive, "brand name" driven health care have likely not been getting the best after all. Fabulous podcast on a related thread, "Reckoning With End of Life Care" @ http://www.radiolab.org/story/end-life-care/
4
There is plenty of room for the health system to improve its ability to mitigate patient suffering, no question. But those caring interactions still need to be assessed alongside the quality of the services delivered. I have been responsible for taking care of two aging relatives, both of whom endured significant medical complications from physicians who were "nice people." There was an inordinate amount of physical suffering, but they sure felt positive about their doctors! if I have my druthers, I'll happily take competence before kindness.
8
It boggles the mind that doctors and hospitals are just now starting to think about patient suffering.
16
What is truly remarkable is that it has taken years to reach some fundamental concerns about patient care. The patient is not his/her disease. The patient is a person with a medical problem. The whole person needs to be considered in solving the problem. The medical health-care complex is too large to satisfy everybody...every time--but basic human consideration needs to be encouraged and considered.Respecting the patients needs, and time is another important step to getting the basics right.The overall level of dissatisfaction with healthcare is epidemic. It has been a silent epidemic too long ignored by the healthcare community.
208
A few years ago, I was "dismissed" by my doctor to whom I had complained about erroneous statements he had made about in my medical record, which ultimately made my health insurance premiums skyrocket. He recorded that I had COPD! Six years later, I still do not have that condition. I wanted to take him to the AMA, but was afraid of the reaction from other doctors, in my area. He was irate that I would dare to question his judgement. My personal care was certainly not uppermost in his consideration. He is not unusual, as far as I am concerned.
3
A more interesting question might be what is it about the culture such that they required feedback (in Utah you might be publicly shamed with scores posted) to implement these often common sense behaviors? What forces are at play that lead super bright folks to fail to address some pretty obvious needs?
4
The headline is a bit confusing. Its straight forward reading makes it seem that being less attentive is the goal. It should read: "Doctors Strive to Do Less Harm by ATTENTIVE CARE." Besides that the more obvious obstruction to the suffering outlined is not mentioned. Reliance on Press Ganey reports shows how off the mark, hospital practice has become. A patient's personal physician who knows the most about a patient's emotional health, has left the room. Patients are cared for by hospitalists and overworked nurses. This is an outcome of hospitals trying to improve their bottom line. A better question to ask patients is how they feel when they know their trusted physician, enough competent nurses are in charge of their care, and when they are housed in a single room. A patient's personal provider who has taken care of them for years shapes their ability to handle a hospital environment. Let's start with the basics and correct a movement that has eliminated the patient's chief knowledgeable advocate, their personal physician.
5
Doesn't it seem remarkable that people have to be told that it's not good to wake a patient at 4 in the morning? You needed a poll and a bunch of meetings to tell you this? I'm glad that some hospitals are making changes, but I take from the article an increased sense of the absolute invisibility of the patient to hospital staff and doctors.
23
Physicians in New York City!! Long waits, careless and inattentive treatment, misdiagnosis and indifference are common issues--and I am saying that based on my interactions with numerous doctors over the course of last 15 years. It is impossible to find a doctor to whom patient's time is also important, and patient's health is also important. Complain to insurance companies--good luck--they have a nexus with doctors. Of course, doctors may be more careful for some segments of the population, but to majority of the patients. Everybody is a little bit racist--isn't it?
3
Admitted on a Friday, my father was under the care of four different teams of "hospitaliist" doctors by Monday afternoon. By the time their notes had passed through so many hands they struggled to understand why he was there. His own doctors, who knew him well and worked in the same building, had no participation in his care as an in-patient.
The docs we're almost impossible to reach. The only good communication was the recorded self-praise I was forced to listen to while waiting on hold, so I know all about their award-winning team system.
The docs we're almost impossible to reach. The only good communication was the recorded self-praise I was forced to listen to while waiting on hold, so I know all about their award-winning team system.
18
Don’t get sick on a Friday. That was an important lesson I learned first-hand. If your condition isn’t critical you will languish in the hospital all weekend waiting for someone to come to work on Monday for some test or procedure you need. I’m convinced that if I had presented myself to the hospital on a Monday instead of a Friday my stay would have been 3 days instead of 5.
1
My problem was not being awakened by doctors wanting to give me meds or draw blood but by the other patient or patients in the room who had TV sets on! I had no problem going back to sleep after an interruption of a few minutes, but could not sleep with FOX news coming in from one side and a religious program blasting at me from the other side or infomercials and talent shows. Let the patients who need to watch TV wear earphones.
39
The survey from my surgical center sat on my desk for months. I could not compress the trauma that I suffered from my experience before, during and after a minor surgical procedure into the answers to the survey questions. The comment space was much too small to list everything that had gone wrong for me. I never returned the survey.
19
I remember a urologist about a year ago. I was absolutely astonished the guy talked with me for about 30 minutes to take my history. I even mentioned it to him and he said that's how he worked. (I was comfortable, at least up until the catheter part at the next visit.) He was in his 60's.
6
At a recent stay in a hospital, I found that the night nurses were caring and helpful but during the day they became invisible. I couldn't get to a bathroom or get a bedpan. I got the wrong lunch meal - I'm a diabetic. and calls for a nurse took forever to be answered. I think part of the problem was not enough nurses. Guess they were saving money.
19
I was and am still suffering from the indifference which turned to rage by a prominent NYC surgeon at The Hospital for Special Surgery in NYC. At first I felt lucky because everyone said he was the best and I had a complicated break in a bone. The repair was magnificent. The hospital stay was difficult with harried overworked nurses but the real problem was the famous doctor himself. When the time came for post operative visits the wait was long. - never less than 2 hours. People in the waiting room were in pain and I also have Multiple Sclerosis and the hot waiting area was becoming more and more difficult. One elderly man, a diabetic, pulled out a snack only be told no food or drink was allowed in the waiting area. We were all miserable but no one said anything. On my second visit I waited over three hours and was steadied myself to say something to the orthopedist and simple said, "wow, Dr. ----- , it was a really long wait to see you today." Careful to not sound angry, simple matter of fact. He, in turn, blew up at me. Sent the assistant out of the office and began yelling at me, his face an inch from mine - me that HE had a long hard day and that I should think about how things were for him. That did I think about how HE had to stop what he was doing to fix my stupid clavicle emergency and I should be grateful. I told him I was grateful. Fighting tears, I left, unseen, untreated, shaken. When I called the hospital told me it was not in my best interest to complain.
29
That is horrible! No one should be treated the way this surgeon treated you. He could have apologized but I've noticed that most doctors find it beneath their dignity to apologize to the "stupid" patients they see. In fact the psychiatrist I saw complained to me about how hard her life was going to become because she had to put in a new electronic system that was going to cost her thousands of dollars. In other words she was going to have to enter the 21st century.
I hope you tell others of your experience and NAME the doctor who was so rude to you. His behavior was unacceptable no matter how good a surgeon he was.
I hope you tell others of your experience and NAME the doctor who was so rude to you. His behavior was unacceptable no matter how good a surgeon he was.
3
I had a similar experience with a prominent physician, who authored several books and was the resident expert on a network morning show. As I was struggling to come out of anesthesia after a biopsy, she leaned over my gurney and chewed me out for being so fat that it made it HER job harder. Never mind that I feared I had cancer. I guess I made her late for lunch with her agent.
1
Thanks for your kind words! Maybe the worst part is that I have extensive hardware that needs to come out and I'm told by every doctor I ask that I have to go back to this guy to have it done. I am honestly scared of him and so am living with painful hardware in my clavicle. The doctor has many reviews online saying that he is a bully - one person described him as "something coiled and ready to strike". I don't know why a hospital would be so supportive of a doctor with such a bad reputation with his patients.
2
Last time I was in the hospital, a nurse came in at midnight, right after I just fallen asleep amid the beeps and hall noise and (seriously), asked: "Are you asleep?"
"I am now." I replied.
I always thought that the constant vitals checks and blood draws and being given meds at odd hours was meant to make the hospital stay so unpleasant on purpose.
Good to know that it's just plain insensitivity.
"I am now." I replied.
I always thought that the constant vitals checks and blood draws and being given meds at odd hours was meant to make the hospital stay so unpleasant on purpose.
Good to know that it's just plain insensitivity.
7
Who wrote the headline "Doctors Strive to Do Less Harm by Inattentive Care"? First it is not clear; is the less harm to occur by (a) providing less inattentive care or (b) providing less unnecessary, over-attentive care in some situations. My interpretation was (b) before reading the article. Second nowhere in the article is the word inattentive used, or inattentive care defined or discussed.
It was a good article describing how hospital are trying to improve service but the headline does not fit the article at all.
It was a good article describing how hospital are trying to improve service but the headline does not fit the article at all.
7
One huge thing that has caused me huge concern a small bit of suffering is hearing medical professionals outside of hospitals of offices discussing patients. That gives major pause to anyone who has a medical matter they would like to be kept private. And although, it technically is not supposed to happen, it does. I've actually tailored where I sought medical help based on who I knew worked at the hospital.
I also once had a friend's mother call me to ask what my condition was. She was a lab tech and noticed my name when she was running my blood work. It was a small thing but that caused me a lot of apprehension in the future.
I also once had a friend's mother call me to ask what my condition was. She was a lab tech and noticed my name when she was running my blood work. It was a small thing but that caused me a lot of apprehension in the future.
3
I worked at Harvard's medical library. You would not believe what I overheard on loud cell phone calls.
1
I work in a medical office and every year we get training on privacy issues. Your story with the lab tech sounds exactly like the "what not to do" examples in my training. Clear violation of HIPAA and I'd probably get fired if I did something like that and got found out.
2
I believe one very significant way to reduce suffering is to respond to the patient immediately. I know this from personal experience. I suddenly developed excruciating back pain on a Sunday. Luckily, I was able to reach a physician within a half hour. He assured me that I would be seen the next morning and told me who would be seeing me. My pain dissipated almost immediately. And, I didn't feel the need to go to an ER, because I knew I would be taken care of.
It's simple. Stress exacerbates suffering. Communication and action reduce it dramatically. Remember this: how did you feel when your mother kissed your scraped knee?
It's simple. Stress exacerbates suffering. Communication and action reduce it dramatically. Remember this: how did you feel when your mother kissed your scraped knee?
1
Sorry, we're not your mother. If I responded to every patient immediately, I'd get nothing done and have no life. If patients had to pay physicians for their time in 15 minute increments, like they do lawyers, their call frequency would plummet.
2
Many years ago I was in a hospital in Hawaii with a compound broken leg. A night nurse came around at some very dark hour to take our vitals. She put her hand on my forehead and then ran out of the room. My mild fever had spiked to something over 105. I actually felt fine as my sweating had stopped but the next thing I remember was someone from the kitchen putting a huge bag of ice on my chest, slicing the bag open with a knife and pulling the bag away leaving me covered with ice. Saved my life.
3
"One Utah doctor ..rated in the first percentile nationally....The next quarter, he was rated in the upper 90s..." When a rating system tells a doctor he is one of the worst in the country in March, and one of the best in June, there is something fundamentally wrong with the rating system. Using patient surveys creates artificial and arbitrary measures that distract from the real questions of who gets better with the fewest complications, errors and inefficiencies.
My highest ratings as an ER doc was when I gave everybody narcotics liberally, and ordered every fancy expensive test I could, "just to be sure" and to convince the patient I was "thorough" and I "cared"
My highest ratings as an ER doc was when I gave everybody narcotics liberally, and ordered every fancy expensive test I could, "just to be sure" and to convince the patient I was "thorough" and I "cared"
328
yes, the press-ganey month to month ratings are based on very small numbers of evaluations and are therefore NOT STATISTICALLY VALID. This happens all the time. One disgruntled patient and your scores plummet.
How true! Try explaining to an addict why he should really not receive more addicting medications or a parent that their precious child does not need more radiation to prove that their head bump is not a catastrophe, and watch your Press Ganey scores plummet!
For that matter, try implementing any of the "discussions" supposed to be prompted by "Choosing Wisely" campaigns, and watch both your scores plummet and your throughput time go through the roof.
Then look for another job.
For that matter, try implementing any of the "discussions" supposed to be prompted by "Choosing Wisely" campaigns, and watch both your scores plummet and your throughput time go through the roof.
Then look for another job.
1
What you mention brings up the flawed nature of reliance on these surveys: 1) results can be easily gamed, and 2) often times the number of surveys returned/analyzed is so small that the results have no statistical significance. (I'm looking at you, Press Ganey...)
1
This is ridiculous. Doctors are human and recognize human suffering. This should not need to be taught. When patients suffer and needs are ignored it is due to one of two reasons. Number one - the medical culture and paternal reductionist attitudes. Number two - which may have partially caused number one - is overwork. Physicians are given too much too do with too little support staff. It's all about money now and hospitals do not have enough staff. And, the staff that they do have are less qualified.
8
Thank you rini10. People/patients should also know that many of the moments of suffering that patients endure are also generated from previous complaints in press ganey surveys! The hospital I practice in instituted hourly nurse checks at night time as an answer to inpatients complaining that there was no contact with the night nurses. And yes , this implementation was against physician advice!
The problems of the overworked physician, and the hand-off of patient care from one shift -worker physician to the next will only worsen as health care in this country becomes more and more of a numbers game- the general public forgets that private practice physicians, who went into medicine in the first place to care for people, are now trying to pay their bills, continue to give their staff in the office ( a small business) raises, pay astronomical medical liability premiums, all while insurance reimbursements are decreasing, and insurance corporate returns are flying high!
I would love to spend more time with my patients. The reality is, that I spend as much time as I can, and move on the the next person,so that I run on time ( and people therefore don't complaint about wait times).
We really need a national dialog about this.
The problems of the overworked physician, and the hand-off of patient care from one shift -worker physician to the next will only worsen as health care in this country becomes more and more of a numbers game- the general public forgets that private practice physicians, who went into medicine in the first place to care for people, are now trying to pay their bills, continue to give their staff in the office ( a small business) raises, pay astronomical medical liability premiums, all while insurance reimbursements are decreasing, and insurance corporate returns are flying high!
I would love to spend more time with my patients. The reality is, that I spend as much time as I can, and move on the the next person,so that I run on time ( and people therefore don't complaint about wait times).
We really need a national dialog about this.
1
The nurses, techs, respiratory therapists, housekeeping staff, etc. are overloaded as well - the entire hospital environment is a nightmare.
2
Yes but from reading the comments here, that is all the doctor's fault, isn't it? That's what most of these people seem to think. They seem to have no idea of how things actually work
Inattentive care is what leads to complications for patients. When doctors give an audience of 7 minutes on average to a patient who is sick there is no guarantee that the relevant information is gathered by the doctor or absorbed by the patient. Even better is when a patient's care is disrupted because the insurance company drops the doctor or the doctor leaves the panel. I've received numerous letters from my insurance company touting the benefits of having a primary doctor, a long term relationship, seeing the doctor when I need to but the whole system is rigged against these things. There is no continuity of care. It's quite difficult to see the doctor when you are ill because all the appointments are taken or double booked.
Even better is the fact that if you tell a doctor or the office staff that you have no insurance they don't offer to help out. If you say you can't see the doctor for a scheduled appointment because your insurance has run out and you cannot afford the fee the usual response, or the one I've received is thank you and good bye. The feeling I walk away with on the rare occasions that I visit the doctor, is that it's more about the money than my health. It's the same feeling I get from the insurance companies: it's about the money, not my health. I don't trust the insurance company's "advice" or the doctors. In American medicine it's about the money, not the patient or health.
Even better is the fact that if you tell a doctor or the office staff that you have no insurance they don't offer to help out. If you say you can't see the doctor for a scheduled appointment because your insurance has run out and you cannot afford the fee the usual response, or the one I've received is thank you and good bye. The feeling I walk away with on the rare occasions that I visit the doctor, is that it's more about the money than my health. It's the same feeling I get from the insurance companies: it's about the money, not my health. I don't trust the insurance company's "advice" or the doctors. In American medicine it's about the money, not the patient or health.
15
My geneticist wrote a letter to my insurance co. requesting a DNA test. The letter sounded like my survival depends on finding out if I have Marfan syndrome. My co-pay for the DNA test would have been $800. I will never know if I have Marfan syndrome b/c I can't afford the co-pay.
I took my son to the UNC ER one night at 5 p.m. after he sliced his foot running. We were put in a room and waited, and waited, and waited for someone to attend to him. Nothing life threatening, just needed some attention. My wife brought us food and finally at 11 p.m. I told the ER nurse we were going to leave. She told me to wait and someone could at least clean it out. Never saw a doctor and my son limped out of the ER.
I spoke with the head of the ER the next day and suggested that someone should come by an ER room at least hourly to see how the patient is doing and give a status of when a doctor might be available. She thought this simple solution was really a good one and said maybe a resident could perform the task.
I thought to myself, really, you never thought of this before? All of the training, mental brilliance, etc., fails to provide doctors with basic common sense.
I spoke with the head of the ER the next day and suggested that someone should come by an ER room at least hourly to see how the patient is doing and give a status of when a doctor might be available. She thought this simple solution was really a good one and said maybe a resident could perform the task.
I thought to myself, really, you never thought of this before? All of the training, mental brilliance, etc., fails to provide doctors with basic common sense.
213
Of course they have thought of this before. Either they don't have the staff to do this or they don't want to do this. The doctor was obviously placating you with empty words to make you believe that your ideas will be considered.
2
'Out of sight, out of mind,' it's not a proverb for no reason.
I bet the nurse just pretended to agree with you to get rid of you. Is that concept being used now in that ER? Didn't think so.....
Most of the doctors I know or know of are less interested in their patients than their patients' ability to pay the doctor's Lexus or McMansion payment.
41
Why should a trained professional want to be paid for what they do?
After all, the average physician finishes med school hundreds of thousands of dollars in debt. Training (med school plus residency) takes a decade after college (and often longer) during which time pay is nothing (med school) or subsistence (residency and fellowship).
And yet there are many specialties, especially primary care, where the physician compensation is quite low (in my community, senior teachers/administrators in the public schools make more than primary care MDs).
After all, the average physician finishes med school hundreds of thousands of dollars in debt. Training (med school plus residency) takes a decade after college (and often longer) during which time pay is nothing (med school) or subsistence (residency and fellowship).
And yet there are many specialties, especially primary care, where the physician compensation is quite low (in my community, senior teachers/administrators in the public schools make more than primary care MDs).
3
Then you are hanging out with the wrong doctors.
1
Nowadays, not so much their Lexus or their McMansion as their student loans. We could do better not burdening young doctors with $250,000 in loans--they would be less inclined to go into for-profit plastic surgery.
3
Wish I'd had this survey after I was constantly awakened in the night by nurses, and during the day by candystripers offering magazines, after completing 36 hours of labor; or when a resident hallucinating from lack of sleep tried to give my 3-month old baby a (probably unnecessary) spinal tap for RSV; or when nurses refused to allow me to breastfeed, for no discernable reason; or having to wait four hours for a "shift change" before being allowed to leave. The callousness and incompetence of our medical establishment is astounding. Holy Cross Hospital, I'm looking at YOU.
150
Patients are said to haveva disease (e.g., pneumonia)and experience its symptoms (e.g., coughing, shortness if breath). Accuracy, please.
3
I applaud the effort to put the patient at the center of medical care, however this is not a new concept. George Harrell, MD was the founding dean of Penn State College of Medicine in the 1960's. http://www.nytimes.com/1999/08/29/us/george-harrell-91-medical-school-de...
He created a Humanities department in the College of Medicine, and all students are required to take courses in Humanities. He built a hospital with only private rooms to protect patient privacy. I trained at Penn State and was shocked when I later interacted with other physicians who did not share the ideal of humanism in medicine. It is good to see the concept is finally catching on.
He created a Humanities department in the College of Medicine, and all students are required to take courses in Humanities. He built a hospital with only private rooms to protect patient privacy. I trained at Penn State and was shocked when I later interacted with other physicians who did not share the ideal of humanism in medicine. It is good to see the concept is finally catching on.
48
Interesting that thinking about the patient's perspective came as a revelation.
596
It didnt come as a revelation - but these Ivy League doctors have found a way to aggrandize themselves for noticing something the rest of us have known all along.
next come the NPR interviews.
next come the NPR interviews.
1
It's a revelation to the NY Times. It is NOT a new thing to the medical profession, which has been working on this topic since Hippocrates. Remember the source.
You would think that is a no brainer !!!!
"... and I will take care that they suffer no hurt or damage." This from the oath all doctors swear, the Hippocratic oath. Or was that the hypocritic oath?Ah close enough. You can see how they might have gotten it confused. This is 2015 and doctors are finally thinking from "the patients perspective" instead of their own perspectives. Well, wonders will never cease as my grandmother used to say...
26
Surveys can be misleading. How true.
I work in a clinic where surveys are randomly passed out as the client checks in. By the time the client actually sees the health care professional the surveys have been completed, usually rating the health care professional with all "excellents". In fact, the whole survey is all "excellents".
I work in a clinic where surveys are randomly passed out as the client checks in. By the time the client actually sees the health care professional the surveys have been completed, usually rating the health care professional with all "excellents". In fact, the whole survey is all "excellents".
13
I'm growing accustomed to being a data point and a revenue stream. I recently smiled at a doctor I'd consulted the day before as we passed in the hall. Perhaps he didn't recognize me with my clothes on. More recently I had a Doctor's appointment that left me reeling. I was actually seen and heard. It was a heady experience. I felt understood and much better for it. As a patient, I'm considering a new strategy. If they'll stop typing, I'll turn around and look at them.
35
I've worked in hospitals, and I've concluded that physicians do their best not to make eye contact with anyone in a hospital except other physicians. I eventually concluded that they'd learned it was the only way they could avoid unplanned hallway consultations with patients and their families.
The headline is hysterical. It says you will be harmed less if the doctor doesn't pay attention to you.
Didn't the Times recently publish a survey that cardiac patients do better when the top cardiologists are away at a convention?
"Doctors Learning to Pay Attention" would have been a great headline and front page news.
Didn't the Times recently publish a survey that cardiac patients do better when the top cardiologists are away at a convention?
"Doctors Learning to Pay Attention" would have been a great headline and front page news.
26
That's exactly what I thought. It made sense, given how much harm is caused by over-treatment and inappropriate treatment.
1
That can follow last year's article "Doctors learn to wash their hands".
2
During a recent 4 day hospital stay, I calculated that I managed to get 8 hours total of sleep due to constant blood tests, patients with dementia screaming during the night, nurses entering my room at all hours with no explanation and then failing to close the door or turn off lights, etc. It is a refreshing idea to adjust hospital routines for the good of the patients, rather than to accommodate shift changes and rounds. It is also essential that the patient know who is in charge of his or her care, as many doctors with little knowledge of one's case often stop by only once and give conflicting comments. My recommendation to anyone facing hospitalization is, the less time spent in the hospital, the better the chance for a fast recovery.
110
Not only should one stay away from hospitals, one should never, never take prescription medicines. If you know anything about herbs or have agood herbalist, you can pretty well tak care of yourself without taking prescription medicines and without seeing doctotrs. I am 82 years old and in good health. This is my secret.
Nurses should use flashlights when entering patient's rooms at night. My one night in the hospital was miserable - I heard the nurses laughing at the nurse's station the entire time. And I am a nurse BTW.
2
I just spent a week in the hospital. I was assigned to a private room, blood tests were taken by the tech I requested (who worked a night shift, but I was happy to wake up briefly in exchange for her skill), I was never woken during the night otherwise, everyone who entered my room from housekeeping to food services asked if there was anything else they could do before they left, the RN's and CNA's were all responsive and generally caring, etc. I'd been in this hospital three times last year and again got excellent nursing care.
On the other hand, one of my physicians changed an order without checking with the hospitalist, and that could have been disastrous if I hadn't known that it was the wrong move and had my son escalate to the charge nurse and to the hospitalist who immediately overrode her order.
On the other hand, one of my physicians changed an order without checking with the hospitalist, and that could have been disastrous if I hadn't known that it was the wrong move and had my son escalate to the charge nurse and to the hospitalist who immediately overrode her order.
Ok, let's get scientific about this. Doctors need surveys to find out how and why their patients suffer. Right? Now wait a minute.
Nowhere in this article did I read how doctors have put stock in what nurses have tried to tell them or how nurses impact doctors' decisions about how to treat suffering of their patients.
After all, we nurses are first in line to assess what's going on with patients - whether in doctors' offices, ER's, hospitals, homes, on the streets - you name it. I don't think it's that we haven't been given credit ever - there are many doctors who do respect what we say, and read what we document.
But when nurses seem to get left out of the equation for finding solutions to health care problems, foremost suffering, there lies a problem.
For an article just as this, not to even mention our expertise, or that there may be some value in nurse input, it may just tell you why doctors overlook what causes patients to suffer.
Nowhere in this article did I read how doctors have put stock in what nurses have tried to tell them or how nurses impact doctors' decisions about how to treat suffering of their patients.
After all, we nurses are first in line to assess what's going on with patients - whether in doctors' offices, ER's, hospitals, homes, on the streets - you name it. I don't think it's that we haven't been given credit ever - there are many doctors who do respect what we say, and read what we document.
But when nurses seem to get left out of the equation for finding solutions to health care problems, foremost suffering, there lies a problem.
For an article just as this, not to even mention our expertise, or that there may be some value in nurse input, it may just tell you why doctors overlook what causes patients to suffer.
720
Take it a step further, Nurse Mima. If medical articles acknowledged that there ARE nurses in hospitals, perhaps doctors would begin to notice, too, which just might be the impetus needed to reduce hospital-induced suffering.
3
I am not a nurse but I agree. It was obvious to me that the nurse's notes were never read - if the system even allowed for them (I was told they "used to be able to do it" but it wasn't working let alone include them in a discussion with the patient. There is also too much a nurse or other care giver is not allowed to do such as sit with a patient while they eat to both encourage and make sure they are eating enough and the proper food. My mother actually starved to death in the hospital (partially voluntarily - eventually she just gave up with all the inattention). But no one listened when she said and the family repeated daily that she could not get the food down. When I told the nurses and doctors that she was not eating, they too looked at her charts and said she ordered her food as if that proved she was.
2
A friend of mine who began her career in the ER of Bellevue Hospital - NYC - told me that doctors who introduced new interns to the staff instructed the interns to pay close attention to what the nurses told them and not to challenge what they said. If a nurse in the ER of Bellevue told an intern s/he was wrong, the intern should just stand corrected.
8
This is an old Osteopathic Medicine concept: focus on the whole patient because everything is connected. And good sleep boosts the immune system.
I'd like to see a study of chronic sleep problems versus cancer diagnoses.
Do folks who have trouble sleeping actually have a higher incidence of cancer?
I'd like to see a study of chronic sleep problems versus cancer diagnoses.
Do folks who have trouble sleeping actually have a higher incidence of cancer?
19
As I was reading, I kept thinking, none of this is true of my primary care doctor--who is an osteopath.
The current research evidence on sleep and cancer incidence is a bit mixed. One reason is that there are lots of different ways to measure "trouble sleeping" -e.g., length of sleep, latency to fall asleep, disrupted sleep, individuals feeling fatigued. Poor sleep is also correlated with obesity, another cancer risk factor. But there is a strong suggestion that there is a connection, at least for certain cancers, and I am doing some research in this area.
While hospitals seem to be the focus of this article, there is a great opportunity for the family physician to improve, especially in the area of obesity. I asked my doctor why physicians do not prescribe a specific plan for weight loss that includes changes in eating and fitness habits. His response was that most are ill-trained in this area, and the tendency is to simply mention to a patient that they should lose some weight. We all know that most people are very compliant with what a doctor prescribes. Are doctors not obliged under this same "do less harm" principle to do more to reduce the growing obesity problem in the US?
6
I once asked my doctor why he didn't keep track of when his patients needed updates on tetanus, or physicals. He said it was too much trouble. HUH? My dentist and optometrist send me reminders when they need to see me. Why can't the doctors do the same? I had the same "discussion" with the psychiatrist who prescribes medication: why couldn't she call me if she hadn't heard from me when my prescription was due to be refilled. Her answer was that she doesn't like to disturb her patients since they don't always like being called. Isn't it part of a doctor's job to follow up? If they call and leave a message that puts the ball in our court to respond. It seems that they want the money without the responsibility.
2
But think how much money they'd lose if no one were diabetic, hypertensive, arthritic...
1
“We all know that most people are very compliant”. Would that it were so. Surveys of compliance with drug regimens have shown for decades that about 50% of patients take what's prescribed until they feel better, then desist. It's the bane of TB treatment and why directly observed pill taking was instituted for the homeless population at least.
1
FINALLY!!!!! Doctors are beginning to listen to their patients and with something more than their stethoscope!! The patient/doctor relationship should be based on, and built on, "team effort." You can't throw a quarterback out on a football field alone and expect him to win the game...he needs someone to protect him, and someone to throw the ball to. It's called TEAM EFFORT! Doctors also need to realize that those years in a patient's body trump their years in medical school...many patients know their bodies and know them well. But, if the doctor refuses to listen, it could result in, not only indifference, but the difference between life and death. After suffering through many years of trying to be diagnosed properly (heart disease), I penned a book entitled "Can You Hear Me Now: or do I need to yell into your stethoscope?" I fired four cardiologists during my journey in being properly diagnosed...yes, fired...I paid them, they worked for me, and they were not doing their job. I congratulate those doctors who are now stepping forward, realizing that patients shouldn't have to yell into their stethoscope in order to be heard. As far as surveys, the majority of them are ambiguous at best. Many involve a "yes" or "no" or pencil in the circle type answer, which never results in a true reading of exactly what that patient suffered, or did not suffer, through during their hospital stay or doctor visit experience.
12
What about the loud speaker in the hall in the middle of the night," Maint. call so and so." etc. And for the doctors listen to what the patient tells you, rather telling him whats wrong. Seems basic but happens too often.
3
Most hospitals use a pager or cell phone to call maintenance now, but I do remember the days of medical school, in the "80's when at 2 AM one of my class mates would call the hospital operator to see if we could get her to page our fictitious friend, and, if we succeeded, we would hear on the hospital-wide overhead speaker, " Dr. Dover, Dr. Ben Dover, please call the ER."
Hospitals are no longer places of healing...they are mash units who attempt to discharge patients as quickly as possible because of insurance company demands. A few years ago I had gall bladder surgery and responded badly to anesthesia. The docs wanted to keep me an extra day and my insurance company refused because gall bladder surgery "does not require an overnight." They had to manipulate the system, moving me into a bed in the ER for recovery. Add concerns about payment/insurance companies to the list of patient suffering. Lack of sleep, noise, a "room-mate that is noisy, demanding, snippy, etc. is also a problem.
76
You are right on the money. Upon my mother's third entry to the ER in under three weeks with the same (undiagnosed) symptoms, I was told "we need to get her out of here. The insurance isn't covering us any more." (meaning although my mother would not have to pay, the hospital would not be reimbursed). That is an exact quote. My response, "I agree. But she isn't going anywhere until you find out what's really wrong with her and change her diagnosis." The only thing they did for the next three weeks was try to get her stabilized long enough so she could get out to rehab. When I asked what the plan would be if/when she experiences the same thing, the answer I got was. "you'll bring her back." My response:"That is not a plan." She languished with virtually no care for three weeks because she kept needed a transfusion but they never looked for the reasons. After three weeks of not eating, prodding, poking and no sleep, etc. she opted to die. I hope it cost them plenty. But really it is all about the money -- insurance companies run the game. Maybe it is time for a doctor/hospital rebellion?
1
There's nothing like a little behavior modification to turn us back into the caring human beings we probably were before getting caught up in the shuffle.
32
I found that doctors and nurses can become so clinical, and perhaps legally concerned, that they become insensitive to patients. My mom, who is not a complainer, was hospitalized at North Shore Hospital last year and her roommate had a family health situation going on that had caused her to get sick. My mother's room was flooded with the emotional and dramatic family members of her room mate until all hours of the night. When my mom complained she could not sleep she was told there was nothing that could be done about it. And the nurses (who probably had their hands legally on what they could say about the room mate's situation) were not sympathetic to my mother, and seemed annoyed at her, for letting they know she was not able to sleep. a No offer was made by staff to try to control the stream of family members or move my mother to another room. It was a profound relief to get her out of the hospital and home to get better.
150
Yes. My husband was struck suddenly with a cataclysmic illness while away from home. The hospital he was rushed to had individual Tvs at each bed. His roommate played his 24 hours a day. He was hard of hearing and it was very loud. We asked the nurses to turn it off after he fell asleep and they said they could not. Eventually I started to sneak past his curtain and shut it off at night. It was the only way we got any sleep! A simple policy change on TVs (or head phones) would have made a terrible situation less stressful.
Similarly, a friend had emergency surgery and was very sick. He was woken round the clock for weeks. The sleep deprivation he suffered caused hallucinations and psychotic behavior. The man was in a horror film! Finally his wife demanded he be allowed to sleep for 6 straight hours each night "even if it killed him." It didn't kill him and he recovered much more quickly.
Similarly, a friend had emergency surgery and was very sick. He was woken round the clock for weeks. The sleep deprivation he suffered caused hallucinations and psychotic behavior. The man was in a horror film! Finally his wife demanded he be allowed to sleep for 6 straight hours each night "even if it killed him." It didn't kill him and he recovered much more quickly.
16
Unfortunately Cathleen's mother's experience might be the norm rather than the exception, with most insurance covering only semi-private rooms even for patients requiring a lot of care. My "roommate" was wheeled in at 2 am following emergency surgery with full court press of physicians etc setting her up. Lights on for at least 45 minutes, not so much as an acknowledgement or apology to the other patient in the room! Also happened she had bowel surgery, so there was a nice calibrated container sitting in our shared toilet that was never emptied or cleaned (or perhaps even measured and charted!) after she used it. The copious soiled paper waste was likewise never emptied until I put the trash container in the hall. Oh, and she had a very large and supportive family visiting at all hours with the TV blaring....I felt powerless to complain since I had "minor" surgery and she was clearly suffering, but I feel I should have been "compted" the room!
2
There used to be a time, not that many decades ago, when there were visiting hours at a hospital and visitors were allowed in only then and the number in the room was also monitored by a pass system.
Most of the hospitals I'm familiar with these days are all single rooms.
But, if a hospital has any section where patients are doubled up, they need to have and enforce visiting hours.
Staff and patient life would be easier.
Most of the hospitals I'm familiar with these days are all single rooms.
But, if a hospital has any section where patients are doubled up, they need to have and enforce visiting hours.
Staff and patient life would be easier.
1
Touchy feely doctors and hospitals with top customer service may be for some, not everybody. My close friend was told he had one month. He lasted six. He fought to the end and was confident of beating the thing. When he was in the hospital over the last six, the goal was to get out. That helped him fight. The most pleasant hospital stays are the shortest. I'm like my fiend, I want my doctor to get me out ASAP. If a sunny good morning takes up an extra five seconds, I'd rather spend those five seconds somewhere else.
3
You make it sound like it is an either-or situation. It isn't. A doctor can be pleasant, competent and efficient. It might take a little longer to listen than to tell; it might take a little longer to sort through and process everything they hear but in the end, efficiency will be greatly enhanced through better diagnosis.
1
I remember my first hospital stay, for the birth of my first child in 1986. I wasn't even sick, but the parade of people that came to wake me up early in the morning was amazing (and unrelenting). First there was the nurse that took my temperature. Then, just after I had dozed off, a vampire came in to get some blood. After another attempt to shut my eyes, yet another nurse came to ask if I passed stool the day before... and this went on and on, after breast feeding in the middle of the night!
61
Another reason to embrace home birth.
I know the feeling. It's been a long time (thank God) since I was in the hospital, but the routine seemed guaranteed to make sure no patient ever got an undisturbed sleep.
Things have changed a lot since 1986 with regard to childbirth. Each person has their own room in which they labor, give birth, and then stay with the baby until time for discharge which is usually within a couple of days. The family has a lot of access and the husband and other children can be there. The doctors seem more accessible and the nurses are very accommodating. The Mothers are encouraged in breastfeeding. I have observed all this in the recent births of two grandchildren at a large hospital.
I'm glad to find out that there are doctors who are actually concerned about their patients' suffering in hospital. Now if only that could be diplomatically communicated to some of the other staff, especially those who work with patients and are known as 'technicians', 'aides', 'nursing care assistants', or whatever the current title or euphemism might be at a hospital near you. THOSE are the ones who, when I was recovering from a quadruple coronary bypass, made sure to wake patients up to be weighed (to measure edema) at about 5am, wake them again for blood tests an hour later, and then leave the doors open so we wouldn't miss a minute of hallway clatter. And then there was shower time - a daily ritual to prevent infection, but why the water had to be maintained at a very uncomfortable 45 degrees Celsius (113 Fahrenheit) rather than 39 or 40 (102-104 Fahrenheit) - and, yes, there was a clearly marked regulator - was beyond me. The nurses, generally a very nice, supportive bunch, agreed with me, but thanks to a history of labour disputes they were understandably loath to take on a bunch of co-workers who carried chips on their shoulders that could be measured in hectares (or acres, if you will). In today's excuse for an economy it was always easier to fire a professional who earned a sort-of-almost-fair salary and then to hire someone who made barely more than the minimum wage, so the nurses had to tread lightly. As did the docs, lest they lose their staff privileges. Fun!
69
Agree. But you were lucky to get a shower. We were told they don't do that on this wing. My mother got one or two in-chair cleanings the entire month she was in the hospital. And years prior to her final stay, she got zero - nada - nil in over three weeks.
1
Never leave anyone alone in a hospital. Bring a pad of paper and take notes, that will increase ones level of care. Nurses and doctors are no different from any other person one would encounter, some are really good, others just bad at their job.
My son was in Desert Regional Med Center in Palm Springs for ten days, I lived in his room, slept in a chair next to his bed. One nurse tried to get me to leave, another complimented me for being so concerned about his care, he had broken his femur. Big bone and injury.
I also stayed in a motel and would go to the hosp at 0530 every morning to talk to the night shift nurses to ask how he was. They were great.
My son was in Desert Regional Med Center in Palm Springs for ten days, I lived in his room, slept in a chair next to his bed. One nurse tried to get me to leave, another complimented me for being so concerned about his care, he had broken his femur. Big bone and injury.
I also stayed in a motel and would go to the hosp at 0530 every morning to talk to the night shift nurses to ask how he was. They were great.
111
My wife is a PT and has always stayed with me during my 14 surgeries. She knows how easy it is to give the wrong pill or cut the wrong place.
4
There is a word for diseases caused by doctors or medical (mis)treatment, that word is iatrogenesis and it is VERY VERY real. When it is intentional it is called malpractice. If, as this article says, doctors looked at their patients' experience from the patients' point of view, rather than their own, it would elicit better outcomes across the board.
That would, however, require a degree of empathy, and as we all know, this is incompatible with the absolute hubris which many doctors comport themselves with.
That would, however, require a degree of empathy, and as we all know, this is incompatible with the absolute hubris which many doctors comport themselves with.
62
So right....google says that iatrogenesis is the THIRD leading cause of death in the US. To the tune of 225,000 deaths per year. That beats Ebola by a mile.
1
I have had multiple surgeries since 1960. I have noticed that hospitals don't use a commercial buffing machine on the floors anymore - that is a great improvement. Everyone knows that when you have a cold or flu, you don't like to be around loud noises, or people waking you up. It would seem like common sense could have kicked in years ago at hospitals when people are normally in more pain than when they have the flu. I'm glad that hospitals and doctors have improved since 1960 when they were more like torture chambers.
7
But sometimes the right still doesn't know what the left hand did. My Father was in for kidney stones. One nurse gave him a sedative and pain killer so he could sleep. Another gave him a laxative to clear him for a MRI. No further elaboration is needed.
What’s the point of a quieter environment if they come in every hour, or more, and wake you up for something? I recently had to stay overnight for some testing and it was the worst night of my life. And now you have the “hospitalist” and never even see your own doctor. I’m afraid I shall pass from this world without ever seeing the inside of another hospital. I’m old so I can make that statement.
1
(Writing from my husband's account.) Caution, people: extreme organ recital alert. Inattentive care from doctors does indeed cause needless suffering. I can't remember how many times I've received inadequate care from American doctors, which led to more serious conditions. However, 2 incidents take the cake.
In the first one, I developed severe edema, was sent to the ER, had the usual tests taken (all organs OK), then sent home with Lasix, a diuretic. No follow-up with any doctor. Turns out I was in the first stages of veinous insufficiency, a condition whereby the veins that pump blood up to your heart don't work anymore - hence the episodes with edema continued. I finally received help in Switzerland 6 years later, when I collapsed with pulmonary and peripheral edema. Gosh darn it, they actually performed extensive tests on me, referred me to a specialist, and I was diagnosed, had surgery, and now for the first time in years I can breathe more fully, and I don't faint anymore.
A lot of doctors flat-out do not listen to their patients, which leads to the 2nd incident. I had my thyroid ablated, and when it was time for me to go onto Synthroid, I developed severe chest pains. I went to my doctor, and he actually laughed at me, told me I needed to see a psychiatrist, saying, "The pain is coming from your head!" Didn't even test me with any instrument. Five weeks later, I wound up in the heart ICU, my BP had shot up to 220/150. Thanks, American doctors. Lauren Rowell
In the first one, I developed severe edema, was sent to the ER, had the usual tests taken (all organs OK), then sent home with Lasix, a diuretic. No follow-up with any doctor. Turns out I was in the first stages of veinous insufficiency, a condition whereby the veins that pump blood up to your heart don't work anymore - hence the episodes with edema continued. I finally received help in Switzerland 6 years later, when I collapsed with pulmonary and peripheral edema. Gosh darn it, they actually performed extensive tests on me, referred me to a specialist, and I was diagnosed, had surgery, and now for the first time in years I can breathe more fully, and I don't faint anymore.
A lot of doctors flat-out do not listen to their patients, which leads to the 2nd incident. I had my thyroid ablated, and when it was time for me to go onto Synthroid, I developed severe chest pains. I went to my doctor, and he actually laughed at me, told me I needed to see a psychiatrist, saying, "The pain is coming from your head!" Didn't even test me with any instrument. Five weeks later, I wound up in the heart ICU, my BP had shot up to 220/150. Thanks, American doctors. Lauren Rowell
58
Hugh Rowell: I think the blame is partly yours, much as you do not want to hear that. In the first instance, you should have followed up with your private doctor. The emergency room is not your private doctor. Venous insufficiency due to faulty valves is usually not treated with lasix - that is reserved for edema due to cardiac insufficiency, which is what you developed in Switzerland. You should have been seeing your private doctor all along. It is also quite a stretch to say that the two events, six years apart, were causally related.
In the second case, when you developed severe chest pains, you should have gone straight to the ER. That five weeks later you wound up in the coronary care unit with hypertension suggests that this was an ongoing problem possibly related to the first problem. If the chest pains were so severe, why did you wait five weeks before emergency treatment was necessary?
the patient does bear some responsibility for seeking out proper medical care - reading between the lines it is apparent that you have left out a lot of vital information - usually it relates to failure to follow up on the part of the patient.
In the second case, when you developed severe chest pains, you should have gone straight to the ER. That five weeks later you wound up in the coronary care unit with hypertension suggests that this was an ongoing problem possibly related to the first problem. If the chest pains were so severe, why did you wait five weeks before emergency treatment was necessary?
the patient does bear some responsibility for seeking out proper medical care - reading between the lines it is apparent that you have left out a lot of vital information - usually it relates to failure to follow up on the part of the patient.
2
Doctors tend to laugh in your face here when they don't know the answers and are too lazy to find them. The "idiopathic edema" which I had suffered from since childhood was finally diagnosed as Hashimoto's disease when I was in my late 50's.
2
Did you not think that perhaps you should make an appointment and follow-up with a doctor if you were unsatisfied with the state of your health?
2
The history of hospitals may provide some guidance for alleviating suffering. Pre-modern hospitals were charitable organizations often staffed and lead by female nurses dedicated to curing the physical, emotional (and moral) suffering of individual, lower-class patients. Male doctors co-opted treatment in hospitals in the late nineteenth century as a means to raise their professional profile. The doctors used hospital patients as a pool of subjects to test new scientific theories of medical intervention. Alleviating emotional suffering was pushed aside in favor of curing physical ailments that could be statistically measured and quantified.
Considering the history its not surprising that many of the doctors were surprised and incredulous until they saw the statistics on their poor care. Hospital leadership taking steps to seriously support the founding mission of many these institutions to alleviate suffering is a good thing. But relying on statistical methods of measuring care still encourages mechanical approaches - fixes that will result in higher ratings on surveys; rather than encouraging meaningful interaction and listening to patients to creatively address their individual needs.
Considering the history its not surprising that many of the doctors were surprised and incredulous until they saw the statistics on their poor care. Hospital leadership taking steps to seriously support the founding mission of many these institutions to alleviate suffering is a good thing. But relying on statistical methods of measuring care still encourages mechanical approaches - fixes that will result in higher ratings on surveys; rather than encouraging meaningful interaction and listening to patients to creatively address their individual needs.
33
Medicine does adbance, and it does so using scientific methods, including statistics. Without this generations-long process medicine would still be in the middle ages.
It is encouraging to see that physicians are beginning to focus more on the significance of their interactions with patients. I choose my own physicians with a requirement for kindness and empathy as well as experience and excellence in their specialty. However, no matter how capable the doctor, when I have been hospitalized it has been the nurses who had the greatest impact on my experience. A kind, caring nurse inspires trust that I am being well cared for; this belief supports and accelerates healing. A callous nurse who resents every press of the "call" button makes me feel unsafe in the hospital. No matter how "good"' the hospital, a patient really needs an advocate in the person of a relative or friend who is present in their room with them. I have had a couple of Nurse Ratchetts in my experience, and they made for anxiety and even fear while I was hospitalized. Even a mundane act such as failing to close the door when exiting a patient's room at night becomes a problem when there is noise in the hall and the patient cannot get out of bed to close that door. The behaviors that need change are a reflection of the character of the care-giver and turn up most often when no one (except the patient) is watching.
52
Agree, a good nurse is worth her/his weight in gold.
3
Paying more attention to patients is a good idea, but relying on representatives of a for-profit market research corporation as sources for an objective article on the subject isn't.
Press Gainey make their living producing surveys that they claim provide important insights, and selling them to hospital and outpatient administrators, who, themselves, have never treated a patient, so that they can come up with new rules and policies for doctors to follow, thus justifying their large administrator salaries and their patently false claims to be contributing something of value to the care that is actually provided by doctors.
The chief impediment to good, patient, thoughtful communication between physician and patient is lack of time. The chief job of the administrators that pay for these surveys is to hound doctors to spend less time with patients, and more time checking meaningless boxes on electronic forms, so that they can collect data, so that they, collectively, can use those data to create more time-consuming rules for doctors, whom they are pushing to work faster.
If the health care system would turn more of its money to paying those who actually provide health care, and less to administrators, survey corporations, billing and coding specialists, and others who contribute nothing, then doctors, nurses, and technicians could better work together to provide the high quality care that they are trained to, and earnestly strive to, provide.
Press Gainey make their living producing surveys that they claim provide important insights, and selling them to hospital and outpatient administrators, who, themselves, have never treated a patient, so that they can come up with new rules and policies for doctors to follow, thus justifying their large administrator salaries and their patently false claims to be contributing something of value to the care that is actually provided by doctors.
The chief impediment to good, patient, thoughtful communication between physician and patient is lack of time. The chief job of the administrators that pay for these surveys is to hound doctors to spend less time with patients, and more time checking meaningless boxes on electronic forms, so that they can collect data, so that they, collectively, can use those data to create more time-consuming rules for doctors, whom they are pushing to work faster.
If the health care system would turn more of its money to paying those who actually provide health care, and less to administrators, survey corporations, billing and coding specialists, and others who contribute nothing, then doctors, nurses, and technicians could better work together to provide the high quality care that they are trained to, and earnestly strive to, provide.
351
Well, using the surveys as an improvement tool seems to have really helped relieve suffering at the hospitals mentioned, so I imagine patients at those hospitals are happy. I don't think just paying people more always automatically improves their behavior. Also, someone has to make sure that regulations are followed and the lights stay on. They also serve who only sit and write.
1
I refuse to answer surveys from clinics for these reasons. If I have an issue with a doctor I simply say so at the time. In the hospital, however, you can yell all day and noone will be listening. The surveys I’ve been sent, howver, deal mostly with, “was the waiting room clean and inviting?” or “was the appointment setter polite when you made the appointment”. I skip all the stupid questions, write them an essay on what I think of for-profit healthcare and send it attached.
1
Brilliant observation
3
Keep in mind this is a hospital, where noise and pain and tests occur all day long unfortunately. I doubt that will ever resolve.
Just set foot in the ICU and see an example.
Just set foot in the ICU and see an example.
10
All day long is one thing, rnahouraii. As Dr. Bennick discovered, all night long is usually not necessary except in ICU.
3
you would be surprised at what happens at night on the wards of a hospital. People are sick and suffering.
Taking "vital signs" is not an interruption.
Taking "vital signs" is not an interruption.
1
That is not the noise of 4 am blood tests, 5 am weight sessions, people leaving the door open to the noise of the nurses and doctors talking and conversing loudly in the early hours or when you are trying to nap to catch up on the sleep you didn't get during the night. The most humane, restful care I ever had was in 2 different ICU.s by the way.
1
OMG how shocking! Doctors have discovered that their job involves reducing suffering! What an idea. And why did they go to medical school?
Apologies to those great docs out there who I usually manage to find.
Apologies to those great docs out there who I usually manage to find.
49
Money. The guys I knew taking the MCAT IN 1984 went to med school as a kind of glorified technical school that would make them rich. That's. the. whole. reason.
It sounds like a form of trickle-down medicine. If you have the money, you get the care, if not, Sorry, Charlie!!
7
Not knowing what is going on, not being given enough information or being spoken to in science/medicine speak create suffering for patients and families. As a pastor I sat once in a neurosurgery waiting room. The man whose wife had hit her head and just had emergency brain surgery was a college professor and an assertive guy. When after surgery the doc occasionally lapsed into med-speak ("sub-arachnoid tear"), the prof-husband would tap him on the knee and firmly say, "talk English to me." Unfortunately, many less assertive and/or less educated folks are too awed by doctors or scared of the hospital setting to do that - they do not understand, but nod and thank the doctor.
In my nursing career it was usual for us, after doctors left, to ask the family if they understood what they had been told -usually they have not and we would re-explain. Some of that is not the doc's fault as it is a high anxiety situation - it is hard to take anything in. That said, family/patient anxiety can be significantly reduced if medical/nursing staff communicate well and in language the general public will understand. All must also understand that people need to be told hard, complex or confusing things over and over in order to understand and integrate the information.
In my nursing career it was usual for us, after doctors left, to ask the family if they understood what they had been told -usually they have not and we would re-explain. Some of that is not the doc's fault as it is a high anxiety situation - it is hard to take anything in. That said, family/patient anxiety can be significantly reduced if medical/nursing staff communicate well and in language the general public will understand. All must also understand that people need to be told hard, complex or confusing things over and over in order to understand and integrate the information.
183
You are so correct about the difficulty people have trying to absorb and understand material in a high anxiety situation. I would like to see doctors learn to write down the diagnosis/procedures for patients.
2
Far to many patients unfortunately undergo procedures ordered for them by having no clue. I twice needed tests in a hospital, ordered by my physician, when I knew something was amiss. One was an scan for which I was supposed to be injected with a dye. When already on the table with no dye, I objected. They called the physician and cleared it up. His staff - not the smartest one to begin with - had issued a referral for a procedure without the dye. They had also spelled bilateral 'bylitarel' on another test. Now that was really funny.....
The technicians complimented me for pointing out the error, and remarked that patients, when asked what are your here for, generally reply: because the doctor told me so.
Physicians should always explain any procedures to patients in simple terms and in writing. And don't let the writing be done by staff that can't spell.
The technicians complimented me for pointing out the error, and remarked that patients, when asked what are your here for, generally reply: because the doctor told me so.
Physicians should always explain any procedures to patients in simple terms and in writing. And don't let the writing be done by staff that can't spell.
3
THis article points out the need for the medical community to acknowledge their patients as sentient beings and not just bodies to be manipulated.
203
Perfect statement. I am searching for Dr's in NY who answer questions and not say " oh just do what I tell YOU"
I got spoiled in LA . SAG had started health centers with 1st rate doctors and who sent you to specialists who operated in the same way. Paradise for patients
I got spoiled in LA . SAG had started health centers with 1st rate doctors and who sent you to specialists who operated in the same way. Paradise for patients
1
They think of us as sacks of biochemicals.
1
The medical community has to acknowledge as well that their patients are customers, not cash cows for their overblown administrational apparatus, and treat them with respect.
2
A little bit of indifference causes a lot of suffering. In dealing with my aging parents' health issues I found that one caring person does make a difference. And boy oh boy, NOBODY can get a good night's rest in the hospital (I'll leave it unnamed but it was in La Jolla, California.) My father insisted on going home as early as he could (in his late 60s, in for a surgery, 2-3 night stay that he shortened to 1 night) simply because he knew that the lack of sleep was more detrimental to his recovery than anything else. Also, MY GOODNESS, have you ever tried to be DISCHARGED from a hospital? So many people apparently need to sign off that the process is super slow and always getting stuck. Both my parents and my husband spent most of the day they were supposed to be released simply waiting ... and waiting... and waiting... because someone somewhere couldn't Dr. X to sign a form. My father was told around 6am he'd be leaving. We were actually allowed to leave around 3:30pm. It was hard to even get any lunch since food service stopped (because, duh, he was being discharged) and I was afraid to leave his room to go get food. I harassed nurses, I phoned... Nothing happened. So, that was a day of exhausting waiting where my dad missed a meal while trying to recover from major surgery and not a single person at this La Jolla, Calif. hospital even noticed or apologized!
384
I think I know the name of the unnamed hospital, and I'm sorry, and surprised, to read that your father had such a terrible experience there. My grandmother, in her late 80s, was treated like a queen there when she had two surgeries for cancer and extended stays a few years back. Her nurses and other personnel were attentive to her needs and let her sleep through the night when caring for her during both visits. My grandmother even became friends with her lead nurse, and they still keep in touch. Discharge took awhile, but we expected that, and we were grateful that the hospital staff gave us frequent updates about the process to relieve our anxiety. This, to me, is the definition of exceptional medical care - while recovery was painful and long, her suffering was minimal.
More to the point of this article, my grandmother's ward was reserved for cancer patients, unusually quiet, and somewhat isolated, and her room was private, all of which helped greatly with her ability to rest properly and recover quickly. (So did the fact that my mother was able to spend many nights in the room with her in a fold-out bed and the rest of my family, which is guilty of joke-cracking and prank-playing, visited every day and spent hours laughing together. Those important steps toward alleviating her suffering were, of course, not addressed in the article!)
More to the point of this article, my grandmother's ward was reserved for cancer patients, unusually quiet, and somewhat isolated, and her room was private, all of which helped greatly with her ability to rest properly and recover quickly. (So did the fact that my mother was able to spend many nights in the room with her in a fold-out bed and the rest of my family, which is guilty of joke-cracking and prank-playing, visited every day and spent hours laughing together. Those important steps toward alleviating her suffering were, of course, not addressed in the article!)
3
(Lauren again.) I'm so sorry you and your family went through this, and to top it off, your dad had had major surgery. Unbelievably unkind staff - which reminds me of something!
If you read my (almost) unending ramblings above, about my second incident with uncaring doctors, I at least had very nice and caring nurses (unlike your situation, I'm sad to hear).
Since I was in the heart ward of the ICU, the food was beyond horrific - green beans boiled until there were no nutrients left, mere husks remained of their former selves (with no salt!). On my second night there, when I almost didn't make it, the nurses snuck in a ham and cheese sub sandwich, with all the fixings, along with potato chips!
Can your father have a nice cheeseburger now? I certainly hope so, and best of luck to you and yours. Lauren Rowell
If you read my (almost) unending ramblings above, about my second incident with uncaring doctors, I at least had very nice and caring nurses (unlike your situation, I'm sad to hear).
Since I was in the heart ward of the ICU, the food was beyond horrific - green beans boiled until there were no nutrients left, mere husks remained of their former selves (with no salt!). On my second night there, when I almost didn't make it, the nurses snuck in a ham and cheese sub sandwich, with all the fixings, along with potato chips!
Can your father have a nice cheeseburger now? I certainly hope so, and best of luck to you and yours. Lauren Rowell
1
Your observations about discharge extend well beyond La Jolla. I had very similar experiences in Ohio. I've often wondered if I had tried to walk out of the hospital, perhaps that would have hastened the process.
13
Physicians can succeed by stepping out of themselves and imagining roles reversed: what if I, or my parents, or my spouse, were the patient? How would a Doctor earn my trust and confidence? What would make me feel respected and cared for? What would help me understand what living with a diagnosis means? Does the MD hear me out about what I've gone through before telling me about research studies? What would make being an inpatient tolerable and help recovery? Am I seen as a person rather than a patient ID number? I think that identifying with those they treat would help improve care quality.
80
NM, I suggest that a lot of medical personnel don't even see patients as an ID number, but rather see them as "the diabetes", the "appendectomy", etc.
4
Finally someone has realized that waking the patient up in the middle of the night is not usually necessary and greatly disturbs the patient. What a concept.
478
i remember one hospital stay years ago when i was awaken every 4 hours to have my vitals checked the old fashioned way, and not closing the room door after the nurse left.. couldn't sleep a wink.
4
On the other hand, I finally found a lab tech who could draw blood from my tiny slippery veins the first try every time--and she worked the night shift. For the rest of the week, I specifically asked my doctor to order my labs for after midnight so she could take mine. Made all the difference to my recent hospital stay.
13
Usually it's the nurses who wake the patient up, not the doctors. Rare to find a doctor making rounds during the night.