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Shotgun

 

 

 

Riding Shotgun at the Hospital

Charles Atkins, MD

Published in The Waterbury Republican September 11, 2005

 

I’m a doctor and like many healthcare professionals I’ve had the experience of shepherding a loved one through a hospital stay. Each time this happens, I see things that give an awful clarity to the statistics on fatalities due to medical mistakes (According to the Institute of Medicine about 40,000-90,000 a year). Hospitals can be dangerous places.

I’ll begin with a dream I had as a medical student. It took place in the chemistry laboratory, but instead of test tubes and beakers, there was a patient in front of me hooked to tubes and machines. My lab partner and I diligently followed the manual, but something went wrong and our patient’s blood turned to oatmeal. Panicked, we fumbled through the book trying to find the antidote for oatmeal. We were unsuccessful; the patient died.

Over the years I’ve thought a great deal about that dream and about the incredible responsibility we take when working with patients, especially when it comes time to send them to the hospital. No one knows better than physicians and nurses as to the kinds of things that can, and do, occur. From the too-tired resident who misplaces the decimal point in a medication order to the nurse mandated to do a double shift, who miscalculates, mistranscribes, or otherwise screws up a bag of intravenous fluid. Most of these errors go unnoticed with little or no harm to the patient, but sometimes . . . blood turns to oatmeal and people die.

This is why most doctors and nurses that I know, take a special interest in family and friends when they go into the hospital. We become the difficult relative or friend who asks questions and are frequently unhappy with the answers.

Case in point--my octogenarian friend Lisa, with whom I write a weekly column, called me in tears from her hospital bed having just kicked an aide out of her room. She’d thought she was to go home, but the aide had told her she needed to have a line inserted. She’d replied, "absolutely not" based on a bad experience she’d had months before, when she’d developed painful and disfiguring lymphedema.

A nurse came in to ask her why she was refusing. Lisa stood her ground, but felt horrible; she comes from an age where you don’t question doctor’s orders.

More alarming, at least from my perspective, was that I had thought she was getting discharged. Why would she need a PIC line? "Do you have an IV in?" I asked.

"Yes."

"Is it working?"

"Yes."

"This makes no sense. Either something’s going on that you need to know about, or else somebody screwed up."

I had her call her attending physician, who came by to see her and was completely stunned; he had not ordered the line.

If this were an isolated event, I wouldn’t go off on this rant, but it seems that whenever someone I care about goes into a hospital, someone has to ride shotgun. When I mention this vignette to others, I’m barraged by similar stories.

As I hear, or witness, various near-death adventures in the hospital, I see that the mistakes can come at any time, and from any direction. The other thing I notice is patterns. I find four of them:

  • Patients are not listened to, and their concerns, which are often the harbinger of something bad going on, are not taken seriously.

  • People lose their personhood and become the ‘diabetic ketoacidosis in 4C’ or the ‘schizophrenic decompensation in cubicle two’.

  • Tests and laboratory results have replaced the art of careful history taking and medical examination.

  • Important communication between healthcare providers does not occur.

Having worked in several hospitals, as house officer, attending, and medical director, I bring this up with sadness because I understand how these problems developed. Years of make-or-break cost cutting due to managed care, Medicare and Medicaid reimbursement rates etc. have taken their toll. For many employees, hospitals have become high-stress environments—as born out by national surveys--where the patient’s comfort, dignity and safety have become casualties—there’s just not enough time.

        So this is why whenever someone I care about takes a trip to the hospital, I make certain that I have their number, they have mine, and I check in daily. But I feel for the person who doesn’t have a friend or family member that’s a doctor or a nurse; who rides shotgun for them? Who will stop the oatmeal?

 

 

 

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