One Friday in late April, I was at a conference and couldn’t stop coughing. I thought it was allergies or my asthma acting up. I kept taking Benadryl and using my inhaler, but the croupy cough kept getting worse. I left early and headed home. But, by 6pm that evening, I knew I needed to go to the ER.
Hospital No. 1:
On Friday evening, I arrived in the ER at my local community hospital. They were extremely efficient and personable. While I was getting a breathing treatment, they were trying to do the medication reconciliation, but I couldn’t talk and remembering my medications was not high on my list. I gave the nurse my iPhone after opening up my online health record so she could access my medication list. I was stabilized and sent home a few hours later with instructions to return if things got worse. Twenty-four hours later, on Saturday evening, I could barely breathe, and I went back to the same emergency room. The decision to admit me was made immediately.
This admission started off differently than any I had ever experienced. The nurse spent over an hour going over my medical history, medication list, and looking over my entire body. They included my husband in everything, and this helped to alleviate some of his anxiety about my condition. I spent the next five days getting tests, breathing treatments, steroids and oxygen. I was continually amazed at how friendly and engaging the staff was. This was consistent from my nurses, the nursing supervisor (who introduced herself at every shift), housekeeping, respiratory, x-ray techs, food service staff, etc. Everyone went above and beyond for my needs. It didn’t matter whether it was technically their job or not, it truly was all about me, the patient.
I work in the healthcare industry and have been hearing about bedside shift changes for years, but have never personally experienced one until then. I even took a picture because I was so impressed! They engaged me in this routine every time. It was an opportunity to learn about my lab results, tests that would be performed and why, and even let them know about things that they did not have documented. I found the shift change at the bedside an unspoken invitation for me to participate. The staff also gave me information on every drug I was administered so that I could learn more about it on my own time.
When I was being discharged, I asked the hospitalist to call my primary care physician (PCP) with all the information he gave me. I was afraid that something would get lost in translation. He made the call, spoke to my doctor, and sent her the discharge notes. After spending five days in the hospital, I got hugs and well wishes from everybody as I was leaving.
Hospital No. 2:
On Saturday, two days after discharge, my knees became swollen to twice their size. I called my PCP’s office, and the covering physician suggested making an appointment with urgent care (affiliated with my PCP’s office and a major medical center.) When my husband and I arrived, we had a short wait. We were taken to the examine room and told that the doctor would be right in. As the doctor was walking in, she was introducing herself while looking at my chart. We couldn’t even understand what she was saying. I told her why I was there and that the covering physician suggested I check in with urgent care. I also handed her the discharge notes, thinking they might be helpful. She asked me where the notes were from. When I told her, she said she couldn’t use them because they weren’t from the current institution. I was a shocked by her dismissal of information that could be very relevant.
The doctor told me that she would run some tests just to make sure nothing else was going on. When I asked when she would get back to me with the results, she replied, “Maybe later or first thing in the morning. I have a toddler to deal with when I get home.” I was a bit shocked by this, and my husband looked like he was going to explode. She then said, “I assume you don’t want to wait since you came here instead of the ER.” I told her the covering doctor thought she would make the assessment and decide if I needed to go through the ER. She told me that someone would be in to take blood and other tests and left the room.
Next, the medical assistant came in to take blood. My husband asked her to wash her hands, and he added that I have a history of MRSA. I wish I had a picture of what happened next.
![iStockHandWashing_000011187977Medium[1]](http://www.engagingpatients.org/wp-content/uploads/2013/07/iStockHandWashing_000011187977Medium1.jpg)
She put her hands on her hips and flippantly asked him which way he wanted her to wash her hands – “with soap and water or hand sanitizer?” She was indignant and told us she washed her hands before she came in. Of course, she had touched the door and several other things. When my husband and I were leaving the office, we had to walk through a very narrow hallway where the medical assistant and doctor were having a discussion. They were going back and forth:
MA: I always wash my hands out here before going into the rooms, you see me!
DR: l know you wash your hands out here every time.
This conversation continued as my husband and I walked by. They were either unaware that we could hear them talking or, of more concern, didn’t care.
Needless to say, the conversation on the ride home was quite emotional as my husband and I recounted these two very different experiences.
I am what you would call a healthcare “frequent flyer.” I was born with bilateral club feet, and I have been in and out of hospitals my entire life. This experience highlighted for me that my expectations of healthcare are so low, but not anymore! For more than a decade, I have worked in the healthcare industry in quality and safety, and my perspective has been shaped by these experiences.
What struck me most about Hospital No. 1:
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Beside shift change – A practice geared toward engaging, informing, and educating the patient as well as the caregivers. I saw first hand how a bedside shift change can help to significantly curtail communication errors so commonly made at this crucial time.
- A culture of compassion and respect – Not only were the doctors and nurses attentive and responsive to my needs, everyone throughout the organization (x-ray, food service, transport, etc.) treated me, and my husband, with kindness and dignity.
I am hopeful that as more organizations adopt patient- and family-centered practices, experiences like mine at Hospital No. 1 will become the norm. Clearly, though, my experience at Hospital No. 2 indicates that we still have a long way to go.
What have your hospital experiences been like? Were you engaged in your care? Did your family members feel included on your care team? Or, can you relate to the frazzled medical assistant being asked, yet again, to wash her hands? The doctor distracted by the active toddler at home? What is your perspective?
6 Comments
Thanks Linda for sharing your personal insight into the healthcare system and the difference effective communications can make in regard to patient engagement. I also agree with your commentary around bedside shift changes… a point emphasized in the AHRQ’s recent guide to improving patient and family engagement.
Linda, I am struck, but not surprised, by the extreme differences of care that you received. Your experience highlights the positive changes that are occurring as well as how much change is still needed. The impersonal and arrogant care that you received at the Urgent Care Center flies in the face of common sense. The outright lack of communication, by their choice, is one of the primary reasons behind many unnecessary medical errors. Thank you for sharing your story and showing two very different faces of healthcare.
I recently received the best of the best care during a complex open heart procedure in a local health facility. During routine follow up, my provider was concerned that I might be developing a complication. She ordered a culture and put me on an antibiotic as a precaution until the culture result was available. She clearly wrote “fax results immediately” on the lab slip. Three days later, I was still taking an antibiotic that was not pleasant and could be interfering with my warfarin levels. So I personally began to try and track down the culture results. The lab (within the same health system as my surgery) had not faxed over the results – “we must have missed it.” The results had been available 48 hours before my call! I told the staff member that I really needed the results of the culture because I was taking a drug that could be harmful to me while awaiting the results. I am a nurse and was capable of understanding what a positive versus a negative culture meant. But she would not budge from policy that patients could not get results unless ordered by the provider.
There was no provider available in the office that day, so even after the fax I had to wait another day for the “negative” results when I could stop the unnecessary drug. While I don’t believe I was harmed by this, it was a frustrating finale to what had been a very positive experience and I believe demonstrates that ALL aspects of the patient’s experience need to be held to the same standards of excellence.
Linda Snell, e-patient Dave deBronkart recently blogged about how withholding personal health record information is a US Government civil rights violation and subjects the withholders to civil rights penalties. Here’s the link: http://epatientdave.com/?p=6901
This is a great blog Linda, and thank you for sharing your story. Unfortunately, I believe that the patient centered care experience is still the exception rather than the rule. I rarely go for ER or Hospital care, but in the past several months, I have had the opportunity to do so. An ER visit to my local medical center was so NON patient centered that I left and went to the competitor. The competitor had their act together and I had a fine experience there. During another visit to the medical center just a week ago, for outpatient lab work, I found myself lined up in a hallway, with no chairs, in a line of a half dozen or so people waiting just to see the receptionist. The signage in the hall basically ordered us all to wait, like herded sheep, in the hallway until it was “our turn”. I had back pain at the time, another woman was very pregnant and a third patient looked very ill. But, we followed “orders” like the compliant patients that we are expected to be. In the grocery store, they would have called help to the front to help the overwhelmed worker. My medical center needs a lot of lessons on patient centered care, but so far, my letters to them with offers to help with PFACs have fallen on deaf ears. My experiences are no different from most patients I have spoken with here in Maine. We need to keep talking about this, both privately and publicly. The unacceptable long time practices of a paternalistic industry are just not going to cut it anymore.
Linda, Thank you for this thoughtful and important story. How good that — at least once in awhile — our stories are good ones, but I shudder at the attitude in the Urgent Care Center, because I think that under just the right (i.e. wrong) circumstances, it could be lethal. It would be interesting to know whether that first hospital has a patient advisory council or is finding other ways to engage patients in improving care — or whether the results were obtained via staff and maybe even administrative input.