Patients and families must be tireless in expressing any frustrations

I was reading the other day in a magazine the personal account of a woman who had a “perfect example of a mitral valve click” (a type of heart murmur) that was so textbook in sound that she was asked to be a listening post for a class of medical students. She was pleased to help, but was disappointed in how of the 15 examiners no one treated her like a person. She was a murmur. As I shook my head at the indignity imposed on a patient willing to subject herself to teaching, not just diagnostic testing, I was reminded how easy it is for medical practitioners to fall into this trap.

Ever see a cardiac surgeon meditate? They cannot sit still long enough. These folks worship busy. Their frenetic activity is best observed during their morning rounding ritual on hospitalized patients before going to the operating room. I recall a younger surgeon who once lived inside my skin surrounded by an entourage of residents, medical students, physician assistants, nurses and pharmacists sweeping through hospital corridors, snaking into patients’ rooms spouting medical jargon, shouting instructions and transcribing orders. A meek nursing student summons the courage to ask why the group spends so little time actually talking to and examining their patients, and the cocky chief resident sneered sarcastically that if they did that the ritual would be called “stops” not “rounds” as if perpetual motion was a desired outcome.

As the horde swept into a room occupied by a young man who had his congenitally deformed aortic valve replaced five days ago, the time for discharge planning was presented to him and his wife, assignments designated to effect follow-up and referring physicians identified for forwarding medical records. After 120 seconds of focused activity, the recessional for this patient was sounded. However emerging from the door our path was blocked by the patient’s wife who politely asked if we had time to answer one question. Displaying a trace of patience and compassion, I acquiesced, and mentioned how gratifying it was that her husband had such a rapid and uncomplicated postoperative course. Well, she stuttered, if you say so, but how come he does not remember his own name and who I am? This stopped the lemmings’ migration in the next heartbeat. Redirected, the throng quickly diagnosed and initiated treatment for the occult infection causing the mental status change. The patient did ultimately have complete recovery, thanks to his wife.

Impossible, you ask? No, because in the hyperactive world of cardiac surgery otherwise responsible and competent medical staff lose focus and forget that the most important thing in their universe when they approach the bedside is that particular patient. There is no next event horizon until all questions have been asked and answered, all tests reported and ordered and examinations performed. Or provisions for accomplishing these tasks clearly defined. Patients and their families must be educated that they should take nothing for granted. They are their own best advocates. Hospitals are populated by professionals, but they are imperfect. Though quality assurance teams doggedly try to correct systemic errors, mistakes or omissions are not 100% avoidable. Patients and families have the right for accountability and must be tireless in expressing any frustrations or complaints. And what self-chastising revelation did I glean from this experience? I could tell you, but I have not got the time.

Norman Silverman is a cardiothoracic surgeon and founder of Heart Surgery Guide.

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  • http://makethislookawesome.blogspot.com/ PamC

    What’s a person to do when they’re going it alone? It’s great that the man’s wife stopped the doctors. But what if she wasn’t there? Shouldn’t there be a responsibility of thoroughness on the part of our doctors?

    • heartsurgeryguide.net/

      yes, pam, you are 100% correct. but unfortunately, what profession or what person is 100% perfect in practicing their skill, art or business? no one, we are human. the message is that patients and families must be their own best advocates, they must ceaselessly ask questions and demand answers. now, if a patient has no loved ones and is entirely alone, this is a tragic circumstance that hopefully is not only infrequent, but the double whammy of medical personnel lack of thoroughness will not render harm.  a suggestion for those who feel alone is to have in their living will or directives a clause stating same and a directly stated reminder to all medical caregivers to take special care as this person has no advocate. calling attntion to the problem and being proactive should give some comfort that special attention will be given

      • Anonymous

         Pam, when a person has to go it alone and often when they
        have family, they hire a professional patient advocate.  A patient
        advocate guides the patient throughout the medical continuum, so the client
        understands the diagnosis, prognosis and treatment options, which in turn ensures
        true “informed consent”.

        A patient advocate will coordinate care and facilitate communication among all
        the caregivers, making sure the questions are asked and answered and all the caregivers
        are on the same page, providing patient centered care by treating the
        overall patient, not just the specialty. Don’t navigate the health system
        alone!

        Jacqueline O’Doherty
        Certified Patient Advocate

         

        • http://pulse.yahoo.com/_LSGDWPRY6JLBPB43EO6MIAURZI what

          Pam (and anyone else who’s alone)
          I, possibly like you, is all I have.

          Sometimes we’re forced to rely on “the kindness of strangers”-
          so while you’re still well enough -
          Please take but a moment to read this:
          http://tinyurl.com/65be42d

          and then take another moment to read the best approach to choosing a patient advocate:

          http://patients.about.com/od/caringforotherpatients/tp/Choose-a-Patient-Advocate.htm

          ..and…
          sorry about the “bold” type,  don’t know where that came from! =)

  • http://twitter.com/LittlePatient Haleh

    I agree with you one hundred percent.  Patients need to advocate, do it loudly and not be intimidated.  I commend you for being such a great doctor.  Why?  Rather than ignore the wife once she advocated, you took her concern seriously and reevaluated your work.  Now that’s a doctor/patient partnership of the best sort.

    Haleh Rabizadeh Resnick, Esq.- Speaker and Author of Little Patient Big Doctor: One Mother’s Journey.

    • heartsurgeryguide.net/

      thank you very much for kind remark