I need to blow off some steam. Sorry, in advance. I'm afraid you don't really understand what happens in the so-called "trenches" of my emergency department. Let me tell you just one story today.
A man was transferred from another hospital to our for specialty hand care. According to him he was just "minding his own business" and some dude up and stabbed him in the forearm. It was a through and through wound. The ED at the other hospital took a look and decided the guy had some severed tendons and possibly nerves to his hand. These injuries require, sometimes, a hand surgeon to repair. So he was given some pain medicine, and x-ray, and tetanus and antibiotics, then put in an ambulance for a 50-mile trip to our hospital, because our hospital unlike theirs, has hand surgeons available for emergencies 24 hours a day.
Today was a typical day for the ED. By typical I mean crazy bat-shit busy. The patient was placed in a room and I finally got to him about an hour later. Before entering his room I skimmed his triage note which read, "Dr. Hand Surgeon (name left anonymous) aware of patient coming." Now, it is customary practice for me to evaluate all the patients that come into my emergency department. So that's what I did. I undressed the wound and examined it. The patient was very unhappy with this - I was the second doctor to do so and "nothing yet had been done" to paraphrase the patient. I walked out of the room, ordered some morphine and requested the hand surgery service be called. I told them about the transfer and that Dr. Hand Surgeon was aware of the patient and could you please come see the patient?
I was just going through the motions, as much as this pained me. I knew this patient did not have an condition that required emergency surgery. He needed urgent referral to a hand surgeon, preferably the next day. Nevertheless, our hospital being the level 1 trauma center that it is and with our policy of accepting any and all transfers for whatever reason they may be, I had no choice but to call my hand resident colleague.
The recommendations of the consultant were: loose closure (suture), splint and follow up in the hand clinic. That's it.
Perhaps this doesn't strike you as absurd, so let me spell it out. A patient was transported here for an evaluation of a medical condition that was not an emergency. That's a real expensive ride. And a waste of the patient's time. When he arrived the service he was sent to see did not know of his arrival, so I needed to see the patient first. I had plenty of other patient's to see and my involvement in his care added very little, if anything, to the value of his care. Although it certainly added cost. Then the consulting service gave recommendations that could have been given over the phone.
Believe it not this happens every single day. Unnecessary transfers for non emergent conditions that could be handled with good outpatient follow-up. Or necessary transfers to services who are clueless of the transfer. This takes a considerable amount of my time accepting the patient in my ED and calling he appropriate services, beds, admissions for patient who have known diagnoses.
Let me get back to my story. So, as I am dressing this guy's arm and splinting it, his girl starts yapping away as if I am not there how "we just walk around in our white coast and sit on our asses at the computer the whole day not doing any work," and how the "nurses are lazy checking the email and don't give a shit about their patients." I invited her to look at the email my nurse was not checking but she refused. "I know how you guys work, I know what's really going on." Contrary to what you may think, she was not psychotic. She was, actually, a sort of typical disgruntled, if a bit unfiltered, "customer" who I see every day.
It was hard to restrain myself. "I'm sorry you feel this way, we work very hard here providing you with free care and you should appreciate that. You are rude to assume we are doing anything less than that." But as I say this I know I'm walking a thin line, and have probably crossed it. She is incensed. My candor, as usual, backfires and the patient escalates. I asked security to have her escorted to the lobby.
In medicine we have the maxim: "would you do it if it showed up on the front page of the city newspaper?" I know you think about this all the time. And because you think about it, I think about it. I don't want to embarrass you. But exactly how groveling do we need to be? I'm a highly trained and educated physician. This person was a moron. It is sad that I feel ashamed to stand up for myself and my staff. And I have the very uneasy feeling that if she were to lodge a complaint, the hospital would not back me and instead try to make things all nice to avoid any risk to the hospital's public image.
This is the culture here at our hospital, and to be honest, at many hospitals in this country. It is nauseating. It is a sign that ultimately our patient care is not good, like we have an insecurity complex. Like we know our reputation and the confidence of our "customers" is not that strong. We're afraid people will find our vulnerabilities and exploit them, and that's why we grovel.
