A commenter recently asked the other day about staging patients, especially mental health patients, in the hallways. This is sometimes done, along with triage and initial assessments, because of the very real lack of appropriate space in a busy, full emergency room. What do I mean by this?
Well, as any of you know who have ever been to the ED for anything at all, once you get through the front desk area and the triage nurse, you are shuffled off to a room of some sort and the initial assessment process begins, with history taking and vital signs done and maybe even a test or two before the doctor sees you.
Sometimes this part of the process involves talking about intimate details of your presenting complaint, taking your clothes off and dressing in one of those flimsy, drafty gowns, and being poked and prodded a little bit. It’s not stuff that would normally be done right out in public for all to see, as it is your illness or injury and your history and your body, no one else’s. Most of the time, EDs are set up in such a way that we all get the level of privacy we expect and deserve in that kind of situation. It’s not a private room in an expensive medical suite in a gleaming tower somewhere, but then again it’s not meant to be. We all get that, and we deal with it.
However, sometimes this principle gets pushed to the extreme.
I was asked to see a patient in an emergency room the other day, a routine psychiatric consult like all the others I have done over the past four years via telepsychiatry equipment and protocols. I reviewed the historical information, the labs, the ED’s assessments of the patient, and the nursing notes. As always, some of the information was sensitive, involving previous abuse and other issues that are private. I finished my review, sent word to the hospital that I was ready to see the patient and waited.
Very shortly my monitor fired up and I was presented with a picture much like the one at the top of this post. I could see a corner of the hospital hallway, a broad, flat, curved plastic bumper railing on the wall, a gleaming white floor, and sitting there, right out in the middle of it all, my patient.
I quickly swiveled the camera around, much like one might do with the camera on top of the Mars rover, to assess my relationship to the terrain. Yes, we were indeed out in the middle of the hallway. There was the nurses’ station, with a couple of people staring over at the equipment (it is still quite novel to many people who are not used to it, so you still get a lot of stares), the far end of the hallway with a whitecoated doctor walking clipboard in hand into a patient room, a mop bucket and mop sitting down at the far end of the hall.
It did not appear that we were moving toward a room. We were stationary in the hallway. That did not bode well. I asked the question, already knowing the answer.
“Are you getting us set up in a room for the consult?”
“No, doctor, we don’t have any open rooms at all. Everything’s full. Two traumas, sick kids. Every room. We’re going to have to do this out here.”
Um, no we’re not.
“I’m sorry,” I said, trying not to sound too incredulous, “but I’m not going to do a psych consult in the middle of the hallway. This should be a private conversation between the patient and me. This won’t work.”
“Well, I don’t know what we can …”
I cut her off, bless her heart.
“Listen, this won’t work, okay? I’ll be glad to interview this young lady when you have a more private place for us to talk. I’m going to move on to my next consult for right now, but call me back on the monitor just as soon as you have a room. Thanks.”
I hung up on her.
Now, I realize that I was abrupt. It was one of those days, as I remember. You know, lots to do, irritable people, unsolvable problems. The usual, but more so. I didn’t have a lot of patience that day. I’ll own that part of the interaction.
However, when it comes to the care of my patients, and the privacy and respect that they deserve, I do not compromise. Talking in the middle of the hallway about a history of sexual abuse or an abusive spouse or active drug abuse just does not cut it. Never.
I don’t care if you have run out of rooms. I don’t care if it’s change of shift. I don’t care if you’re itching to get this patient out of your hair because she might be a little more demanding and vocal than you’re used to.
That’s not my problem.
Give these patients who present with mental health issues the same respect and attention and care that you would give your own mother if she came in having a heart attack. They deserve no less.
Oh, by the way.
Ten minutes later, the hospital called back and my patient was sitting in a room, door closed, camera ready.
We proceeded without further problems.
The halls of medicine should remain just that.
Not exam rooms.
Greg Smith is a psychiatrist who blogs at gregsmithmd.