1. Very little revolves around the patient. For a place dedicated to healing, the hospital does a poor job accommodating patients. Labs are drawn in the middle of the night, so the doctor has them early in the morning. There is no standard rounding time, so the patient is constantly awakened throughout the day. Vitals must be measured every few hours. Patients often comment about being happy to be discharged so they can finally rest, and I understand why.
2. Nurses are stretched too thin. The nurse-to-patient staffing ratios often create a situation where even the best nurses are simply spread too thin. This problem is magnified when one patient is particularly ill and requires more attention, often at the unintentional detriment of other patients. As I’ve mentioned before, a good nurse makes a doctor so much better.
3. Sundays are unique. As noisy and bustling as a hospital ward can be during a weekday, it can resemble a ghost town on Sundays. It can be eerily quiet. Many families come in to visit after church, and there are not many procedures occurring unless there is an emergency. On many occasions, I’ve lingered a few extra minutes in a patient’s room to chat about an NFL game or shoot the breeze about whatever is important to them. It’s a nice change from the typical frantic pace.
4. Some medical services aren’t available on the weekend. It always irritates me when my patient needs a test or service, and I cannot get it done because “it’s the weekend.” It sends a bad message to patients that care isn’t as important on the weekend as during the week. Of course, we both know the reason for this is money and staffing. Instead, patients simply wait until Monday, which is frustrating for everyone involved.
5. I sometimes can’t discharge you. Similar to the previous point, if you need some sort of supportive device or service, there’s a good chance I can’t get that for you on the weekend. It’s not my fault. The people that can arrange it or help me are off and won’t be back until Monday. In addition, most nursing homes won’t accept new patients over the weekend, so I’m stuck there too. Despite both of us being frustrated, there’s nothing I can do.
6. Families often don’t talk to each other. It’s not uncommon for every member of a family to want a personalized update from the physician. This can be exhausting. And it can be particularly challenging when there is conflict amongst family members with none of them speaking to one another. When this type of action gets excessive, I designate one family member the contact person or ask all family members to come to the hospital at the same time, so we can have one group discussion.
7. Insurance companies are a constant obstacle. It’s maddening how often insurance companies obstruct good medical care for patients. Of course, insurance companies shouldn’t agree to pay for services that aren’t warranted. But they go overboard every single day to save money. I recently had an 88-year-old lady with acute gout of both her ankles rendering her unable to walk. I was treating her appropriately, and she was slowly improving, but our physical therapist thought she would benefit from a short stay at a local rehab facility. The insurance company denied her. She can’t walk! So instead, we kept her in the hospital until she could be safely released to home. This greatly increased the cost to the patient. Complete nonsense.
8. Patients often leave Against Medical Advice (AMA). Many patients decide to leave before they’re medically ready to do so. And despite providing education on the risks, patients still elect to leave. At times, this can be from the pull of addiction to drugs and alcohol, but other times it’s understandable. I’ve had patients who must leave so they don’t lose their job or get evicted. This is a tough situation, and I empathize with them.
9. Be willing to support colleagues. Let’s face it. Caring for acutely ill patients in the hospital is stressful. In addition, no one wants to work weekends or holidays, but it’s part of the gig. When I work a weekend or holiday in the hospital, the slower pace allows me time to interact more with the nurses and get to know them on an individual level. In turn, this benefits the patients through increased team camaraderie.
10. Impactful moments are there if you pay attention. There can be pressure to see patients as quickly as possible due to the sheer volume of work required. Not in a negligent way, of course, but in a way that maximizes efficiency. Despite the hurried hospital pace, there are certainly opportunities to show patients you care. In my hospital, one of the best places I’ve found to do this is radiology, just outside our ER. This is where patients wait to undergo their respective scans. Their faces easily show their worry, and I’ve made a point to speak to these patients even if I don’t know them. It’s fulfilling to see how much they appreciate a passing doctor showing interest in them, if only for a moment.
Kevin Tolliver is an internal medicine physician who blogs at My Medical Musings.
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