Reviewing my cataract surgery: A casual disregard for patients

At last it was time for my cataract surgery. Having had one eye surgery done by a different physician in another New York eye and ear specialty hospital a few months earlier, I knew what to look for and could make comparisons from a patient perspective. As I noted months ago on this blog, I really had no choice of hospitals. If I wanted my trusted doctor to do the operation, I would have to go where he recommended. But my patient experience was much different this time and made me aware of how many places in the chain of care where mistakes can occur.

At admission that morning, I received a 25-page Patient’s Guide to Surgery. It was full of useful information for people facing surgery. But how is someone who is about to have an operation in a few minutes going to make use of stuff they should have seen weeks ago? That’s a good question for The Joint Commission, the hospital accrediting organization, next time they evaluate this hospital.

Then, while waiting for my surgical prep, I observed discourteous treatment of patients. An elderly man fiddled with the tie on his robe, but a brusque hospital worker sticking thermometers in patients’ ears and wrapping blood pressure cuffs didn’t help him as he struggled to get the ties in the right place. Hmmm, I thought. Is this the kind of patient-centered care the Institute of Medicine advocated for more than a decade ago?

My next encounter was with a distracted nurse who quickly put a bunch of drops in my eyes and asked questions about my medications. She was reconciling what was listed in the charts my doctor had sent over. Reasonable enough.

Then we hit a communications barrier. It was the first time I was speaking English about my medical records to another person who’s English I did not understand. I got a flavor for what non-English speakers experience in medical settings. Frustration is the word that comes to mind.

The nurse, who could not clearly pronounce the generic names of eye meds, repeatedly asked me if I was still taking them. Finally, I asked to see the list and ticked off the current regimen. It was the only way to communicate.

How do patients and staff members communicate when the stakes are higher than stumbling over the word acetazolamide (Diamox) to lower intraocular pressure? With more people speaking English as a second language, this is a potential problem and all the more reason to have a list of your medications and clear pre-op instructions with you when you step into a hospital.

Next I was told to dress for the surgery. “Leave your blue jeans and shoes on,” the nurse instructed. That was different from the last time where the hospital was adament there were no shoes, jewelry or anything allowed in the operating room. The hospital had also given me a brochure from The Joint Commission called “Speak Up” when I checked in. It said I should ask questions. So I did.

“Why was it okay to keep my shoes on?” I asked an orderly. They were hardly sanitary having helped me tromp over foreign soils recently, not to mention dirty New York City streets. “We want to make it easier for people to walk,” he explained. He added that they would be covered with foot covers and that was good enough.

Maybe that was okay. But I had serious doubts whether the IV that was leaking blood and fluid down my arm was okay. I have had a few IV’s before and knew this wasn’t the way they worked. The nurse anesthetist had not checked to see if it was placed correctly. I asked for her supervisor to check it out.

The supervisor found that the device needed to be tightened to stop the leak. When my doctor showed up, I asked him to check too. I have written about needless deaths from hospital inflections. If fluids were leaking out, could harmful organisms be floating in? I don’t know. But given the serious infection problems in hospitals, I wasn’t about to take a chance.

The last thing I remember before zonking out was an orderly pulling me backwards on the table. Apparently I was not positioned correctly. For a second I thought of a half-naked nursing home resident I met several years ago who was being pulled backwards in her wheel chair. That patient-centered care thing again.

I can’t give the New York Eye & Ear Infirmary high marks for patient-centered care. In too many ways that recent morning, their staff communicated a casual disregard for patients and an inattentiveness to both patients and process. Red flags both.

Trudy Lieberman is a journalist and an adjunct associate professor of public health at Hunter College in New York City. She blogs regularly on the Prepared Patient Forum.

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  • Scott

    I get that people want perfection at all times in hospitals, but really? Basically, you think this warrants a whole article on this blog because,
    1. You saw a patient trying to tie his gown and a busy nurse didn’t drop was she was doing to rush over to help…
    2. The person doing your med reconcilliation didn’t speak perfect English…annoying, but certainly no disregard for patient care.
    3. Your shoes were left on and covered during surgery…
    4. Your IV was misplaced, and likely corrected, which you never mentioned.
    5. You were repositioned for your surgery…
    6. Oh yeah, the materials you were given. I think maybe those could have been given to you earlier as well. I am assuming you had the chance to ask questions to your doctor ahead of time though, and it was nice for them to even have a handout like that.

    Sorry, but I don’t see a disregard for patient care here, just another person who has run out of things to complain about. I’ve certainly heard very valid stories of poor patient care, but this just isn’t one of them.

    • Chris

      “A Casual Disregard for Patients” ^^^ see above ^^^

    • Darla

      You are a boor! Stupid to boot. You could not discern if your life depended upon it. Dumbass.

      • Scott

        After seeing all of the comments you have left here, I am not even angry about all of your senseless attacks. I really just please hope you consider getting some help. I am sure you have at least some loved ones that would be very grateful.

  • PoliticallyIncorrectMD

    What is your point?

  • southerndoc1

    Wow, they forced you to interact with someone who speaks English with an accent.
    You are a real piece of work.

    • Chris

      There is a difference between dealing with a medico who speaks English with an accent and with a medico whose grasp of the English language is questionable. It is mildly frustrating to deal with the first; it is dangerous and frightening to deal with the second. For instance, for every 5 out of 10 of his or her words that I cannot make sense of, I have to assume that that same language barrier is preventing him or her from understanding at least half of the words I am speaking.

      Admittedly this is not such a problem in something where there is a list written in English to refer to. But when you are trying to tell a medico something in narrative, and they are just smiling and nodding but then after a few minutes you ask them to repeat to you the gist of what you’ve just said … and they simply can’t, because the English language comprehension skills were just not there to begin with ….. well then that’s a problem.

      • Darla

        Agree, Chris

      • Suzi Q 38

        Maybe you were so snobby you intimidated them.
        If you made them feel more comfortable, they probably would speak more.
        Maybe YOU weren’t speaking clearly.
        What state are you from?
        This would tell me about your accent.

    • Darla

      Are you illlegal? Also, are you one of those charlatans who has indecipherable penmanship? If so, you are part of the problem.

      • Suzi Q 38

        Go back to your “cave.”

  • Eyes

    Can you post the article about your first surgery? I assume there were horrendous problems, as you went elsewhere for your second. Luckily, you do not have a third eye, I assume. A balance between complaints and an attention grabbing headline and the miracle of regaining sight would give you more credibility, as your points are valid. But, once a reporter, always a reporter, so I guess maligning and complaining sell more papers.

    • Darla

      We must assume that it went well since it was referenced to have been a success, but you are so anal retentive that you cannot comprehend what was written in a clear and concise manner! As for the slam against journalists in general, I dare you to compete on that level, scuzzbucket for brains.

      • Eyes

        Aw, Darla – I assume you are the author, getting defensive. I don’t blame you, your article was offensive and ridiculous. As far as scuzzbucket for brains – shameful – I am sure I have a higher IQ then you. As far as journalistic competition, my comment is light years better than your article. Scuzzbucket – I kind of like that – although my Mensa educated brain knows that is not even a word. Poor Darla, certainly no darling when it comes to this one. Sorry that your first ophthalmologist kicked you out – I assume the second did as well, but at least you don’t have a third eye to match your foul mouth.

        • Suzi Q 38

          message meant for Darla.

    • Suzi Q 38

      She has little credibility because she is whining about very little.

  • John Henry

    So, what was your visual outcome? All this other stuff sounds like entitled whining by someone who feels the world just has to hear what she thinks.

    • Darla

      You need your butt busted by someone who can accuse you of whining!

  • http://twitter.com/DrSherryChandy Sherry Chandy

    Reading this hypercritical nay outright biased article I seriously wonder if the author is trying to manufacture drama where there was none.
    The IV line problem in particular started me thinking.
    “But I had serious doubts whether the IV that was leaking blood and fluid down my arm was okay….”
    (is the writer saying blood was dripping from the IV bottle onto her hand?Was she getting a blood transfusion?!)

    “I have had a few IV’s before and knew this wasn’t the way they worked. The nurse anesthetist had not checked to see if it was placed correctly. I asked for her supervisor to check it out…..”
    (REALLY? You are sure that the nurse anesthetist did not check if it was placed correctly and this is based on your judgement because the professional did not spend as much time as you thought was necessary? Just because I’ve had a few teeth pulled out before makes me equal in expertise to a fully certified dentist?)

    Sorry but I find that the writer seems intent on making a mountain out of a molehill. This is an excellent example of damage to the cause of ‘real’ instances where patients faced problems in their healthcare maze.

    • Darla

      Sherry Chandy, put on the other mask now. Poor baby.

  • azmd

    I read your piece very carefully and still cannot discern that any actual mistakes were made in the delivery of your care. One can see that the hospital and its staff gave you some opportunities to nit-pick, which you have enthusiastically taken up, but there don’t appear to be any real medical errors documented here, as you claim there to be.

    • Darla

      So, who are you, God? Read it and then tell me where the statue to a critic is erected in this world>

  • petromccrum

    Trudy I agree with you. These issues are problems.
    I absolutely disagree with the the rest of you. Yes we are demanding perfection when our health and well being is on the line. How can you possibly think that not speaking and understanding English is not a problem. This situation shows a total disregard for the patient. I have seen much much worse.

    • Scott

      You can demand it all you want, it just won’t ever happen. Medicine is an imperfect science to begin with. Add in conflicting views about how things should be done, a myriad of other issues (costs, time, communication, etc)…then, oh yeah, everyone is still human. Medical providers and hospitals are constantly looking for ways to improve pt safety, but nothing will ever be perfect. Based on your comment, I won’t assume that you are old enough to understand that. I hope that you have never made a mistake, ever, since that is what you demand. If you haven’t, I might entertain the idea that you could demand constant perfection from the rest of the world. Besides, one of the main points that we have raised is that there wasn’t even an actual medical mistake in the first place. People miss veins sometimes when starting an IV. If you had any medical experience you would know that. It happens, its unavoidable. You fix it, move on with life, and everybody is fine. Honestly, I don’t believe that the woman’s English was that bad, or she wouldn’t have been hired in the first place. If it was, sure, fire her, but no true mistake was made.

      • Darla

        Medicine as a science is not really a truism. Medicine is a practice. They mostly don’t know what the hell they are doing and that is why people are maimed and killed daily. The challenge is that there are few good physicians today. Remember the Hippocratic Oath states to first do no harm. That means no physical or mental harm, Scott. Now, go take your prozac, you angry and petulant child.

    • Darla

      Petro, absolutely correct. When Scott’s behind is on the table and they are lifting his scrotum to remove his cojones, maybe he will speak up about what malpractice was committed. A doctor is not a god but a body mechanic. He is supposed to repair the body as a mechanic repairs an automobile. PERIOD!

    • Suzi Q 38

      She is not complaining about the nurse’s ability to care for her; she is annoyed with the fact that she did not pronounce certain generic names for eye meds. The nurse could speak English, albiet not perfectly. I rarely find a person, even one born in the U.S. with out a geographical or cultural accent of some sort.
      Nothing wrong with it.

  • LastoftheZucchiniFlowers

    I will suggest that all of you who are annoyed with the author and this article read “My Voice”, by Dr. Itzak Brook. ‘A Physician’s Personal Experience with Throat Cancer”. When we disregard patient complaints – no matter how WE interpret their ‘validity’; we are losing the point which is patient safety. Yes – we resent it because we know that day to day we are all doing our best to get the job(s) done as best we can in often impossible situations of fewer staff, more patients and endless ‘outcome measures’. We are ALL potential patients and I suspect that when we are on the bloody end of the IV (which I agree was likely just a messy stick not entirely tidied up and NOT an infection control issue) the field looks a bit different. When WE or our loved ones are facing the knife it’s a very vulnerable and scary time. To my fellow providers/ancillary personnel who were angered by this piece I ask you to think again and put yourself in the patient’s place and remember that while we are doing our routine work – they are scared and nervous. Can’t we allay their fears just a bit by acknowledging this? After all – we are in a privileged position as surgeons (and surgical ancillary personnel) and it would do us good to remember when we were students and first learned of the leap of faith required by the patient who surrenders their consciousness to us….

    • Scott

      I’ve been there. So have other family members. We aren’t whiners. I have had worse things happen and didn’t really even think anything of it. Just like this patient, I ended up just fine (I’m assuming. She never even mentioned what the team actually did to help her). If the outcome is good, why go on the internet and rant and complain about it? Sorry, in her case, it just isn’t at all justified to get on here and degrade the extremely hard working system of medical providers that perform daily feats to improve the lives of others. It is an insult and a step backward.

      • Darla

        Oh, Scott, STFU for a while. You are too immature to have lived much life, you poseur.

    • Darla

      Agree with you, Lastof.

      • Suzi Q 38

        “The nurse, who could not clearly pronounce the generic names of eye meds, repeatedly asked me if I was still taking them. Finally, I asked to see the list and ticked off the current regimen. It was the only way to communicate.”

        REAlly?? What a jerk you are to focus on the way she PRONOUNCED generic names of eye meds.

        BFD. Tell “Darla” that this is NOT a non-English speaker….it is just that her pronunciation is off with the generic drugs. She speaks English or she wouldn’t have a job.

        Just like I heard an actress on Grey’s anatomy pronounce the antibiotic CEFAZOLIN (sea-faz-a-lynn)..maybe it should have been pronounced (SEA-FA-ZO-LYNN)…who cares???

        What snobs.

  • petromccrum

    Obviously you people have never been patients. The main problem is your ATTITUDE!

    • John Henry

      Not.

    • Scott

      Not all patients are such brats. You would be surprised. Your type is actually quite the minority. Most are great. I would venture to guess that all of us have been patients, probably several times over – I know I can speak for myself.

      • LastoftheZucchiniFlowers

        I can tell you are STILL a student by virtue of your oddly placed hubris and LACK of insight. Grow up a bit. Then come back and post when you’ve got some time and experience under your belt. I suspect about 15 years of hard time in the trenches might correct your skew.

        • Scott

          What lack of insight and what skew do I have that needs correcting? You actually have no idea how old I am or how much experience I have “in the trenches.” I will tell you that I happen to be a non-traditional student with more than enough experience to back up everything I have said in this thread. I also can tell you that it doesn’t take 15 years of experience in anything to understand that this article was unfounded. The overwhelming majority here that seems to agree with me. So what is your basis for this attack on me? Or do you just have nothing else to contribute other than trying to attack a medical student?

          • LastoftheZucchiniFlowers

            My ‘contribution’ is in my original post to the fits of pique that you and some others which you take odd comfort in calling ‘the majority’ have expressed that this author DARED to level criticisms against what she saw and PERCEIVED to be substandard care. I find your commentary immature – especially given that we KNOW that patients frequently misunderstand the myriad visual/physical/emotional bombardments which can effect the pre/intra/post operative experience. I’ll lay bets that you have no future as a surgeon because your ‘skew’ (calling your patients ‘brats’) defines YOU and not THEM. Worse, you sanctimoniously align yourself with oncology patients who you claim sit quietly and slowly expire for which you expresse some bizarre approval? You have, as I’ve said, more to learn that you realize, and very little time to do it if you are a ‘non-traditional’ student. Best buck up and get on board with reality because this is NOTHING compared to the tirades you face from your future patients if you don’t readjust your attitude. Lesson One: No one’s opinion of their health care experience is ‘unfounded’ and only a scared, insecure nebbish gets upset when someone finds fault with their care. Perception is reality. Or have you never learned that either?

          • Darla

            You said it, medical student, which means you are going to have a real attitude adjustment in the near future or malpractice. I hope it is the latter but hope in the process that you don’t irreparably harm some poor patient. Scuzbag that you are.

      • Darla

        Scott, your demeaning attitude needs a readjustment and you probably need something to remove the bug up your ass.

        • Guest

          Hmm…I have been a patient numerous times (as have members of my family, including my small children). I see nothing demeaning in his post.

    • Noni

      I have, my parents have, and my husband and children have been. I DEMAND communication, but I would never be so foolish or unrealistic to DEMAND perfection. As others have mentioned, as long as humans are providing medical care perfection will never ever happen.

  • Suzi Q 38

    Get used to people not speaking English perfectly.
    We have a lot people here from different countries.
    They pass the boards in English, which is extraordinary, but maybe their pronunciation needs work.
    Have some patience. If you were trying to work in Spain or Italy your pronunciation of their words would not be 100%, either.

    If you were speaking to a USA citizen, born in Hawaii, you may have difficulty understanding their English at times. Ditto for the southern part of the US. Accents, unless you are used to that particular region or state, are difficult to understand sometimes.

    You sound a bit “snobby.”

    You sound like the “hospital police.”
    Not removing your shoes is a good reason to object. I would have just taken them off.

    • Darla

      I lived in Spain, France and Germany and I learned to speak their languages. Suzy Q, you must be understanding of American citizens who live here and pay taxes to pay for the schooling of the foreigners who come here to do that education on our dime while we have to suffer through their insufferable English. Shut up. We don’t need any more apologists for immigrants who refuse to assimilate and take all the jobs. The author’s points are valid.

      • Suzi Q 38

        “Shut up.”
        LOL. I don’t have to. “You are not the boss of me now.”

        • LastoftheZucchiniFlowers

          Many years ago I was watching the Tonight Show with Johnny Carson (That’s a LONG time ago!) when the guest was the great ‘accent-less’ actor from Puerto Rico, Jose Ferrer. I have often marvelled at his role in ‘The Caine Mutiny’ when he sucker punched the supercilious character played by Fred MacMurray. Anyway Ferrer had this sage comment about ‘people with accents’ and I never forgot his wisdom: Americans who speak English as their first language must never, ever denigrate anyone who speaks English with an accent because they ALREADY SPEAK one more language than YOU.
          He spoke the truth.
          I am from the Northeast and currently live in the South where people tell ME that I have an accent which they find difficult to ‘understand’. Imagine that?

          • Suzi Q 38

            Thank you for your story about Jose Ferrer….

            I explain to my students all the time…..English is one of the more difficult languages to learn to speak.

            The English in the Southern part of the US is so different from the North. The English in the East is so different from the West. The Canadians speak English differently as do the the people from England, Wales, and Ireland.

            MY COUSINS are difficult to understand. They are from Hawaii. I have to “hang” with them for a couple of days before I get the gist of their English. When I leave, I have their accent, they don’t have mine. My husband says it takes me a few days to revert back to our casual English from California.

            What was the name of the drug, anyway? Was it that important? I amazes me how punitive and picky people can be with others that are trying to help them.

            A nurse that speaks various exotic languages in addition to English would be a prime hire in our state. They can assist with patients that come from other countries. They need medical care, too; and their money is “green.”
            It doesn’t matter what color they are. It beats waiting for the paid translator to arrive.

            My doctors are from all over the world, including the U.S. I have two friends from Nigeria that are nurses, and several from the Philippines. Their accent is very apparent.

            I wouldn’t want them to change a thing.

  • Anon

    I dunno, if I were a journalist commenting on someone’s ability to speak English well, I’d make sure my own English was flawless. Perhaps not confusing “who’s” and “whose” in that very paragraph?

    Or maybe I’d give you the benefit of the doubt and realize that you are more than a single sentence or a single encounter and not be so quick to pass judgment.

    Sincerely,
    A fourth year medical student who has tripped over the word “acetazolamide”

    • Darla

      Keep tripping and take your antidepressants.

    • Suzi Q 38

      You are so right.

  • Darla

    I agree with the authoress about medical communication. Scott, you need to remove the twig up your behind and get a clue. If you are going to become a professional medical provider, you had better learn to communicate. And I, for one, am tired, oh so tired of the non-or-poor English speaking immigrants who come here and get a free educational ride and cannot master English. Take a few English courses and get better at it because, Scott, like it or not, if they cannot communicate, the health providers are freaking useless. You are not a professional and if you are, you are on the road to no patients on the roster.
    We need to demand good care. This country has become third-world and is riding on a thin rail now. I can’t wait until you, Scott, and others of your ilk are in the patient position and nobody says diddly to you about what is happening. Your attitude sucks!

    • Suzi Q 38

      Darla,
      You sound like a racist cliche.

    • Guest

      You are an ignorant idiot.

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