What's Your ER Experience?
Friday, March 30, 2007
Anil Menon, MD
Being a health care worker, you’re exposed to many viruses and often become a victim of the very illnesses you are trying to treat. Rhinoviruses, coronaviruses, and the respiratory syncytial viruses (RSV) are the typical culprits that cause the “common cold.” Let’s not forget the enterovirus, which triggers gastroenteritis - in plain English, this means diarrhea and vomiting. The only means of prevention against these viruses is routinely washing your hands, getting proper amounts of rest, drinking fluids, and decreasing your stress levels – easier said than done, especially for a first year resident.
The flu virus is one you CAN nip in the bud by getting the flu shot. This is especially important for people who are at a higher risk of infection, such as health care workers…However, I ignored Dr. Bob’s advice and skipped taking the flu shot. Needless to say, I came down with the flu in February. If I were describing my case to one of my attendings, I might say "A 30 year old male, Emergency Medicine (EM) resident complaining of fever to 104 for 3 days, non-productive cough, runny-nose, decreased oral intake, tolerating liquids - looks like the flu." The compassion I received from my fellow residents helped strengthen me. They could easily commiserate, because a short sentence like that evokes a fear of non-existent down time. However, my experience with my own doctor wasn't as warming. Though I knew I had the flu and I knew the treatment would be oral rehydration and rest, I still scheduled an appointment to make sure I was not missing anything--as I said, I'm still in training. My doctor was behind schedule, when she whisked into the room, trying to catch up. She quickly looked into my ears and throat, before saying hello, and told me I was correct all along and probably should have saved my energy and stayed in bed. I've been there. I understand. Despite knowing the disease and knowing how the system works, I left disappointed and feeling overlooked.
Even more troubling was the fear that I might have treated some of my patients similarly while trying to manage new diseases and new systems. Different patient encounters flashed in my mind as I tried to reevaluate my interactions. My memories also brought me back to a class held at the Stanford Graduate School of Business (GSB) called interpersonal dynamics or nicknamed "touchy feely." In class we practiced giving, receiving, and eliciting feedback. Feedback is something they find hugely valuable in management positions--making it the most popular GSB course--but I thought was overlooked in medicine--spurring me to register. A moderator helped direct this free form discussion that would twist and turn in unexpected ways. It always surprised me how different my perceptions could be from the other people in the discussion group. The only way to find out was to ask them directly, and they were often happy to answer. Most were also receptive to suggestions that were based on feelings. Instead of saying you are a careless doctor, we started saying the speed of your examination made me feel unimportant. Both asking for and giving feedback can be anxiety provoking, but I think it would be worse to head on a trajectory of leaving people unsatisfied than not being able to ask.
I’m interested in hearing feedback and suggestions for improvement from any readers regarding your experience in the ER. I know Stanford Emergency Department is committed to improving customer service and I'm sure more people than myself are interested in hearing what you have to say. This year the Stanford ER staff even participated in a day long retreat focusing on customer service and areas in need of improvement. The role playing and discussion amongst ourselves was an important step toward our commitment to customer service, but nothing beats direct feedback. I also have to say nothing beats the eye opening experience of the doctor being in the patient’s role.
I invite you to leave comments about your ER experience,
Anil Menon, MD
7 Comments:
At Sat Mar 31, 10:59:00 AM 2007,
Barbara said…
I know that ER doctors and nurses are overworked. Most of us are. The difference is that the consequences of not being listened to can be dire in an emergency situation.
A few years ago I had a nasty experience in my local ER. My daughter, then aged 6, had been ill for several days. She had been to the doctor three times in four days and was finally diagnosed with bronchitis. The antibiotics were not helping as her temperature continued to climb and her breathing became shallow. On my way back to the doctor, I was stopped at a red light when I heard this odd noise like a raspy panting dog. Frighteningly it was my daughter. I headed to the ER. Long story short, the antibiotics in her system disguised anything showing as wrong in her blood work. I was told to go home and give "it" a few days. I have this limp child in my arms, not crying, not squirming, nothing and I was told to go home, that it was a virus and the child needed sleep. I refused to leave, took verbal abuse about taking up a room and having my pediatrician paged. Needless to say, she had serious pneumonia and was in an oxygen tent in the hospital for 5 days. I still shake when I think I might have left.
At Thu Apr 05, 06:04:00 PM 2007,
Anil Menon, MD said…
Barbara,
I do agree with you, there is no excuse for overlooking a diagnosis. A limp, inactive child is definitely a sign that something is wrong. Your experience is understandably scary. It is the same fear that keeps my nose in the books many nights, not wanting to send someone home without the right treatment. I'm glad you persisted and got the right treatment.
Do you think your experience was the product of a rushed environment or physician indifference?
Anil
At Sat Apr 07, 12:03:00 PM 2007,
barbara said…
Hi, Anil--
Good question. I felt that the medical professionals were following a script and they were unable to stray from it. They did the initial tests called for like blood work and vitals. But my daughter's temperature was low and her white blood cell count was reasonable because of the antibiotics she had been on; and the doctor said he didn't hear anything serious enough to indicate a need for a chest x-ray. There simply was no serious creative thinking about her symptoms. Sort of like the routine check-up was relatively normal so the child must not be very sick.
Barbara
At Sun Apr 08, 06:38:00 AM 2007,
Anonymous said…
Trillium Hospital Mississauga,
Easter Weekend 2007
Waiting room time usually 6 to 8 hours
If you arrive at 6am 1 to 2 hours
I was concerned that my Bronchitis was out of control when 2 days of BiaxinXL
didn't seem to be working as every 4 hours my fever, chills and body aches reappeared keeping me totally dependent on Tylenol for 7 days straight. I was told that the BiaxinXL would take another day or so to help. It was -3 today and I really think the fresh air helped relieve my swollen bronchial tubes.
Any who, moral of the story...it cost me 10$ to park the car and a 2 hours wait in an uncomfortable chair to hear a doctor tell me to basically be patient. Perhaps next time I'll just go for a walk outside and breath some fresh cold air..a lot cheaper. Oh and Ginger tea really seems to help take the edge off for some reason. lj
At Sun Apr 08, 06:51:00 AM 2007,
Anonymous said…
My third child, at the age of 6 months, almost died of pneumonia and had been seen by 3 doctors before being properly diagnosed. He saw a stand in for our family physician in an office visit, and 2 ER room doctors. My mother diagnosed him and then I called Sick Kids in Toronto when he started showing no signs of getting better on the antibiotics and began getting huge tongue sores and vomiting bile. I rushed my child to a different ER where they quickly grabbed him and put him on IV antibiotics. He had double pneumonia and was hospitalized for 7 days. I wanted to sue every last one of those doctors...all three that saw him but just thanked God my baby was finally getting better. Don't know how they missed that one.
Thank goodness I sat up with him and watched and monitored for signs of improvement. If I had not have done that my child would not here to be the beautiful 13 year old he is today. Doctors must be so careful when they pass off a diagnosis. It totally could mean someones life. I would not want that responsibility..Hat's Off to the Good Doctors Out There. LJ
Mississauga, ON Canada (near Toronto)
At Mon Apr 09, 02:44:00 PM 2007,
Anil Menon, MD said…
I grew up in Minnesota which is where the Mississippi starts so I like the sound of Mississauga and I am glad to see you comprise 66% of the comments posted so far.
Sick children and long waits are not surprisingly a universal problem. Actually, I thought the waits were supposed to be longer in Canada. LJ, I'm glad your child was also treated appropriately. Often it is difficult to determine exactly how sick a child is or will be at first sight (though experienced doctors begin to develop a sixth sense for this). Because children are not as vocal and because no one wants to make a mistake with them there should be several layers of redundancy in their treatment. My experience is to arrange close follow up when the diagnosis is uncertain by way of a phone call or immediate visit with their pediatrician and clear instructions on when to return. Did any of that happen or did your own sixth sense push you to get the necessary follow up you described?
I'm not overlooking the main thrust of your post, that EVERYONE deserves careful attention because it is SO important. In my case, I needed it even when I knew I didn't have anything life threatening.
Thank you for sharing. It helps us improve.
At Mon Jul 02, 10:10:00 AM 2007,
Anonymous said…
I HAVE LITTLERLY BEEN GIVEN THE WRONG MEDICINE,A BREATHING DRUG AND WALKED OUT OF THE ROOM.AS SOON AS THE DOOR STOPED I COULD'NT BREATH"NOTHING".I COULD'NT SAY OR SCREAM ANYTHING,THANK GOD THE R.T. WAS THERE AND I 'ROLLED'OFF THE BED TOGET HIS ATTENTION.HE IMEDIATELY PUT SOMETHING IN THE I.V. AND I COULD GET SOME BREATH BACK.THIS HOSPITAL HAS ALMOST KILLED ME MORE THAN ONCE.ALSO MY DAD WENT IN ON THE AMBULANCE FOR SEIZURES,WE LIVE ON A RANCH 65 MILES AWAY,AS WERE GETTING READY TO GO IN,A CALL COMES IN AND SAYS ,COME AND GET HIM OR WERE GONNA PUT HIM IN THE WAITING ROOM,HE HAD NO CLOTHING.AS MY BROTHER WALKED INTO THE ROOM,MY DAD WAS IN A FULL BLOWN GRANDE MAUL SEIZURE AND MY BROTHER HAD TO SCREAM TO GET ANY HELP.HE WAS AMMITED FOR 4 DAYS WHEN HIS OWN DOC SEEN HIM! NO I'LL GO SOME WHEREELSE EVEN IF I DIE FOR I "WOULD THERE".!!!
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