I originally wrote this blog entry on my other blog, back in April. I am posting it here in response to a new blogger friend, RoseChimera, who I thought would appreciate reading about how my experiences as a patient will affect how I hope to practice medicine in the future.
E. has been home from the hospital for two and a half weeks now and I sometimes forget that he is actually almost four weeks old and that he spent the first week of his life in the NICU. As much as I would love to forget the events of that whole week, there are definitely some important lessons that I hope will stay with me as I continue my journey in the world of Medicine. Before I reflect on what the experience as a patient (or the mother of a patient) has taught me, I want to say that I am extremely grateful for the care that E. received while in the NICU: We had some wonderful nurses and some very dedicated physicians and residents while we were there.
When A. was born, I remember feeling that my experiences in the hospital during his delivery and the two days I spend on the post-partum unit were exceptional. I felt like the nurses, lactation consultants, residents, and physicians were all very helpful, doting, and concerned over the wellbeing of my new baby and I. Unfortunately, I can’t really say the same about this hospital stay. I’m sure the reason I feel this way has everything to do with the complications that E. faced and his eventual need to be admitted to the NICU. In addition, this experience was probably different because as a medical student, I have a deeper medical knowledge base and I know a little more about how health care personnel are expected to interact with their patients.
Throughout our entire time in the hospital, I constantly felt that I was not being “listened to” by the people who were responsible for E’s care. The most obvious examples of this were the multiple times I expressed my concern over E’s well-being to my nurses over the course of the night before he was admitted to the NICU. I really could not shake the feeling all night that something was not quite right and despite this, I was constantly told that my concerns were nothing to worry about. It is very possible that this may have been the case. However, not once did anyone actually take the time to consider why I was concerned and take a closer look at E. This feeling is compounded by the fact that both my obstetrician and the labor and delivery nurse were concerned about E’s respiratory efforts immediately after he was born: In the short time that E. and I were still on the labor ward, NICU was called twice for a consultation on E., and both times they said he appeared normal. I am convinced that if someone had taken the time to observe him more closely when people, including myself, expressed concern, things would have turned out very differently and E’s condition would never have become so acute.
Somewhat related to my feelings of not being “listened to,” were the continual ways in which my questions about E’s condition and rationales for care were answered. In reality, very few of my questions were ever adequately answered the first time I asked them. The extent to which my questions were answered followed a strict dichotomy: If the nurse/physician knew that I was a medical student, I usually got a detailed and acceptable answer, and if they didn’t know, I almost always got a canned response. In my opinion, my level of education shouldn’t have had any effect on the ways people talked to me about E. and his care. I realize that medical conditions and the associated medical jargon can be confusing to people not versed in the field. However, this should never be an excuse for a doctor or nurse to let patients or their families feel like their questions and concerns are not valid. Physicians, and all health care providers, should make every effort to answer questions to the satisfaction of the people asking them, and they should be able to do so in a way that accessible and understandable to the person asking the question.
Let me illustrate one of the more frustrating experiences I had with regard to this concern. On a Friday, E’s doctor told us that he was very happy with how E’s x-ray looked that morning and if things were progressing as well by the next morning, they were going to clamp his chest tube and we’d probably be able to go home on Monday. On Saturday morning, I was eagerly awaiting the great news that his x-ray showed more improvement and that they would be clamping the tube. When I arrived at E’s bedside that morning, however, I was told by the nurse that the doctors were not happy with how the x-ray looked and they weren’t going to do anything with his chest-tube until Monday. This was the only information that the nurse gave me and I was devastated. It turned out that a different doctor was responsible for E’s care over the weekend and when I asked him why E’s care plan had changed, he smiled at me politely and said, “sometimes these things take time to heal.” I was choking back the tears as this new doctor walked away from me. Not too long after this incident, the resident who had accompanied the doctor earlier came up to me, introduced himself, and asked me if I was the medical student – because he’d heard that the mother of the baby with a pneumothorax was a medical student. I said that I was and then I told him that I was confused as to why the approach to E’s care had changed so much overnight. He then took the time to show me E’s most recent x-ray and explain to me why the doctor had decided to take a more cautious approach with regard to clamping the chest tube. While I was still saddened by the setback in our timeline, I felt much more assured that E. was receiving proper care. Most importantly, however, I felt as though I was a recognized and respected person who was included in the care process for my own child. This feeling is one that every person should feel with regard to their own or their child’s health care; it should not be some sort of privilege afforded to the small number of people who have the background or expertise to ask the right questions and understand the medical lingo.
I could probably write twenty pages about the other events that happened in our short hospital stay that have made me reflect on how I want to approach my patients when I am a physician. While nothing could have ever made me feel completely at ease or take away the heartache that I felt while my infant son was in the NICU, there are small things, that if done differently, could have made the situation much less harrowing for my family and I. The way in which my concerns were brushed off as insignificant made me feel like I was a nuisance to the nurses. Visiting my son in the morning, after a long, sorrow-filled night without him at home, and having to wait fifteen minutes for an update on his condition so the nurse could “finish her charting” before talking to me filled me with anger and loathing. Having a doctor spit out a generic, nugatory answer to a question that I had about my son’s condition rather than take the time to make sure every question and concern I had was addressed left me feeling alone and uncertain. Feeling like a nuisance, anger, loathing, loneliness, uncertainty… All of these are feelings that I never want to elicit in my future patients. They are not only distressing, but they result in a negative experience and, most importantly, they are very easily avoidable. Every instance that contributed to my negative in-hospital experience could have had completely opposite results if only the people involved made a conscious effort to put themselves in my position and attempted to understand what I needed from them at that moment. It doesn’t take much time to show patients kindness, empathy, honesty, and responsibility when it is needed. These small gestures might require a little more effort, but they certainly make for a superior patient experience and will most likely leave a lasting, positive impression on the patient when they look back on their experiences. When I think of some of the wonderful physicians I’ve had in recent years, I realize that what makes them so good at what they do, and what makes me remember the positive ways they’ve impacted my life is that they always made the extra effort and put in the necessary time to ensure that I never experienced any of the feelings or emotions that I felt in the short week that E. was in the NICU.
Meet Rose Chimera: http://rosechimera.wordpress.com/