Monday, February 16, 2015

Report from the field

Lisa Suennen--who knows health care very well indeed--offers this summary of a recent tachycardia hospitalization experience.  So much rings so true.  But for those of you who are convinced that EHR technology is the answer in general, or that Epic in specific offers the solution to proper exchanges of patient medical information or has solved the ease-of-use problem, read on:
  • I was told to ring the bell if I felt my heart racing. So I did on two occasions. In both of those situations, no one responded to the call bell. Since the nurses had no way of knowing if my reason for ringing was a crisis or not, it was quite discomfiting when I later walked into the hall to get attention by interrupting the very loud discussion the nurses were having about their favorite TV shows at the nursing station. On that occasion I was told, “Oh sorry, we just never hear the bell.” Later, when it happened again, I was told that the nurses are simply too busy to respond to patients calls. True story.
  • I got downright bullied by a doctor who wanted to rush me into procedures that I felt to be unnecessary, premature and excessive. When I questioned his recommendations (based on my own wonderful doctor’s input), he tried to guilt me into compliance and treated me with unbelievable rudeness. He scoffed—literally scoffed—when I told him that if I needed any actual procedures I would see my usual doctor, thank you, who happened to be at a different hospital than where the ambulance took me. He told me that I was being shortsighted and that the services at both places are the same so it made no difference. Lord, I hope that isn’t true.
  • That same doctor, and his retinue of residents, “attended” to me without ever speaking to me, looking me in the eye or asking me how I was feeling.  It was not until I asked the doctor a question did any of them look or talk to me.   It was insulting and made me feel like a diagnosis, not a human. When the chief resident finally spoke to me, she asked me questions that made it clear she had not read my chart, inconveniently located in her hand.
  • In the first room I was put in there was a seriously disturbed person in the next bed who started screaming and swearing at me when, at 3 am, I asked her to turn down the volume on the television. Granted, I was immediately moved (the nurses did hear the lady screaming at me if they couldn’t hear the call bell), but the new room had a very ill person in it who hacked and coughed and spewed lord knows what around the room. If they ever answered the nurse call bell, I would have asked for a Lysol bath. I was pretty sure that I didn’t enter the hospital with ebola, but I was not so sure I’d leave without it.
  • I was told, “don’t worry, since this hospital and that hospital where your doctor works both use Epic, your doctor can get all the records by just signing in.” Hahaha…that’s a good one! These two hospitals are in entirely different health systems and I got to tell my new case manager friends about how Health Information Exchanges work and how the absence of one would mean that I needed a paper copy of my records to take along, thank you. I’m guessing that most patients don’t know that and walk out without their information–a nightmare in the making when you have a lot of follow up to do.
  • Incidentally, I found out that none of the information collected in the hotel room or ambulance made it into my hospital record. None of it. So in other words, the data from the most critical part of the experience was apparently lost since ambulances generally do not transfer clinical detail to hospitals. Fortunately (?) some of this information was recovered eventually since the paramedics had left all of the original EKG readings on the floor of my hotel room. Hello HIPAA. This made me realize how important this connectivity between emergency responders and hospitals really is. I kind of knew that (hence my support of Beyond Lucid Technologies, which helps solve this problem), but the lesson was brought home in a big way through direct experience.
  • I was given test after test without being given results unless I specifically asked for each one. Since each test result was going to determine the next steps about my care, my stay, my life, I was kind of annoyed to have to keep on asking what the hell was going on. I was particularly annoyed when, at midnight, I was carted off to a CT scan that hadn’t been mentioned. OK, uncle, I figured. I’ll have the test, but I did not enjoy being told that I had to figure out how to jam my shoulder down flat despite the fact that a twenty-year old botched shoulder surgery makes that literally impossible. The tech “helping” me with this told me she would just “push my shoulder down” and strap it if need be. That would have sent me right back to the orthopedic wing of the hospital as they frantically searched for the nails falling from my shoulder to the floor, so I firmly suggested we find another way. She was overtly exasperated at the inconvenience.
  • And speaking of Epic, I watched my nurse and doctor argue about the doctor’s mistakenly putting in test orders using the wrong time convention (“regular” time vs. military time), thus accidentally scheduling my test 12 hours after it was supposed to happen. The doctor took serious umbrage with the nurse pointing out the error, even though the nurse was right, and the nurse spent much of the rest of the shift telling me what a jerk the doctor can be. Not too professional all around.
  • And the crowning glory: I just received all of my claims letters notifying me that all of my charges were rejected. The reason: I am no longer covered under the plan. Well that’s exactly right, because they sent the bills to whatever happened to be in their information system rather than to the payer noted on my recently issued new insurance card, which I had produced on demand at least 3 separate times in the first 3 hours of the experience. So now I get to chase that one down.


nonlocal MD said...

"Rings so true", indeed. I keep wondering when the critical mass of anger at this kind of familiar story will be reached and precipitate actual change. It's sort of like the cable companies, everyone hates them but nothing changes because the customers have no leverage.

Mary K said...

I am so sorry. Speaking as a nurse leader, I wish you would have talked with the charge nurse, the nursing supervisor, or anyone else in the nursing chain.

I recently had the experience of reassuring a patient who was afraid that if she complained, her nursing care would suffer (retaliation). No one should be made to feel helpless, and that's exactly what we do in the hospital.

Barry Carol said...

Maybe one of the doctors out there can comment on this but my perception is that at least part of the problem may be that ER doctors are often evaluated based on throughput. The doctrine is to order all the tests you think you will need right away so you can “treat em and street em” as quickly as possible. In this environment, time is the constraining resource which is not conducive to extensive patient interaction. Moreover, since ER doctors are often dealing with patients they don’t know and may never see again, defensive medicine also comes into play.

Even if Press Ganey patient satisfaction scores are looked at by hospital management, they may not get much weight in this context. Patients, for their part, aren’t anxious to spend any more time in the ER than they have to. I don’t have any good ideas on how to fix this that would work for all parties,

IT pharmacist said...

Shameful, nauseating, reprehensible, and unfortunately all too common. How many of us reading this are uncomfortable that this could occur in our own hospital? Yet, what are we doing now to change this type of catastrophe? Action is needed now.

Anonymous said...

Couldn't hospitals and doctors be "shamed" by social media.

Something more systematic than than this posting by Paul or something similar done by the patient.

A rating service for hospitals and docs with the ability to post comments like these.

If healthgrades, and its competitors don't do the job maybe something new is needed.

It sounds like the patitent - Lisa Suennen - might be helpful in that regard.

Just a thought.