Tuesday, January 13, 2009

Doctor Visits

I had 2 doctor visits in 24 hours. Not as a patients advocate, helper or observer, but as a patient this time. There is probably nothing I dislike more than going to the doctor.

I have been suffering with allergies for months. Stuffy nose, sneezing, watery eyes, it just was not getting any better!

Last night I went to an allergist and was tested to learn I am allergic to almost every tree, plant and flower imaginable, my dog and probably some other things I lost track of. I entered the doctor’s office to be greeted by a large sign that told the patients how much doctors are paying for medical malpractice insurance. I wanted to walk right out since this doctor obviously felt that reading about his (their) high cost of medical malpractice insurance was my priority while I struggled to breathe, but instead I continued with the visit, that was interrupted by phone calls, conversations and a very distracted young doctor trying to answer everyone’s questions. She examined my arms, wrote some notes and prescriptions and told me to come back in a month. I don’t THINK so.

I’m surprised that some doctors act as if they are doing us a favor when in fact, I think I brought my business to her and wrote her a check!

This morning I kept my appointment with an ENT to see if there were other reasons for my chronic stuffy nose. How I found this doctor is really probably not written in any of the patient safety books……………….At a meeting of about 10 women, I apologized for my stuffy nose when one suggested I see this doctor. Upon hearing his name, many of the other women said they too use him and think he’s wonderful. So, ‘I must go see what he could do for me’ I thought and made an appointment.

I was uncomfortable that I could hear the conversation in the room next door clearly but it was a young child and I could hear he spoke in a genuinely loving manner to the patient and whatever family was in there with him.

I asked the doctor to tell me what he was doing, and each move he made, he explained it. The exam, x-rays and testing were all explained in detail and upon the results, he said he was going to make sure I understood what he said. He showed me diagrams, wrote down information and practiced “teach back” allowing me to try my new nasal spray. We went through my medications, options and even last nights prescriptions from the allergist so he could compare what he was recommending compared to these.

Little did he know what “baggage” I carried with me into his office. His office was right next door to the hospital where my son had his tonsillectomy that killed him years earlier. I saw the restaurant where we got coffee and breakfast during the surgery and the driveway where I rushed back with a bleeding child in my arms. He used the same “scope” on me that led my son to begin the downward spiral of medical treatment that would soon lead to him leaving us forever and my pain, so great, would cause me to spend the years that followed helping others understand how medical nightmares begin and that sometimes, they never end.

I was a “good” patient. I asked my questions and listened intently apologizing in my own mind for judging this kind and gentle doctor before I ever came to see him. I want so much to just go to the doctor like other people, ask my questions, be treated and leave. But, that could never happen. Forever I will be on guard, probably suffering from post traumatic stress that has not been recognized following a medical error.

Instead of just suffering, I use my experience and the experiences I have learned from the people who work in healthcare, patient safety and quality management and others who have suffered but so graciously share their experiences to try to help change the way healthcare is delivered and the way people are treated following an adverse event.

No, I don’t recommend doctors but I will keep my appointment with this one. I hope he will keep me as a patient! And maybe, his gentleness is what I need to get me through the trauma of a stuffy nose.

Monday, January 5, 2009


I was at a Queens, New York diner yesterday with some family from out of town. We were enjoying conversation but my cousin, who has been known for her bubbly personality, noticed that the waiter or the busboy would just come by and take things away without asking or, in one case got her order wrong because he may have assumed, she wanted something a certain way. I was surprised that bubbly doesn’t mean outspoken because when I suggested she bring her concerns to his attention, and ask for what she wanted, she wouldn’t. “It’s not that important” she told me.

Earlier in the day I heard a sermon from an out-of-town minister tell about her experience as a waitress and that people would wave their cups of coffee at her and she couldn’t possibly tell them that theirs was not her table. There needed to be enough waitresses at all times to respond to each waving cup of coffee.

I put this in some perspective of how we envision our healthcare system. Would the same people who would allow a waiter give the customer the wrong order also allow the wrong medication to slip though? If a customer is not outspoken enough to call attention to slow service at a diner, how are they going to speak up about a slow response in the hospital?

The culture may be for these people to be polite but given the appropriate tools for communication, everyone gets their needs met. We just haven’t found that tool for communication? Or have we and we are just not all using it? Visit
www.patientsafetyadvocate.org and see what PULSE is doing about communication.

Friday, January 2, 2009

Visit to the Nursing Home

I was invited to visit an elderly gentlemen in a nursing home. I was invited not by his elderly wife, but by their home aide. The woman who cares for the husband and wife daily was worried about the way the husband was being treated in the nursing home. The wife, she told me won’t ask questions and is too timid. The aide also said that when the husband calls for help at night, now that he is immobile following a stroke and then a fall, no one comes. She went on to tell me that the nurses were rude and wouldn’t answer questions. They feared for the safety of this elderly gentlemen, in his 90’s unable to care for himself.

When I visited, the elderly man was sleeping at 11:00 in the morning. He was more than just sleeping, it was pretty obvious to me that he was medicated. When he awoke for a moment, he said they did give him medication to make him sleep after he dirtied himself after breakfast.

I was waiting for the family to come and some friends stopped by to visit. They said he was never as bad as he was today. They feared something was dreadfully wrong. I didn’t mention my thought that he might be medicated but they came to the same conclusion.

When the wife came with their home care helper, a nurses aide came in. He was young and said he just stopped by to see if the patient needed anything. I asked him about bedsores and would he please remove the patients (I am not using names) socks so we can see if there are any bedsores, and, I asked him if he wouldn’t mind showing the patients wife and aide how the skin should look. He was happy to comply, removed the socks and gave the patient a foot and leg massage.

The family seemed surprised at how simple it was to ask. And, how graciously the aide explained bedsores and how they develop. We spoke about how he cares for the patient and stayed available to answer additional questions.

When I consulted with the family later, they said they have meetings with the social workers and dietician. Everyone involved in his care will be having a meeting next week. I suggested they write down their questions and keep notes that can be looked at later.

There were some areas of concern too, such as I couldn’t find any antibacterial hand cleaner and had to go find some at the nurses station. The patient had no water though he is supposed to have water at all times and the television from the neighbors bed was blasting loud, all things that families, of a younger generation may be more likely to speak up about or just take care of.

Patient advocacy is, in many cases generational and the culture needs to be addressed. It really is OK to show an interest in the patient by asking questions, learning from the medical staff and sharing what your expectations are.

Safety must start with conversation.