A note from the other side of the doctor-patient relationship

April 26, 2008 at 3:40 pm (Uncategorized)

  

A few months ago I was involved in a car accident.  My vehicle was T-boned at an intersection by an elderly man who was driving an SUV.  I was thrown into a railing and was pinned inside of my car.  I needed a few seconds to realize what had just happened.  I had enough mental faculty remaining that I could pull out my phone and dial 911.  I remember that there was blood quickly dripping from my head, as well as shouts from nearby pedestrians who were trying to see if I needed help.

Paramedics arrived almost instantly but were helpless to do anything because my car was pinned between the SUV and the rails.  Because of the impact, the doors in my car were sealed shut and could not be opened.  Firefighters had to push back the SUV, breakthrough my windows, and then saw through my passenger side door to get me out.

My neck was a little stiff, my hip hurt like hell, and I was still bleeding from several spots on my face and head despite all of the pressure I had been putting on them with a paper towel.  The paramedics successfully got me out, put a C-collar on me, and tied me down to a backboard.  I told the lieutenant that I was a medical student and I wanted to go to my university’s hospital.  I figured that if the paramedics let the attendings know that I was a student, I would get quicker service.  I reminded the paramedics again on the trip to the emergency department that I was a student at  the approaching hospital and that they needed to let the physicians there know.  Otherwise, I was probably going to have to wait several hours before being seen, despite having just been pulled from a totaled car.  One of the EMTs laughed it off and try to assure me that anyone who comes in from a motor vehicle collision would be seen instantly, regardless of his educational status.

I’ve mentioned before on this website that my university’s affiliated hospital is an urban medical center that caters to a largely uninsured population.  Its emergency department sees over a thousand new patients every day, effectively triages them, and provides care to whoever needs it.  The dedicated physicians and nurses do all of this despite the numerous abuses of the system by the patients who come here.  Unfortunately, due to all of these visits, the time between walking in the door and getting a physician’s ear for five minutes can take up to three hours.  I warned the paramedics that I was going to be in for a wait if they didn’t alert the staff there that I was a medical student.

In the past, whenever my classmates have needed emergent care, they simply pull out their student ID and precede to instantly seeing the attending.  Unfortunately, I had been hit on a Saturday night and did not have my ID with me.  The paramedics never did tell the physicians that I was a medical student.  And I ended up staying in triage—tied to a backboard—for over two hours before finally being seen.  Since I had so much free time on my hands, not being able to move and all, I used the stopwatch feature on my wrist watch to see just how long I would wait.  I was right; the paramedics were wrong.  I was there for a very long time.  So long, in fact, that a police officer was able to arrive from the scene, take a statement, and then issue a ticket with the other person’s insurance information available.  The only person from the hospital who came to talk to me during that time was from finance.  She only wanted my insurance card.  I told her that I was a medical student only to have her brush it off by saying, “They will take care of it.”

During the wait, I really felt as if I needed to use the restroom.  I tried to flag down the nurses to let them know that I had to pee.  No one was paying any attention.  As people in scrubs walked by, I would say, “Excuse me, miss, could you help…” and then watched as the person ambled by without so much as looking at me.  I thought about all the times I had ignored patients in the emergency department who try to get my attention for food, water, a trip to the bathroom, or whatever else was on their mind.  I always ignored them, too, because I assumed that they were psychotic.  And here I was, receiving the same treatment.

When I finally did get to see the physician, he was greatly annoyed that I had to stay out in triage for so long.  Our hospital’s rule is that medical students and residents get seen instantly.  He was frustrated to learn that no one had bothered to talk to me from the medical side in the entire time that I was held to the backboard.  In the end, I didn’t suffer any broken bones.  I didn’t even need stitches.  I couldn’t receive them anyway.  So much time had passed that I was ineligible for any kind of suturing.  Luckily, the bleeding had stopped anyway.  I was sore for the next few weeks, had a little difficulty walking because my hip was in so much pain, and now have several prominent scars on my head and face from where broken glass cut me during the collision.

I saw life as our patients see it: scared, wondering when I would be seen, and greatly annoyed that finance got to me before anyone in healthcare did.

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15 Comments

  1. Miami_med said,

    Wow, that sucks!

  2. Stark Raving Med said,

    Anyone in the medical profession who reads this should be appalled. The fact that your primary concern after this accident was that the staff know you were a medical student is shameful. I’m impressed the paramedic only laughed at your selfishness, I would have told you to shut the hell up and let me do my job. When you graduate, are you the type who is going to insist on always being called Doctor? I bet you’ll have MD plates, too. I don’t care what the hospital policy is, VIP-type treatment should be a thing of the past. You should be triaged based on the acuity of your presentation. Period. Are you actually advocating that medical students and residents be seen over more acute “regular” patients? It sure as hell sounds like you are. Years ago in medical school I went to the ER. I was seen exactly when my symptoms warranted – and consequently waited my turn. Nobody knew who I was, nor should they. It didn’t matter whether I was in medical school, a homeless drunk on the street, or the King of Saudi Arabia. That’s the beauty of medicine. If you think otherwise, you’re in the wrong profession.

  3. former_emt_also_half_md said,

    “I warned the paramedics that I was going to be in for a wait if they didn’t alert the staff there that I was a medical student”

    Oh Dear God in Heaven! I’m sure the medics appreciated your “warning.” No chance was there a conversation with the ED nurses about what sort of service a crybaby med student should receive.

    I’m sure that if you’d flashed your school ID at the uninsured smelly guy with chest pain, he’d have gladly sucked it up for a few more minutes and permitted you the instant attention and treatment that someone of your social status so obviously deserves.

    It’s such a shame that your hospital “effectively triages… and provides care to whoever needs it.” What *is* this world coming to?

  4. average_patient said,

    Aside from the outcry about being seen immediately if you are a med student, it *is* pretty appalling that anyone could come from the scene of a non-minor traffic accident and be strapped to a backboard for hours without being seen or even looked in upon.

    When my uncle died from a heart attack, it was a similar situation. He went to the ER complaining of chest pain, had a history of a previous heart attack right on file there at the hospital, and was put into a room to wait. Nobody looked in on him for an hour, and he died.

    What if you had suffered an internal injury?

    Half M.D.: that’s exactly my point. I couldn’t move my leg due to the pain in my hip. Since I didn’t have any abdominal pain and I needed to pee, I wasn’t too concerned about internal bleeding. I did, however, think that I might have broken my leg. Although not immediately life-threatening, a long bone fracture needs to be examined quickly. And as you alluded to, anyone who gets pulled out of a car, backboarded, and dumped in triage shouldn’t be ignored for two hours.

  5. Buttercup said,

    Half M.D., I don’t think that was “exactly” your point. Re-read your post: your primary point, which you made about 8 times, was that you should not have had to wait because you’re a med student — not that nobody in your condition should have had to wait that long. It’s all there in the way you told the tale. Please think about how your sense of entitlement affects the public’s view of the medical profession.

    Very glad to hear you weren’t seriously injured, and hope your hip is feeling better.

  6. Doctor Dan said,

    Ah young grasshopper. You must have some intelligence, otherwise you wouldn’t be in medical school (IMHO). You also have obviously made a large mistake in revealing your feelings of entitlement.

    I hope you will take these other harsh (but true) criticisms and learn from them. You deserve being flamed here, now prove your intelligence and learn from the criticism.

  7. also 1/2 way said,

    I think you all are missing the point. Half did tell them he was a student a few times, which any student, nurse, physician or employee of the hospital would have done, in fact the upset EMT’s would have done the same. The purpose of his writing was to show that he realized truly what patients in the ED of said hospital go through and that he can now understand that that patient calling to him isn’t crazy, but waiting for care. Being on the other side really sucks sometimes, but the experience can transform you as well as your care for patients.

  8. ilovecash said,

    sheesh, it took that long for them to even see you..? And yeah, I’d say it would annoy me if someone from finance found me before someone from health care did. >.>;;

  9. AT said,

    A) Nobody of any walk of life should spend 3 unnecessary hours on a backboard. It takes 20-30 minutes for pressure sores to begin leading to necrosis and possible sepsis. That is clearly an iatrogenic injury. We don’t often appreciate it, but something as simple as a backboard can have serious risks and consequences which must be weighed against the benefit they may provide (no study has ever verified the belief that backboards prevent spinal injuries).

    B) Of course it’s annoying (to you and every other patient who goes through that) that finance found you first.

    C) It might be selfish to think that you deserve special treatment, but rest assured that most people who aren’t smelly and homeless have some reason to believe that they deserve treatment faster/better/kinder/gentler/etc than they are getting it. It’s a symptom of a system problem and a symptom of a societal problem – we live in a world full of perceived entitlement. Perhaps if ED patients who are more appropriately managed by their PCPs had full coverage for primary care they would seek help earlier in their disease process instead of clogging our EDs knowing that they are guaranteed care by EMTALA… Just a thought… Primary Care is WAY cheaper to fund than ED/Specialty Care, I’ll write that check any day….

  10. Tea said,

    Excellent post, Half! I am sorry that you were in that mess. Whenever you go to the hospital, you need someone there to advocate for you.

  11. Max said,

    I think you’re absolutely right. At anyone’s workplace, indviduals expect preferential treatment. It’s completely normal. This wasn’t about you being a student doctor, this was about you being on your home turf, or at least that’s how I read your post. Everyone jumping down your throat should chill out and stop trying to demonstrate some sort of moral imperative through your story.

    Hope that everything healed ok. Best of luck with the rest of your medical career… be happy you aren’t a lowly first-year like myself.

  12. Joshua Gaines said,

    While not as amusing as some of the other posts on this site, this was definitely the most thought provoking. Thanks.

  13. Mombosuthu said,

    Chill everyone. Half has as much right to a faster treatment as employees have right to employee discounts. It being his home turf, he was entitled to be seen faster as he deserved it due to the work he did there. If you are not happy with that, don’t let me tell you where to stick you heads.

  14. Morsetlis said,

    It’s a teaching hospital, and I certainly hope that medical students and healthcare workers get seen before every other homeless, uninsured person. In fact, this was also the attending’s opinion, and I’m pretty sure they have a better grasp of the system and how unfair it is to insured people.

    That a vehicle collision took more than 1 hour to be seen is already clear evidence that, either triage in that hospital fails, or the hospital is overloaded, or both.

  15. Elaine said,

    Why are homeless, uninsured people being denigrated by some of the posters? Clearly some of you are (and always have been) middle class to upper-middle class and used to a pretty homogenous suburban society, likely in the Midwest or maybe South. (p.s. I’m Midwestern, but have not always had the luck of having parents with insurance and, um, jobs). I went to engineering school in the Midwest and this entitled “I’m more important than poor stinky people” was pretty common. Once people had an experience where they were not entitled to any special treatment, it helped broaden their lens.

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