by Dan Walter
We found out that her real name was Cindy Chapman, and that she died alone and afraid.
Cindy was a paralegal, an activist and a fighter of lost causes who lived in Worcester, Massachusetts. She was part of an online community called RATEMDs, where she had many soul mates. Her posts on health care were funny and cynical and wise. Her screen name was Jane Q. Patient.
My wife, Pam, was especially fond of trading comments and barbs with her. Like others on the forum, Jane Q. was prone to drop off the screen for days or weeks at at time. But she always resurfaced with stories of her battles with the system, her fights for the poor as a paralegal, or her volunteer efforts with the Obama campaign. A few months ago, as the fight for health care reform was reaching a fever pitch, Jane started posting about her own medical complaints. She told of emergency room visits and fights over insurance, and pain, pain, pain. Her postings became erratic, with uncharacteristic typos, misspellings, and fragmented thoughts.
When Jane Q. dropped off the screen again, Pam set out to find her. Having traded some private emails, Pam knew Jane’s real name and had a general idea of where she lived.
After relentless Google searching, Pam hit upon a column by Diane Williamson in the Worcester Telegram. It was the story of Cindy Chapman’s final days. The 48 year old native New Yorker lived with her cat in a room off Worcester Common. She had been suffering terrible back pains over the summer and had been taken by ambulance to the University of Massachusetts Memorial Medical Center Emergency Room on four occasions.
Each time she was discharged with some pain killers, but no answers.
The last time she went there she refused to be discharged and the hospital called the police to eject her from the ER on the grounds that she was exhibiting drug seeking behavior. She was put in a cab and sent home. She called one of the few people she knew in the neighborhood. She said that she was in terrible pain and that she was scared and she didn’t know what to do.
Her neighbor called six primary care physicians before finding one who would accept Medicare and could see her without waiting a year. This doctor found that Cindy Chapman had end stage cancer of the lungs, liver and spine. Two weeks later she was dead.
As the Senate prepares to take up the health care bill, The New York Times quotes one analyst as saying that “All industries stand to gain from this legislation.” But the real question we need to be asking ourselves is whether the Cindy Chapmans of the world stand to gain anything from our new approach.
We’d better hope so. After all, there was a reason she called herself Jane Q. Patient.
Dan Walter is a writer based in Deale, MD.
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Ninguem-What on earth would your defense be to the fifteen million injuries to patients annually? (As estimated by Don Berwick MD). Fifteen million.
Bunker mentality is an interesting description. It does seem as if there is a notion that the ER must be guarded against expectations that it will treat people in pain, otherwise people in pain will be dropping by at annoying intervals.
Ninguem-What on earth would your defense be to the fifteen million injuries to patients annually?
Never felt I had to defend anything to the likes of you, definitely not to payne.
We don’t have facts in this case, doesn’t stop people from opening their mouths.
The medical error studies were discredited long ago. Obviously it’s not zero, but it’s not the astronomical number in the studies.
And pain, whether you like it or not, is a symptom. It is not a vital sign. One gets tired of arguing with people who have absolutely no knowledge of the subject.
Lise:
I’ve seen Dr. Berwick use the figure one million frequently. I’ve never seen the figure 15 million; do you have a reference?
Thanks
NInguem, there are enough facts to know that this woman was in the most pain she had ever known, and called a “drug-seeker” and discharged from the ED – when she in fact was terminally ill with cancer destroying her spine, invading many body systems, and her history included recent onset of chronic cough, vomiting of fresh and old blood, abdominal bloating, explosive diarrhea, gradual onset of increasingly severe pain in her back….
Payne try reviewing the data from the 1999 study “To err is human” (the IOM report). Indeed errors included that occurred but may not have directly “caused” the patients death are included. in the 100,000 K number. Also included are very ill people who died in the paper when an “error” ocurred, which may or may not have had anything to do with the death.
I admit I didn’t read the whole study, but I have previously read parts of it and I just re-read the Executive Summary. I didn’t see where it said anything like this and perhaps you are listing a critic’s assessment of the report rather than something that was in the report itself? Could you show me the part you are referring to? The report is available in full for free at:
http://www.nap.edu/catalog.php?record_id=9728#toc
There are many good reasons for believing the report may be an underestimate:
1. It is based on physician self-reports of medical errors that were entered in the charts. Numerous studies have demonstrated the obvious: that physicians and nurses are loathe to indict themselves by reporting medical errors in the chart thus the actual number of medical errors is likely far greater than this report cited.
2. It fails to take into account people who were injured in a medical setting but later died of those injuries outside the medical setting.
3. Fails to account for all types of medical errors leading to death. For example, the CDC estimated in 2007 that there are over 98,000 deaths a year from hospital infections alone, yet according to a Consumers Union report the IOM report scarcely mentions hospital infections.
http://www.consumersunion.org/pub/core_health_care/011324.html
The simple fact is serious medical errors (not just adverse events such as a mild/moderate drug reaction) are required to be reported. I am not saying everyone is, I am saying that is the professional expectation, and those that don’t are playing with fire.
Some 24 states as of now do not have medical error reporting requirements, and of those that do, they are hardly enforced aggressively and hospitals do have a very strong incentive to fudge the numbers. It may be a “professional expectation” just like taking chronic pain seriously is supposed to be, but the reality is far from what’s expected.
I know you have an axe to grind payne, but as you expect MD’s not to paint chronic pain patients with one brush (which I totally agree with) maybe you should try the same thing with us.
Since you “know” that I have an axe to grind, you can no doubt explain what that my particular agenda is as well as point to examples of my making overgeneralizations about your profession.
We don’t have facts in this case, doesn’t stop people from opening their mouths.
Nonsense. The woman presented with severe symptoms as well as reported severe pain and was slandered as a drug-seeker rather than given a proper medical assessment and treatment.
The medical error studies were discredited long ago. Obviously it’s not zero, but it’s not the astronomical number in the studies.
They were criticized, not “discredited.” Stop making stuff up. There is every reason to believe they are underestimates as they did not include all medical errors and they did not report on errors outside of hospitals.
And pain, whether you like it or not, is a symptom. It is not a vital sign.
Pain behavior is not a symptom, it is an observable sign. Other vital signs may also be elevated where severe pain is present. That pain is a symptom and not a sign may seem logical at first glance, but a little thought quickly dispells that notion. If pain has no objetive signs, how do doctors assess pain in infants or people with dementia? How do anesthesiologists assess pain in people who are under anesthesia? How do veterinarians assess pain in animals?
It is interesting how fast the “pain isn’t a vital sign” people are to jump on a lack of pain behavior or elevated vital signs as evidence that a person reporting severe pain is either faking or exaggerating their pain. Patients may or may not show physiological or behavioral markers of pain and people with chronic pain often have learned to suppress pain behaviors and do not show eleveated vital signs as they have gotten used to being in pain. Other people may have their blood pressure go through the roof while they scream in agony. So pain may be purely subjective, partly objective/subjective, or objective, depending on the observer and patient in question. To dismiss such a potent defense mechanism like pain as a “symptom” is shortsighted.
But if it makes you feel better to call it “Pain: the Fifth Vital Symptom” then go for it. The real problem is you just don’t want to be forced to assess and treat pain.
One gets tired of arguing with people who have absolutely no knowledge of the subject.
One also gets tired of arguing with people who lack the critical thinking skills or intellectual honesty to question the rice-bowl protection propaganda and absurdist medical folklore they swear by even when human life and human suffering are at stake.
Their are not enough facts for any of us to evaluate earlier care not decribed. Did JaneQ have a family MD etc.
For whatever reason she apparently went to the emergency department seeking help. Many milllions of patients use the emergency department as a primary care facility. The workup of back pain when presenting with other symptoms and signs is regretably not the function of an emergency department but that doesn’t mean the ED has no important role in this situation. A proper history and physical exam was required. Severe back pain in the absence of a history of trauma particularlly if of sudden onset can be due to pathologic fracture. Suspicions should have been raised and if the pain was atypical (thoracic) point tenderness should have been elicited. She would likely have died anyway but would not have sufferrred the humilliation of slander. She had little time to live, but she deserved better.
Yes, she had a family md. Actually a team of PCP’s.
The trip to the ED that ended so badly, occurred on a day she had an appointment with the PCP. Sometimes on that day she collapsed on the stairs to her apartment building, she could not walk. Neighbors found her there and called an ambulance, which transported her to the ER.
==
Sometime, not sometimes.
Pain doesn’t kill.
Maybe ignored/neglected pain does http://tiny.cc/Noqpj
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