When the Doctor is the Patient

First of all, it was NOT Mouse’s fault. 

About a month ago, my geriatric, orange tabby cat slipped past me out the door and into the backyard.  In my rush to bring him back inside, I grabbed him, and he panicked.  This resulted in two, nasty puncture wounds on my dominant hand which I knew needed antibiotics ASAP.  Alas…48 hours later, the cellulitis had worsened significantly despite therapy, and I was hospitalized for IV antibiotics and possible surgical intervention.

How many of you remember the 1991 movie, “The Doctor”?  It’s loosely based on a memoir called, “A Taste of My Own Medicine” by Dr. Edward Rosenbaum which recounts his experiences as an oncology patient after he had been a practicing internist for years.  The movie focuses on the vast blind spots physicians can have when treating patients if they’ve never experienced being a patient themselves. 

As a physician who practiced clinically in the hospital setting for a dozen years with another dozen as an expert in hospital utilization, case management, and care quality, you would not be remiss to pity my care team.  I honestly DID try not to micromanage the situation, but….

First up – clarification of status.  I was visited by someone explaining I was “in Observation status” and she had an iPad for me to sign to acknowledge I understood.  What am I signing, I asked?  Oh, just a form the hospital is required to give patients to tell them they are Observation.  Oh, my friends, the audible sigh that was heard when I refused to sign and asked for a physical copy of the form to read!  Then, when I asked more questions, I was told this individual was “just from registration” and really did not know anything about the form.  Being asked to sign a document when in a hospital bed is stressful enough (something I did not truly grasp, before), but it really fails to instill confidence in the institution when the person asking for a signature has no idea why!

Second – any pediatrician, pediatric nurse, or peds-focused therapist or technician will tell you a major goal of care is to minimize patient fear and discomfort by minimizing interventions.  When I was woken at midnight for a blood draw, I accepted it without issue.  But, when another phlebotomist arrived six hours later to poke me AGAIN for a different test, I was not thrilled.  I ended up learning from my nurse that at that hospital, a CRP test – which is a common marker for inflammation – defaults to a midnight draw when ordered by a physician.  An order for a CBC leads to an electronic health record prompt to pick 6 AM or another time for the draw.  Since the CRP default to midnight is invisible to the clinicians, they have no idea they are ordering their patients to be poked with a needle twice instead of once.  Holy moly.

Third, when nursing is short-staffed, patients and families can tell.  No amount of experience or training can polish over an individual who is stretched too thin and worrying if they are providing the best care for their patients. 

When patients are apologizing to their nurses for pushing their call button and nurses are apologizing to their patients for answering the call later than they feel they should have, the REAL apology should come from hospital administration to both parties.