My weekend as an emergency patient and what I learned

If you want to see what health care is really like, there’s no better way than by becoming a patient yourself.

To paraphrase the wisdom of Dr. Seuss, “Oh, the things you’ll learn!”

The truth of this was recently hammered home for me during a weekend in the hospital that started with a Friday night trip to the emergency room, devolved into IV antibiotics, painkillers and surgery, and ended in a (minor) complication that luckily resolved on its own.

Who doesn’t benefit from undergoing a reality check every so often? It’s safe to say I encountered some old lessons that were reinforced and some “Aha!” moments that were new.

Here are a few of them, in no particular order of importance.

- Most of us pay no attention to our gallbladder until it unexpectedly stages a major rebellion. Then we notice very much indeed, especially when it becomes gangrenous.

- The word “patient-centered” can be rather nebulous. What does it mean, anyway, and how do you know patient-centered care when you see it? Here’s a clue: When the emergency room staff’s immediate response is to deal with your medical situation and worry later about seeing your health insurance card, that’s patient-centered.

- People in health care work really, really hard – days, evenings, nights, weekdays and weekends. It can be easy to judge their efforts by the amount of time they directly spend with you, the patient, but this is only the tip of the iceberg.

What you don’t see is the amount of time spent assessing the patient’s situation, reviewing lab results, communicating with the rest of the team, scheduling procedures, making decisions, following safe, evidence-based practices and documenting everything accurately in the medical record. When the behind-the-scenes action is done well, you likely are receiving better care and will have a better outcome, even though most of the work on your behalf will never be visible to you.

- When it’s your health at stake, it’s hard to be objective about costs. The effort has to start somewhere, though. Although physicians have a responsibility to avoid potentially harmful and expensive overtesting and overtreating, this is a two-way street. It needs to be OK for the doctor to say, “We’re not doing a CT scan because it’s unnecessary” and not meet with instant backlash from the patient. It needs to be OK for patients to let go of the I-want-you-to-do-everything security blanket and not fear they’re receiving substandard care. In health care, more does not automatically mean better.

However:

- Cost can’t be the sole consideration. Sometimes it’s OK to delay care and sometimes there’s a less expensive option. But sometimes the patient needs immediate care and sometimes the care needs to be aggressive. This, rather the goal of simply being as cheap as possible, is the real challenge in health care: providing the right care at the right time, not too much, not too little, not too soon and not too late.

- It’s good to ask questions but patient engagement is much more than this. It’s about listening, absorbing information, understanding how and why key decisions are being made, and seeing the big picture. It’s about communicating clearly and accurately. It’s about following directions. This is complex stuff, and a sudden hospitalization is not the best time to try to learn the language and behavior of patient engagement. Far better to start cultivating some of these skills when you’re well, rather than in the middle of an emergency.

- Who wants to be the patient who arrives at the emergency room and is forced to say, “I don’t have one” in response to the question, “Who’s your regular doctor?” You can probably get by, but your hospital visit will likely go more smoothly if you have a primary care doctor who knows you – or, at the very least, if you have a usual source of care.

- Being sick and hospitalized is disruptive, to families as well as to patients. It upsets the normal routine and adds unexpected stress. It can take several days, or several weeks, for everyone to regain their equilibrium. What patients and families don’t need is more frustration from a health care system that’s cumbersome, confusing to negotiate or slow to respond. Organizations that work to minimize this for patients are doing them a favor.

- Health care is organized around systems but it’s delivered by individuals and reinforced by organizational culture. Every one of those interactions counts, and every one of them helps define the line between having a good experience and having a bad experience. This is your shout-out, Rice Memorial Hospital and Affiliated Community Medical Centers, for knowing where that line should be. Bad experiences don’t happen by design but good experiences rarely happen by accident.

Additional reading: Choosing Wisely; Image Wisely; Costs of Care; Center for Advancing Health; minimally disruptive medicine.

6 thoughts on “My weekend as an emergency patient and what I learned

  1. Sorry to hear of your demise. I am dealing with a gallbladder with sludge. I met with a surgeon and say I should have it removed. Better to deal with it before I get where u to too. Hope all goes well!
    Carol

  2. I need to make it clear that this was not really a typical situation. The majority of people with gallbladder disease do not experience anything like this.

    Good luck and good health to you, Carol.

  3. Hello Anne and thanks so much for updating us on your adventure. Some people will do anything to get out of those weekend chores! ;-)

    Loved your elegant précis of the definition of patient-centered: “When the emergency room staff’s immediate response is to deal with your medical situation and worry later about seeing your health insurance card, that’s patient-centered.” It certainly is.

    I agree that patient engagement should ideally include “listening, absorbing information, understanding how and why key decisions are being made, and seeing the big picture”. Trouble is, depending on the circumstances and the diagnosis, almost anything that brings us into hospital via the Emergency entrance is unlikely to predispose us to even the most basic comprehension of what on earth is happening to us.

    I always considered myself a pretty smart cookie until the day, in mid-heart attack, when a cardiologist was called to the E.R. to tell me: “You have significant heart disease.” I recall that I could see his lips moving after that, and I was pretty sure he was talking to me, but I still suspect he started speaking slow-motion Swahili from that point forward. Health care professionals often forget that although this might be their 5th routine heart attack (or gall bladder emergency) of their shift, there’s nothing routine about this experience for the patient.

    Hope you are nicely on the mend by now. You’ve just graduated from an eye-opening immersion course. No doubt this experience and the lessons learned will help to inform your future health writing like no other training possibly could.
    regards and good luck to you,
    C

    • Hi, Carolyn! This episode was 3 months ago – I’m doing fine again. :)

      I had the experience of witnessing a laparoscopic gallbladder surgery several years ago, so I had the advantage of some (limited) prior knowledge. But I often wonder what it would have been like for someone for whom this situation was entirely alien. For me, the mental effort of keeping up with the information flow and comprehending what was happening was frankly more exhausting than being sick.

      It’s so important for health care organizations – and the policymakers – to recognize there are limits to the level of engagement they can expect from patients and that much of the responsibility lies with them to support patients and families and create the right kind of environment.

Leave a Reply

Your email address will not be published. Required fields are marked *

*

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>