Sunday, February 24, 2008
News, In this Issue...

Through the eyes of a patient

A national health care plan won’t improve the quality of American health care—that will have to change from within

"Can my mom please have a blanket?"

“Universal coverage doesn’t solve the problem of lack of quality health care. Having universal access to a chaotic and fragmented system doesn’t solve the problem.” —Elliott Fisher, Dartmouth Medical School

Maggie’s illness was rare. What happens in our health care system when someone has a minor but common health concern that, nonetheless, must be addressed? I found out for myself last summer when I ended up in the emergency department at Emory University Medical Center.

My son and I had gone for a ride on our bicycles when I took a bad spill. Then, like the final wa-waaaa note in a cartoon, my bike—which I always complained was too heavy—landed on me. It was a minor accident, but I was having trouble breathing regularly and couldn’t sit up. My right hand was throbbing and I could barely move it. I tried to slow my breathing, but I couldn’t seem to get enough air. I was freezing cold on that hot July day, and the treetops above me were spiraling away into the distance. My son, who hadn’t yet turned 11, ran frantically from door to door, yelling for help. Finally, an older gentleman happened along and called 911.

Once at the emergency department, things got worse. I had developed a headache that felt as though a battering ram were being used against the inside of my skull. I was so cold that my teeth were audibly chattering. I remembered from the lifeguard courses I took when I was a teenager that hyperventilation and shivering are symptoms of shock. I asked for a blanket. It was as if I had said nothing. “Do you have high blood pressure?” a nurse asked me. “No,” I answered through my clattering teeth. “Could I please have a blanket? I think I may be in shock.”

She took no notice of my words. “Your blood pressure’s really high. If it doesn’t come down, we’re going to have to do something to bring it down,” she said. That scared me and my son. “If you get me a blanket,” I replied, “it might come down.”

But no one made any effort to get me a blanket. Instead, they scurried about, warning me about my blood pressure while I continued to shake, freezing to death, breathing like a racehorse, begging for a blanket. It occurred to me that a lifeguard or a flight attendant would have been more help to me.

“Can my mom please have a blanket?” I heard my son ask out in the hallway. A nurse came in and said “Your son is so polite.” I reiterated his request. “Your blood pressure is really high,” she said. “Do you know why that might be?”

I wanted to answer, “Maybe it’s because no one will get me a goddamn blanket,” but instead, thinking that maybe they assumed I was uninsured, I said “I have great insurance, it’s Aetna. I may already be in your system.” That had no impact whatsoever. Insured or not, the blanket was not forthcoming. Nearby, nurses were chatting about how slow an afternoon it was. I started to feel self-conscious about not being a more important or exciting case. I was, after all, just a 40-year-old woman who’d taken a spill from a bike.

More than an hour after our arrival, a nurse in her 50s popped in, asked why I didn’t have a blanket, and immediately put one over me. My blood pressure quickly eased back down.“CAN MY MOM PLEASE HAVE A BLANKET?”

ADDRESSING DOCTOR-PATIENT RELATIONS

“At first, I thought ‘Man, this is great. Things are going to get better now. Why didn’t they put her in here from the start?’ Then I realized that it was the ‘death suite’—that’s what I called it.”—“Joe” on his wife’s hospital stay.

“I know I sound like an old person when I say this, but we e-mail, we Facebook, we MySpace, but the act of face-to-face communication—of listening—is an important skill, especially in medicine, and it’s a disappearing skill.” --Bill Eley, Emory University School of Medicine

When I got to see a doctor, several hours later, he was compassionate and helpful. He explained how I had injured my hand when I landed on it, the kind of after-care it would require, and why I hadn’t been able to get my breath—I was in a little shock. And he gave me a heartfelt apology for the staff’s delay in getting me a blanket.

So what was the deal with the blanket?

“That shouldn’t have happened,” says Bill Eley, executive associate dean for medical education and student affairs at Emory University School of Medicine. “But it’s a symptom not only of problems in medicine, but of our entire culture. I know I sound like an old person when I say this, but we e-mail, we Facebook, we MySpace, but the act of face-to-face communication—of listening—is an important skill, especially in medicine, and it’s a disappearing skill.”

Eley also points out that while that particular afternoon may have been slow, we don’t know what kind of rush the staff may have dealt with in the previous 24 hours. Emergency departments are more crowded than ever, he says, and the people who come to them are sicker than ever.

“All that stress can numb people who work in emergency rooms,” says Eley. “We work to overcome that, but it can happen.”

Or maybe the nurses just didn’t like me. As Jerome Groopman explains in his recently published book, “How Doctors Think,” whether your doctor likes you has an impact on the quality of care you receive. I assume that might reasonably be applied to nurses, too.

Despite my own experience with Emory last summer, the fact is that the hospital and its attendant medical school are actively involved in developing new approaches to improve the doctor-patient relationship. For example, medical students are assigned to the oversight of one of 16 faculty members—selected for their stellar reputations for bedside manner—whose job it is to act as role models.

“Values are not taught, they’re caught,” says Eley. “You can’t tell a student how to behave with patients. You have to show him.”

On the first day of medical school, Eley and his colleagues tell the new students to take time to see the hospital through the eyes of a patient for the last time—to feel the fear, the vulnerability and the confusion.

“This is the last time you’ll be able to do this,” they are told. “Forever after, you will look at this like a doctor, and nothing is more important than remembering how you felt when you saw it today through the eyes of a patient.” SP