Hospitals

Do all docs need to be hit by a car to understand the patient perspective?

Charlotte Yeh was an emergency physician for eight years, but it was not until she […]

Charlotte Yeh was an emergency physician for eight years, but it was not until she was hit by a car that she experienced the emergency room from the patient side. She was in Washington DC for a business trip and got hit as she was crossing an intersection.

I used to travel to DC for work and I can imagine how terrifying this whole experience must have been. There is not much worse in the world of business travel than getting injured and going to the ER alone in a strange city.

But I have experienced so many elements of her story in other, non-emergency healthcare settings: taking my kids to well baby visits, visiting my dad in the hospital, trying to understand my own treatment options at a doctor visit. We talk about these problems all the time but no one seems to believe they are real. Here are the problems Yeh faced in her ER stay:

  • Fragmented communication
  • Incredibly poor listening skills
  • A rush to discharge with no plan
  • No coordination of care
  • Distracted, overworked staff

Her experience also reflects the most important lesson I’ve learned about our healthcare system: you have to be incredibly persistent and polite at the same time to get doctors and nurses to address what is really wrong with you. Yeh had to ask over and over to have an evaluation of her two pain points — knee and her backside:

…nurses came in and out as I asked, over and over, it seemed, “Is anyone going to look at my knee?” … That night, I began to experience numbness and tingling in my leg and my hip. Three times, doctors or nurses came through, and each time I explained my concerns but was not evaluated. It wasn’t until 24 hours later, during the night of my second day of hospitalization, that I had a neurological exam, which revealed contusion of both the sciatic and the gluteal nerves.

After this terrible experience, Yeh finally understood what patients had been telling her:

After I’d spent four days in the hospital, it dawned on me that not once had anybody come by to ask how I was doing, what I needed, what I wanted, or whether I had any concerns. I then understood something that my own patients had been telling me all the time: They don’t feel engaged in their own care. There is nothing personal about it.

As a medical professional who became an accident victim and then a trauma patient, I was struck by the uneven nature of my care, which was marked by an overreliance on testing at the expense of my overall well-being. Instead of feeling like a connected patient at the center of care, I felt processed. This is disconcerting, especially at a time when patient-centered care — that is, care delivered with me, not to me or for me — is supposed to be becoming the new normal.

Yeh has come to the same conclusion that Dr. Mandrola has: the trend toward relying exclusively on technology to deliver healthcare is a terrible one.

When a test, such as a CT scan or a blood exam, is the centerpiece of care strategies, patient care can be compromised. As medicine and technology evolve, we may have become victims of our own success. We have become test-happy and technology-powered. These tools may provide us with good data on the patient, but this doesn’t mean we’re serving the good of the patient.

The unintended consequence of our current approach is that the clinical measure can become more important than the patient. I am afraid that as a result, we may be training a new generation of practitioners to equate high-quality care with conducting a test. Instead of having the test be used to discover new information about the patient, it is being used to define if one even is a patient.

If I resolved anything on my care journey, it is that the “North Star” guiding all care must be providers using “any means possible,” to know the patient, hear the patient, and respond to what matters to the patient. … Emergency departments can’t hide behind the excuses of “we’re too busy” or “it’s too chaotic” to avoid connecting with every patient.

Yeh’s entire life has been changed by this accident. She walks with a limp and can’t ride a bike. She has lost some of her independence: “Every choice I make each day about where I go requires careful advance planning: What’s the terrain? Will I need to ask for help?”

Patients and parents and entrepreneurs and nurses and doctors will have to keep pushing and insisting for change to solve all the problems Yeh faced during her ER stay. If every doctor and hospital executive and elected official has to have a traumatic experience like this to understand the patient perspective of healthcare, there is no hope for our system.

[Image from flickr user Chad Davis]

Veronica Combs

Veronica is an independent journalist and communications strategist. For more than 10 years, she has covered health and healthcare with a focus on innovation and patient engagement. Most recently she managed strategic partnerships and communications for AIR Louisville, a digital health project focused on asthma. The team recruited 7 employer partners, enrolled 1,100 participants and collected more than 250,000 data points about rescue inhaler use. Veronica has worked for startups for almost 20 years doing everything from launching blogs, newsletters and patient communities to recruiting speakers, moderating panel conversations and developing new products. You can reach her on Twitter @vmcombs.

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