Walking around the ER in Tiny Community Hospital, I had a few realizations. In medicine, we hold onto some things very tightly. We love tradition, we love the known. We don’t always know why, but we choose ‘the devil we know,’ almost every time, no matter how pointy his horns.
For instance: ‘No cell phones.’ First of all, has anyone ever seen a cell-phone interrupt anything we do? No? Neither have I. Admittedly, cell phone use can be rude. If I’m talking to a patient, I don’t want them ignoring me by taking calls or texting to the exclusion of our interaction. And if I were a patient, I wouldn’t want my physician or nurse to do the same. But honest to goodness, cell phones are ubiquitous. We communicate with them, schedule with them, navigate with them, learn with them and we entertain ourselves with them! Even the sign that says ‘no cell phones’ is laughable. Courtesy? Please. But let’s stop deluding ourselves that we can, or should, keep anyone from using their phones while they wait, sometimes hours, to be seen and treated.
How about HIPAA? Great idea, privacy and all that. But it has been done to death. And the unintended consequence is that we have far too many log-on screens and passwords. Furthermore, our computers time-out so fast we can’t keep up! And yet, the real threat to privacy isn’t some poor knucklehead looking over our shoulders. It’s corporations and government, insurers and ‘important’ people who see, and who may share, our most private information. And none of them are defeated, or indeed affected, by passwords or anything else.
Another bit of silliness: the idea that a family member or friend isn’t allowed to translate for someone who speaks another language. Yes, it’s nice to use a service. But the contingencies of time and cost sometimes leave us with little choice other than 1) speak really loud and hope it gets converted into their language or 2) let someone with them do the talking. In this instance, better is truly the enemy of good.
One close to my heart is the maddening way we treat test and xray results. Having gone through cancer with my wife, I know the horrors of what we called ‘scanxiety.’ Waiting to know the answer can be heart wrenching. Fortunately, I was connected as a physician, and I was frankly a pain in the neck. I got the answer as quickly as possible. But for others, the waiting can be horrible. Recently my dad had a CT of his lumbar spine due to severe pain. It took days and days to get results. Ridiculous. In 2015, there is no reason for tests results to take two weeks; rarely even two days. Unless the test is some exotic lab evaluation that has to be sent to East Egypt, we know the results the same day. Making our patients wait is simply disrespectful, or slothful, or both. Information travels at the speed of light people; let’s treat it that way. The days of carrier pigeons and the Pony Express are long gone.
Finally (for today), there’s mental health. We have woefully inadequate numbers of beds and psychiatrists and counselors for the mentally ill. And yet, emergency departments have to hold vast numbers waiting on beds that will never materialize, and hiring sitters to do crossword puzzles while the mentally ill (or the pseudo-mentally ill manipulative) sit in bed and take up space in overwhelmed ER’s. We need a better system, sure. But we also need tort reform so that it isn’t so scary to discharge people. And so we can stop doing a worthless dance that doesn’t make anyone better but merely imprisons them in uncomfortable beds in uncomfortable departments without anyone to actually talk with them.
Anyone else have a few? What antiquated ideas, what anachronisms do we cling to in medicine? And why should we jettison them?
Well said, Dear Brother! I lift you up as you do work as an ER doc that’s every bit as tough and often tougher than my work as an oncologist.
Take care!
Dr. Mike Stoltenberg
Psalm 66:19-20
tom combs - ER doc/author
8 years ago
Sir Leap – I heartily agree. I had not heard the term scanxiety – brilliant. Sometimes it seems as if there is no consideration at all for the emotional burden of time ‘not knowing” when awaiting results of outpatient tests of potentially life-changing significance. Perhaps we of ER experience are spoiled by our accessible resources and the immediacy of our patient exchanges, but can’t those in other parts of the system at least TRY for prompt reporting. Like you I have used my MD to slice through waiting (and even that is sometimes strangely awkward). I feel for others. This… Read more »
{"id":null,"mode":"form","open_style":"in_place","currency_code":"USD","currency_symbol":"$","currency_type":"decimal","blank_flag_url":"https:\/\/edwinleap.com\/wp-content\/plugins\/tip-jar-wp\/\/assets\/images\/flags\/blank.gif","flag_sprite_url":"https:\/\/edwinleap.com\/wp-content\/plugins\/tip-jar-wp\/\/assets\/images\/flags\/flags.png","default_amount":100,"top_media_type":"none","featured_image_url":false,"featured_embed":"","header_media":null,"file_download_attachment_data":null,"recurring_options_enabled":true,"recurring_options":{"never":{"selected":true,"after_output":"One time only"},"weekly":{"selected":false,"after_output":"Every week"},"monthly":{"selected":false,"after_output":"Every month"},"yearly":{"selected":false,"after_output":"Every year"}},"strings":{"current_user_email":"","current_user_name":"","link_text":"Leave a tip","complete_payment_button_error_text":"Check info and try again","payment_verb":"Pay","payment_request_label":"EdwinLeap.com","form_has_an_error":"Please check and fix the errors above","general_server_error":"Something isn't working right at the moment. Please try again.","form_title":"EdwinLeap.com","form_subtitle":"If you enjoy the content you read here, please consider dropping something in the tip jar!","currency_search_text":"Country or Currency here","other_payment_option":"Other payment option","manage_payments_button_text":"Manage your payments","thank_you_message":"Thank you so much! I appreciate the tip!","payment_confirmation_title":"EdwinLeap.com","receipt_title":"Your Receipt","print_receipt":"Print Receipt","email_receipt":"Email Receipt","email_receipt_sending":"Sending receipt...","email_receipt_success":"Email receipt successfully sent","email_receipt_failed":"Email receipt failed to send. Please try again.","receipt_payee":"Paid to","receipt_statement_descriptor":"This will show up on your statement as","receipt_date":"Date","receipt_transaction_id":"Transaction ID","receipt_transaction_amount":"Amount","refund_payer":"Refund from","login":"Log in to manage your payments","manage_payments":"Manage Payments","transactions_title":"Your Transactions","transaction_title":"Transaction Receipt","transaction_period":"Plan Period","arrangements_title":"Your Plans","arrangement_title":"Manage Plan","arrangement_details":"Plan Details","arrangement_id_title":"Plan ID","arrangement_payment_method_title":"Payment Method","arrangement_amount_title":"Plan Amount","arrangement_renewal_title":"Next renewal date","arrangement_action_cancel":"Cancel Plan","arrangement_action_cant_cancel":"Cancelling is currently not available.","arrangement_action_cancel_double":"Are you sure you'd like to cancel?","arrangement_cancelling":"Cancelling Plan...","arrangement_cancelled":"Plan Cancelled","arrangement_failed_to_cancel":"Failed to cancel plan","back_to_plans":"\u2190 Back to Plans","update_payment_method_verb":"Update","sca_auth_description":"Your have a pending renewal payment which requires authorization.","sca_auth_verb":"Authorize renewal payment","sca_authing_verb":"Authorizing payment","sca_authed_verb":"Payment successfully authorized!","sca_auth_failed":"Unable to authorize! Please try again.","login_button_text":"Log in","login_form_has_an_error":"Please check and fix the errors above","uppercase_search":"Search","lowercase_search":"search","uppercase_page":"Page","lowercase_page":"page","uppercase_items":"Items","lowercase_items":"items","uppercase_per":"Per","lowercase_per":"per","uppercase_of":"Of","lowercase_of":"of","back":"Back to plans","zip_code_placeholder":"Zip\/Postal Code","download_file_button_text":"Download File","input_field_instructions":{"tip_amount":{"placeholder_text":"How much would you like to tip?","initial":{"instruction_type":"normal","instruction_message":"How much would you like to tip? Choose any currency."},"empty":{"instruction_type":"error","instruction_message":"How much would you like to tip? Choose any currency."},"invalid_curency":{"instruction_type":"error","instruction_message":"Please choose a valid currency."}},"recurring":{"placeholder_text":"Recurring","initial":{"instruction_type":"normal","instruction_message":"How often would you like to give this?"},"success":{"instruction_type":"success","instruction_message":"How often would you like to give this?"},"empty":{"instruction_type":"error","instruction_message":"How often would you like to give this?"}},"name":{"placeholder_text":"Name on Credit Card","initial":{"instruction_type":"normal","instruction_message":"Enter the name on your card."},"success":{"instruction_type":"success","instruction_message":"Enter the name on your card."},"empty":{"instruction_type":"error","instruction_message":"Please enter the name on your card."}},"privacy_policy":{"terms_title":"Terms and conditions","terms_body":null,"terms_show_text":"View Terms","terms_hide_text":"Hide Terms","initial":{"instruction_type":"normal","instruction_message":"I agree to the terms."},"unchecked":{"instruction_type":"error","instruction_message":"Please agree to the terms."},"checked":{"instruction_type":"success","instruction_message":"I agree to the terms."}},"email":{"placeholder_text":"Your email address","initial":{"instruction_type":"normal","instruction_message":"Enter your email address"},"success":{"instruction_type":"success","instruction_message":"Enter your email address"},"blank":{"instruction_type":"error","instruction_message":"Enter your email address"},"not_an_email_address":{"instruction_type":"error","instruction_message":"Make sure you have entered a valid email address"}},"note_with_tip":{"placeholder_text":"Your note here...","initial":{"instruction_type":"normal","instruction_message":"Attach a note to your tip (optional)"},"empty":{"instruction_type":"normal","instruction_message":"Attach a note to your tip (optional)"},"not_empty_initial":{"instruction_type":"normal","instruction_message":"Attach a note to your tip (optional)"},"saving":{"instruction_type":"normal","instruction_message":"Saving note..."},"success":{"instruction_type":"success","instruction_message":"Note successfully saved!"},"error":{"instruction_type":"error","instruction_message":"Unable to save note note at this time. Please try again."}},"email_for_login_code":{"placeholder_text":"Your email address","initial":{"instruction_type":"normal","instruction_message":"Enter your email to log in."},"success":{"instruction_type":"success","instruction_message":"Enter your email to log in."},"blank":{"instruction_type":"error","instruction_message":"Enter your email to log in."},"empty":{"instruction_type":"error","instruction_message":"Enter your email to log in."}},"login_code":{"initial":{"instruction_type":"normal","instruction_message":"Check your email and enter the login code."},"success":{"instruction_type":"success","instruction_message":"Check your email and enter the login code."},"blank":{"instruction_type":"error","instruction_message":"Check your email and enter the login code."},"empty":{"instruction_type":"error","instruction_message":"Check your email and enter the login code."}},"stripe_all_in_one":{"initial":{"instruction_type":"normal","instruction_message":"Enter your credit card details here."},"empty":{"instruction_type":"error","instruction_message":"Enter your credit card details here."},"success":{"instruction_type":"normal","instruction_message":"Enter your credit card details here."},"invalid_number":{"instruction_type":"error","instruction_message":"The card number is not a valid credit card number."},"invalid_expiry_month":{"instruction_type":"error","instruction_message":"The card's expiration month is invalid."},"invalid_expiry_year":{"instruction_type":"error","instruction_message":"The card's expiration year is invalid."},"invalid_cvc":{"instruction_type":"error","instruction_message":"The card's security code is invalid."},"incorrect_number":{"instruction_type":"error","instruction_message":"The card number is incorrect."},"incomplete_number":{"instruction_type":"error","instruction_message":"The card number is incomplete."},"incomplete_cvc":{"instruction_type":"error","instruction_message":"The card's security code is incomplete."},"incomplete_expiry":{"instruction_type":"error","instruction_message":"The card's expiration date is incomplete."},"incomplete_zip":{"instruction_type":"error","instruction_message":"The card's zip code is incomplete."},"expired_card":{"instruction_type":"error","instruction_message":"The card has expired."},"incorrect_cvc":{"instruction_type":"error","instruction_message":"The card's security code is incorrect."},"incorrect_zip":{"instruction_type":"error","instruction_message":"The card's zip code failed validation."},"invalid_expiry_year_past":{"instruction_type":"error","instruction_message":"The card's expiration year is in the past"},"card_declined":{"instruction_type":"error","instruction_message":"The card was declined."},"missing":{"instruction_type":"error","instruction_message":"There is no card on a customer that is being charged."},"processing_error":{"instruction_type":"error","instruction_message":"An error occurred while processing the card."},"invalid_request_error":{"instruction_type":"error","instruction_message":"Unable to process this payment, please try again or use alternative method."},"invalid_sofort_country":{"instruction_type":"error","instruction_message":"The billing country is not accepted by SOFORT. Please try another country."}}}},"fetched_oembed_html":false}
Can’t say I disagree with any of this. Well said.
Well said, Dear Brother! I lift you up as you do work as an ER doc that’s every bit as tough and often tougher than my work as an oncologist.
Take care!
Dr. Mike Stoltenberg
Psalm 66:19-20
Sir Leap – I heartily agree. I had not heard the term scanxiety – brilliant. Sometimes it seems as if there is no consideration at all for the emotional burden of time ‘not knowing” when awaiting results of outpatient tests of potentially life-changing significance. Perhaps we of ER experience are spoiled by our accessible resources and the immediacy of our patient exchanges, but can’t those in other parts of the system at least TRY for prompt reporting. Like you I have used my MD to slice through waiting (and even that is sometimes strangely awkward). I feel for others. This… Read more »