How did the emergency department staff of a Texas hospital see, and discharge, a patient infected with Ebola? Despite the fact that blame spreads through hospitals faster than hemorrhagic fever viruses, I’m not interested in pinning down a single person, or a single thing, which may have allowed that to happen. I am very interested, however, in offering a few insights into what combination of factors might make it easy to send home a West African with a fever, without establishing the fact that he had a dangerous, contagious disease which finally caused his death.
First of all, America’s emergency departments are straining to keep up with the volume of patients that come through their doors. In 2010, the number of visits in the US was 129.8 million, according to the CDC. This numbers rises every year, despite the belief that the Affordable Care Act would direct people to primary care doctors and away from the ER.
The emergency departments of America bear the brunt of trauma, poisonings and drug abuse, of chronic diseases and social drama. They hold suicidal and psychotic patients for days to weeks when there is no other option available. An Ebola victim, with general, initial symptoms of fever, chills, vomiting, diarrhea, abdominal pain and headache, is a small needle in a big hay-pile of feverish, vomiting, suffering humanity.
Furthermore, many people with insurance (including Medicaid and Medicare) can’t find doctors, and large numbers who had insurance before subsequently lost it in the reshuffling of health benefits that has been going on since the ACA was passed. The emergency department is often all they have.
Second, it’s getting much, much harder to focus on that pesky but ubiquitous feature of the modern hospital, the patient. There is data to enter (which keeps nurses and physicians more focused on screens than adolescent boys playing on their Xbox). The electronic medical records systems are unfortunately complex and rarely intuitive. They require so much information that often, relevant points like ‘fever and came from West Africa,’ can be lost in the midst of endless time stamps, and required fields like ‘feels safe at home,’ ‘denies suicidal thoughts’ and ‘bed rails up, call light at bedside.’
Also, there are rules to follow to avoid censure. There are metrics to measure: time to stroke treatment, time to the cardiac cath lab for heart attacks, time from lobby to room, time from triage to doctor, time to discharge and many more; all of them contributing to the Holy Grail of modern health care, the high patient satisfaction score. (Which is being increasingly tied to job security and reimbursement, despite the bad science involved in the process.) Who has time to focus on a single, sick patient when so much depends on screens, rules and data entry?
Third, the rules for admission are ever more complex, based on what Medicare, Medicaid and private insurers are willing to cover. Patients we admitted without question ten years ago are now sent home and told to ‘come back if you get worse.’ In fact, it’s so hard to admit people that I now send home patients I would never have discharged, simply to avoid the misery of explaining the problem to already over-taxed hospitalists who are themselves constrained hand and foot by impossible rules. In this milieu, an otherwise healthy man with a fever is barely a blip.
I know this because earlier this year I was working in a teaching hospital and called the infectious disease specialist on call. My patient had just returned from a mission trip to the Caribbean and had a high white blood cell count, a fever, chills and rash. I was curious if I should have any particular exotic concerns. The specialist’s annoyed answer was this: ‘Sounds like he has a virus. He needs to see his family doctor this week.’
Now that we have Ebola in the US we are reminded that we in medicine, on the front lines, might miss something important. The medical pundits are wagging fingers and lecturing everyone about how best to manage this crisis. (Lecturing, that is, from the relative calm and safety of television studios, rather than the in the mind-numbing chaos of the ER.)
I agree. We need a plan. But the system, as it stands, functions every day on the very razor’s edge of disaster. We need to address that fact if we’re going to have any hope of dealing with Ebola, or other disasters, in the future.
Ed, Right on again! Now a Texas nurse has caught the virus while caring for Mr. Duncan. Dr. Friedan, head of the CDC said on A Face the Nation interview that the nurse had to have broken protocol because that is the only way she could have gotten the virus. Now that this nurse has Ebola, perhaps Dr. Friedan can fly over to Dallas and show us all how it is done. You and I both know from nuclear drills that when you “dress out” to leave a contaminated area you will get a small degree of contamination. What happens… Read more »
Samuel
8 years ago
Thanks for posting this. You made some very good points.
I hope someone who makes,government healthcare policy decisions is listening.
It is also nice for the general public, to understand the difficulties we encounter.
Elaine Stephens
8 years ago
Well said! It’s everywhere, if you don’t work in a particular department, whether it be the ED or in a classroom in public schools, you have no idea how they function. Although many are ready to criticize.
Thank you Dr. Leap for taking the time to enlighten us.
Elaine
Mike
8 years ago
I agree completely, Edwin. Any serious epidemic with completely overwhelm all of emergency medicine, and the ED doctors will get most of the blame.
Lenny
8 years ago
Essentially the point I made when I emailed the White House 10 days ago and again over the weekend. You can find the link for this by googling “email Obama”. Blaming a breach in protocol is like blaming the dynamite for exploding when you search for it in a dark cave using a torch to help you see. I strongly suggested that we need to close the airports in west Africa and militarily patrol the borders of affected countries. Draconian but necessary if this thing is to burn out. Won’t fix what is broken with our system, but the dysfunctional… Read more »
Anne D. Hesch, RN
8 years ago
Extremely succinct and well said! Sadly, I don’t anticipate anyone who isn’t at the bedside, working on the front lines in the ER, ICU and general hospital corridors, to understand. Again worse, those in the upper ranks of the CDC, the directors of the ACA, and for that matter, the administrators of the thousands of hospital systems nationwide, won’t give a care about what you and the rest of the front-liners think or believe. They have money on their minds and thinking about patient care, patient safety and good, sound medicine, is nowhere near their radars! Soldier on my friend… Read more »
Earl Stone RN
8 years ago
“fuckin’ A”
Elsa
8 years ago
Unfortunately, only those who’ve worked in an ER will understand this. Patients DO NOT understand (or care) why a nurse is late with their medication in the ER or don’t bring them a pillow right away or why they can’t have a glass of ice water. They think they are the only patient in the ER. They think their emergency is more important than getting that STEMI to the cath lab or intubating the status asthmatics 7 yr old that just came in by EMS or getting that code stroke to CT. Of course, you always have the seeker who… Read more »
Jon
8 years ago
I know that hospitals have very strict restrictions on who can be admitted and who can follow up with their PCP, but there’s no way any hospital would refuse to admit this particular patient. Especially with the Ebola crisis going on right now. We don’t do screening for these patients so that we can send them home if they aren’t bleeding from their eyes. Obviously someone dropped the ball on this and let this patient slip through the cracks. It’s a sad truth, but healthcare workers sometimes make mistakes that cost lives. And we can’t blame it on charting, obamacare,… Read more »
Well said! As a retired critical care paramedic of 30 years, I have worked on the box and in the E.D. I agree 100% but ….I also have something to add that WILL NOT BE POPULAR. Did the man EVER mention to the Dallas paramedics that he had just returned from west africa? Did he inform them that he had ridden around with a woman that had ebola and so forth??? Now if this man new that the woman was sick with ebola , why did he not mention it straight away? you know patients and family members love to… Read more »
Melissa
8 years ago
As s former ER nurse, I would have to agree with your commentary. However, I believe strongly that nurses have a voice and should use it. When a nurse has valuable information regarding the care and treatment of a patient he or she should make sure to verbalize those findings to a doctor. Do not rely on technology, it is not human and humans tend to only look at the data fields for which they are completing. Communication is key in everything that we do.
Bob Kaufmann
8 years ago
My mother in law was and my niece is an ER nurse and stressed to the max. They can vouch for this in its entirety. With the rise of 24 hour urgent care facilities you would think that ER services would not be utilized by everybody for every thing, especially in urban areas. They get swamped and a viral patient might well get sent home to get really sick. Disaster awaits the hospital systems in America. It’s right around the corner. They do the best they can. Sometimes it’s just not enough.
Mary Engrav
8 years ago
Thank you as always for your insight. True and insightful article. Rallying behind our ED colleagues, nurse and physician. God Bless all of you.
D.H.B
8 years ago
Well written and right on point. ED nurses are pushed to the limit with the ACA, documentation and timed for every patient encounter. The stop watch never stops.
Roger
8 years ago
As an ole (and old) emergency physician AND as a patient who presented to an ED with 104 or 105 temp (I was so sick that I don’t even remember) with severe vomiting and a WBC count of 18,000, I find all the accusations rather sickening. I have good insurance and I was sent home after a few hours, Zofran and a couple of liters of fluid. Should I have expected more? No, I was well and properly treated and have been well ever since (and I didn’t make anyone else ill) so don’t give me that bull about how… Read more »
Dee Dee Sherrod
8 years ago
Very well written and an excellent depiction of life the the ER.
Deb RN
8 years ago
You have a wonderful way with words, Doc. Yes, we are focused way to much on the red tape to see the pertinent points ahead of us at times! Thanks for your excellent narrative of a crazy day in the ER! Hey, you forgot the drug seekers, the psych patients and drunks that we are trying to keep safe from themselves, by doing q15 minute checks, applying fall precautions, and wrestling and subduing those patients who become belligerent and go berserk in the ER. …..All in a dayS work……
vivian
8 years ago
From this er nurses perspective….this is spot on!
Carol ED RN
8 years ago
Great perspective. As usual, spot on and to the point. ” An otherwise healthy man with a fever is barely a blip” on the screen. Love your brain and your style.
Joshua C
8 years ago
Great article. Got it from my sister who is an Emergency Nurse. Very clear and understandable. When will we allow Dr’s and Nurses to put down the paperwork (computer work) and allow them to do what they are trained to do, heal the sick and care for the suffering.
Connie
8 years ago
Thank you so much, for saying what so many of us have wanted to say, to explain, and to understand.
Dr. Laura Bevis APRN
8 years ago
You hit the nail on the head and did it so well!
Jan Olson
8 years ago
Nicely put. Thank you.
jan
8 years ago
I absolutely agree with you regarding the missed Ebola pt. I work in Toronto and the same type of 3 thing is happening here. I think the computerized system is not very practical or useful in many hospital environments. As you said, information is lost in the maze of required fields, and it is increasingly hard to even properly assess a pt when your head is buried in a computer. You can’t just chart everything later because no tests can be done without everything completed on the computer, and there are tabs upon tabs upon tabs to fill out, and… Read more »
Aj
8 years ago
We need to go back….”caring for the person”……NOT the CEO’s or anything else !!
Follow the many countries that have FREE health care……..for people, NOT the money !!
ER_Dawg
8 years ago
The guy who wrote this article is #1) An amazing ER Doc who TOTALLY gets it. ER’s across America get slammed wide open on most days of the week. Their Doctors, Nurses and Staff carry an enormous burden week end and week out – all to hear gripes, complains, moans and groans from patients, family, and their doctor s( on the other end of the phone) – telling you there’s nothing wrong with grandma Jones and her pneumonia – age 79 with a low 02 sat. of 93% who has a fever and clear CXR findings of infiltrates (pneumonia). As… Read more »
Ron
8 years ago
Well said!
Mary Beth Ellison
8 years ago
This is true, every word.. If only people knew.
MaRk
8 years ago
It sounds like the infectious disease specialist on call is a dick with ears…
Steve
8 years ago
Read this
Dawn
8 years ago
This is truly very scary. As the mother of an Emergency Room Nurse and being a person with some medical knowledge I Am Begging Everyone Wash Your Hands as if Scrubbing Into a Surgery. We The People Remember that line? We Are The best Defense. Always Use good manners when coughing, sneezing try to wash your hands immediately even with bottle water or a hose outlet. Advoid large crowds if you don’t feel good don’t go out. If you have anything expect your household has it. Please simply washing our hands for more than a hot second if at all.… Read more »
Jack Jagoe
8 years ago
This is the best description of E R requirements that I have ever read. Fortunately, to date, my wife and I have received excellent response and care in our Emergency Care circumstances. A downside, as I see it, of the increasing requirements of government and legal report writing required for each medical event is that the doors are opening for federal agencies being assigned to take over the operation of all E R services. The hue and cry for the government take over will be that the government can do it better and, of course, having the government in total… Read more »
Jan
8 years ago
What he said! Even though our government cannot close airports in other countries, the State Department should have stopped issuing visas to people from the affected countries until the outbreak is over. They could, and should, do that even now, but they will not. Why not? They will not do it because the entire health care system is being run by politicians and lawyers and regulators, none of whom have any idea what it means to care for patients. It is about money and political correctness and power.
Aisha
8 years ago
As an ER physician, there are always certainly red flag in a patient’s history that I focus on; they are prominent regardless of the number of patients we see; a patient presenting with that history and a recent travel history to/from Africa is one of those red flags; your excuses are invalid.
Chris B-RN
8 years ago
Three conditions: gastritis, flu, and Ebola. Same symptoms. You are NOT going to be admitted to hospital.
Now we have nurses considering jumping ship because of the risk to their very lives. No nurse sets out to die when caring for patients. Those nurses did not “breach protocol”. Every health care professional needs to regard this disease with AIR BORNE protocol.
What are we going to do when nurses refuse to take care of Ebola patients?
Ginger Lee Doucher-Bush
8 years ago
So first it was “don’t worry, we know how to handle this disease here.” Then it was “there must have been a breach of protocol, or a failure of safety equipment.” Now it’s “we can’t reasonably expect medical staff to notice the signs of an epidemic hat’s been raging while having to fill out paperwork?”
Truly the only time you should worry about an outbreak is when you’re told not to.
Kelli
8 years ago
Great article and you hit the nail on the head.
Smokey
8 years ago
It sounds like an excuse… Heard the phrase “If you’re not part of the solution, you’re part of the problem”?
Cathy, RN
8 years ago
Having been an ER nurse for 40+ years, from what I have read, heard, etc., the first(?triage nurse) that saw the patient who expired, had highlighted the fact that the patient had been in W. Africa and also added exclamation marks, like this !!!!!!!!! She did not miss the boat at all. The problem becomes when the ER Physicians(and there are many) who do not take the time to READ the Triage nurse’s notes!!! Having worked triage for many years, be it understood, that the nurses that work triage are highly skilled and experienced, and do the work that was… Read more »
Amir
8 years ago
Well written, but it might be wise to be a little more careful in the liberties you take in your writing. Specifically I think it is way off base to say that the reason that time to stroke treatment or door to balloon time is tracked is for patient satisfaction. Following those rules should not be viewed as barriers to good care. They are there because not following them may mean patients get hurt, and as a lot of medical literature has shown, physicians cannot always be automatically trusted to provide appropriate and timely care.
Beth
8 years ago
Sounds like teaching nowadays.
JOEL R
8 years ago
I understand what the article is saying and it makes a good few points. But the fact of the matter when a patient comes to the ER complaining about symptom like Ebola and that person tells you he or her just came from west Africa . Hello stop and think write it down like the nurse did and say something express any concern this is not a cold its a life threatening sickness and contagious never mind all the politics behind the insurance company a man is dead and a woman’s life is in danger the nurse I’m referring to… Read more »
Pat
8 years ago
so, if Ebola has been identified since 1976, why is it now so lethal? ED nurse for 44 years…….
Andy
8 years ago
Some of these comments here from doctors and nurses are truly scary. Does caring for the patient come into the equation anymore? Just because you see it all day does not lesson the pain or discomfort the patient is in. You talk about people that come in there for frivolous maladies, fine, get them in and out fast or don’t pay attention. Fact of the matter is most of us don’t go to the ER for a fever or vomiting and if we do then we must have something seriously wrong. The ER is the last place I want to… Read more »
Edwin, THANK YOU! As an ER doc for 18 years, I feel your pain.
Andy (above) you.have.no.clue. None. Spend 12 hrs walking in our shoes, then tell me about it. Whatever it is you do – please- tell me, are lives as stake? Real actual lives? I pity your cluelessness.
Ok, to all of the readers and commenters, thanks for taking the time. Let me be clear, I’m not trying to excuse a mistake. Mistakes happen, I’ve made them myself. And I’m not trying to trivialize the complaints that bring people to the ER. What I’m trying to point out is that for a variety of reasons, mostly regulatory, it’s harder and harder to focus on the most important thing, and that’s the interaction with and care of the patient. Everyone has a ‘pet metric’ they want measured, and the comment is, ‘its just one screen, or just one click,’… Read more »
Barbara
8 years ago
beautifully said…a must read! SCAREY!!!!
Ann , RN, Emergency Dept.
8 years ago
Seeing the Health Care System evolve over the past years, I couldn’t have said it better. Scary to think people know more about their motor vehicles than their bodies. Americans are reactive to illness instead of proactive for wellness. Government agencies making rules and regulating health care is a BAD thing.
Fred Goodwin Jr MD, FACEP
8 years ago
Chaos explained. Truth told. Thank you. Putting into words what we all see and also know to be true. You, Edwin, are the spokesman for this generation in this business. The experience to notice the shifts in care and the snark to make it readable. In terms of how medicine has changed, I’m only 10yrs out from residency but I once wrote an order that simply said, “d/c when no longer homicidal”. Try to find that in your expansive electronic COPE database. Imagine the trouble that order would cause today. He was a pt well know to all who “was… Read more »
barry
8 years ago
Texas actually refused the medicaid expansion… and probably has the public infrastructure of a 3rd world country.
Admira
8 years ago
Thank you Ed for posting this. Each commenter has a point. However, Andy also has an interesting point. Looking at it from a patient point, it feels like patients are no longer in the equation, and this is all about money, bureaucracy and technology. It is scary to think that I’m just a number, not a human being. Most of us dread the ER and don’t even want to go in. However, we have no choice when it is a state of emergency. Over the course of years, statistics have proven that most people die in the E.R before even… Read more »
Racedok
8 years ago
The Texas ED failed patient zero? We will ALWAYS miss patient zero! The first patient that presents dying from anthrax, Marlberg virus, radiation poisoning, pneumonic plague, Hanta virus will still always die. The incidence of these illnesses is infintismal compared to a common illness such as the flu. When a pattern emerges, then we can follow it. When you hear the beating of hooves in the hall, you do not think of zebras! The author makes the point that we need to pay more attention to patient care and not filling out stupid matrices and paperwork. Believe me, that would… Read more »
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Ed, Right on again! Now a Texas nurse has caught the virus while caring for Mr. Duncan. Dr. Friedan, head of the CDC said on A Face the Nation interview that the nurse had to have broken protocol because that is the only way she could have gotten the virus. Now that this nurse has Ebola, perhaps Dr. Friedan can fly over to Dallas and show us all how it is done. You and I both know from nuclear drills that when you “dress out” to leave a contaminated area you will get a small degree of contamination. What happens… Read more »
Thanks for posting this. You made some very good points.
I hope someone who makes,government healthcare policy decisions is listening.
It is also nice for the general public, to understand the difficulties we encounter.
Well said! It’s everywhere, if you don’t work in a particular department, whether it be the ED or in a classroom in public schools, you have no idea how they function. Although many are ready to criticize.
Thank you Dr. Leap for taking the time to enlighten us.
Elaine
I agree completely, Edwin. Any serious epidemic with completely overwhelm all of emergency medicine, and the ED doctors will get most of the blame.
Essentially the point I made when I emailed the White House 10 days ago and again over the weekend. You can find the link for this by googling “email Obama”. Blaming a breach in protocol is like blaming the dynamite for exploding when you search for it in a dark cave using a torch to help you see. I strongly suggested that we need to close the airports in west Africa and militarily patrol the borders of affected countries. Draconian but necessary if this thing is to burn out. Won’t fix what is broken with our system, but the dysfunctional… Read more »
Extremely succinct and well said! Sadly, I don’t anticipate anyone who isn’t at the bedside, working on the front lines in the ER, ICU and general hospital corridors, to understand. Again worse, those in the upper ranks of the CDC, the directors of the ACA, and for that matter, the administrators of the thousands of hospital systems nationwide, won’t give a care about what you and the rest of the front-liners think or believe. They have money on their minds and thinking about patient care, patient safety and good, sound medicine, is nowhere near their radars! Soldier on my friend… Read more »
“fuckin’ A”
Unfortunately, only those who’ve worked in an ER will understand this. Patients DO NOT understand (or care) why a nurse is late with their medication in the ER or don’t bring them a pillow right away or why they can’t have a glass of ice water. They think they are the only patient in the ER. They think their emergency is more important than getting that STEMI to the cath lab or intubating the status asthmatics 7 yr old that just came in by EMS or getting that code stroke to CT. Of course, you always have the seeker who… Read more »
I know that hospitals have very strict restrictions on who can be admitted and who can follow up with their PCP, but there’s no way any hospital would refuse to admit this particular patient. Especially with the Ebola crisis going on right now. We don’t do screening for these patients so that we can send them home if they aren’t bleeding from their eyes. Obviously someone dropped the ball on this and let this patient slip through the cracks. It’s a sad truth, but healthcare workers sometimes make mistakes that cost lives. And we can’t blame it on charting, obamacare,… Read more »
Well said! As a retired critical care paramedic of 30 years, I have worked on the box and in the E.D. I agree 100% but ….I also have something to add that WILL NOT BE POPULAR. Did the man EVER mention to the Dallas paramedics that he had just returned from west africa? Did he inform them that he had ridden around with a woman that had ebola and so forth??? Now if this man new that the woman was sick with ebola , why did he not mention it straight away? you know patients and family members love to… Read more »
As s former ER nurse, I would have to agree with your commentary. However, I believe strongly that nurses have a voice and should use it. When a nurse has valuable information regarding the care and treatment of a patient he or she should make sure to verbalize those findings to a doctor. Do not rely on technology, it is not human and humans tend to only look at the data fields for which they are completing. Communication is key in everything that we do.
My mother in law was and my niece is an ER nurse and stressed to the max. They can vouch for this in its entirety. With the rise of 24 hour urgent care facilities you would think that ER services would not be utilized by everybody for every thing, especially in urban areas. They get swamped and a viral patient might well get sent home to get really sick. Disaster awaits the hospital systems in America. It’s right around the corner. They do the best they can. Sometimes it’s just not enough.
Thank you as always for your insight. True and insightful article. Rallying behind our ED colleagues, nurse and physician. God Bless all of you.
Well written and right on point. ED nurses are pushed to the limit with the ACA, documentation and timed for every patient encounter. The stop watch never stops.
As an ole (and old) emergency physician AND as a patient who presented to an ED with 104 or 105 temp (I was so sick that I don’t even remember) with severe vomiting and a WBC count of 18,000, I find all the accusations rather sickening. I have good insurance and I was sent home after a few hours, Zofran and a couple of liters of fluid. Should I have expected more? No, I was well and properly treated and have been well ever since (and I didn’t make anyone else ill) so don’t give me that bull about how… Read more »
Very well written and an excellent depiction of life the the ER.
You have a wonderful way with words, Doc. Yes, we are focused way to much on the red tape to see the pertinent points ahead of us at times! Thanks for your excellent narrative of a crazy day in the ER! Hey, you forgot the drug seekers, the psych patients and drunks that we are trying to keep safe from themselves, by doing q15 minute checks, applying fall precautions, and wrestling and subduing those patients who become belligerent and go berserk in the ER. …..All in a dayS work……
From this er nurses perspective….this is spot on!
Great perspective. As usual, spot on and to the point. ” An otherwise healthy man with a fever is barely a blip” on the screen. Love your brain and your style.
Great article. Got it from my sister who is an Emergency Nurse. Very clear and understandable. When will we allow Dr’s and Nurses to put down the paperwork (computer work) and allow them to do what they are trained to do, heal the sick and care for the suffering.
Thank you so much, for saying what so many of us have wanted to say, to explain, and to understand.
You hit the nail on the head and did it so well!
Nicely put. Thank you.
I absolutely agree with you regarding the missed Ebola pt. I work in Toronto and the same type of 3 thing is happening here. I think the computerized system is not very practical or useful in many hospital environments. As you said, information is lost in the maze of required fields, and it is increasingly hard to even properly assess a pt when your head is buried in a computer. You can’t just chart everything later because no tests can be done without everything completed on the computer, and there are tabs upon tabs upon tabs to fill out, and… Read more »
We need to go back….”caring for the person”……NOT the CEO’s or anything else !!
Follow the many countries that have FREE health care……..for people, NOT the money !!
The guy who wrote this article is #1) An amazing ER Doc who TOTALLY gets it. ER’s across America get slammed wide open on most days of the week. Their Doctors, Nurses and Staff carry an enormous burden week end and week out – all to hear gripes, complains, moans and groans from patients, family, and their doctor s( on the other end of the phone) – telling you there’s nothing wrong with grandma Jones and her pneumonia – age 79 with a low 02 sat. of 93% who has a fever and clear CXR findings of infiltrates (pneumonia). As… Read more »
Well said!
This is true, every word.. If only people knew.
It sounds like the infectious disease specialist on call is a dick with ears…
Read this
This is truly very scary. As the mother of an Emergency Room Nurse and being a person with some medical knowledge I Am Begging Everyone Wash Your Hands as if Scrubbing Into a Surgery. We The People Remember that line? We Are The best Defense. Always Use good manners when coughing, sneezing try to wash your hands immediately even with bottle water or a hose outlet. Advoid large crowds if you don’t feel good don’t go out. If you have anything expect your household has it. Please simply washing our hands for more than a hot second if at all.… Read more »
This is the best description of E R requirements that I have ever read. Fortunately, to date, my wife and I have received excellent response and care in our Emergency Care circumstances. A downside, as I see it, of the increasing requirements of government and legal report writing required for each medical event is that the doors are opening for federal agencies being assigned to take over the operation of all E R services. The hue and cry for the government take over will be that the government can do it better and, of course, having the government in total… Read more »
What he said! Even though our government cannot close airports in other countries, the State Department should have stopped issuing visas to people from the affected countries until the outbreak is over. They could, and should, do that even now, but they will not. Why not? They will not do it because the entire health care system is being run by politicians and lawyers and regulators, none of whom have any idea what it means to care for patients. It is about money and political correctness and power.
As an ER physician, there are always certainly red flag in a patient’s history that I focus on; they are prominent regardless of the number of patients we see; a patient presenting with that history and a recent travel history to/from Africa is one of those red flags; your excuses are invalid.
Three conditions: gastritis, flu, and Ebola. Same symptoms. You are NOT going to be admitted to hospital.
Now we have nurses considering jumping ship because of the risk to their very lives. No nurse sets out to die when caring for patients. Those nurses did not “breach protocol”. Every health care professional needs to regard this disease with AIR BORNE protocol.
What are we going to do when nurses refuse to take care of Ebola patients?
So first it was “don’t worry, we know how to handle this disease here.” Then it was “there must have been a breach of protocol, or a failure of safety equipment.” Now it’s “we can’t reasonably expect medical staff to notice the signs of an epidemic hat’s been raging while having to fill out paperwork?”
Truly the only time you should worry about an outbreak is when you’re told not to.
Great article and you hit the nail on the head.
It sounds like an excuse… Heard the phrase “If you’re not part of the solution, you’re part of the problem”?
Having been an ER nurse for 40+ years, from what I have read, heard, etc., the first(?triage nurse) that saw the patient who expired, had highlighted the fact that the patient had been in W. Africa and also added exclamation marks, like this !!!!!!!!! She did not miss the boat at all. The problem becomes when the ER Physicians(and there are many) who do not take the time to READ the Triage nurse’s notes!!! Having worked triage for many years, be it understood, that the nurses that work triage are highly skilled and experienced, and do the work that was… Read more »
Well written, but it might be wise to be a little more careful in the liberties you take in your writing. Specifically I think it is way off base to say that the reason that time to stroke treatment or door to balloon time is tracked is for patient satisfaction. Following those rules should not be viewed as barriers to good care. They are there because not following them may mean patients get hurt, and as a lot of medical literature has shown, physicians cannot always be automatically trusted to provide appropriate and timely care.
Sounds like teaching nowadays.
I understand what the article is saying and it makes a good few points. But the fact of the matter when a patient comes to the ER complaining about symptom like Ebola and that person tells you he or her just came from west Africa . Hello stop and think write it down like the nurse did and say something express any concern this is not a cold its a life threatening sickness and contagious never mind all the politics behind the insurance company a man is dead and a woman’s life is in danger the nurse I’m referring to… Read more »
so, if Ebola has been identified since 1976, why is it now so lethal? ED nurse for 44 years…….
Some of these comments here from doctors and nurses are truly scary. Does caring for the patient come into the equation anymore? Just because you see it all day does not lesson the pain or discomfort the patient is in. You talk about people that come in there for frivolous maladies, fine, get them in and out fast or don’t pay attention. Fact of the matter is most of us don’t go to the ER for a fever or vomiting and if we do then we must have something seriously wrong. The ER is the last place I want to… Read more »
Edwin, THANK YOU! As an ER doc for 18 years, I feel your pain.
Andy (above) you.have.no.clue. None. Spend 12 hrs walking in our shoes, then tell me about it. Whatever it is you do – please- tell me, are lives as stake? Real actual lives? I pity your cluelessness.
Ok, to all of the readers and commenters, thanks for taking the time. Let me be clear, I’m not trying to excuse a mistake. Mistakes happen, I’ve made them myself. And I’m not trying to trivialize the complaints that bring people to the ER. What I’m trying to point out is that for a variety of reasons, mostly regulatory, it’s harder and harder to focus on the most important thing, and that’s the interaction with and care of the patient. Everyone has a ‘pet metric’ they want measured, and the comment is, ‘its just one screen, or just one click,’… Read more »
beautifully said…a must read! SCAREY!!!!
Seeing the Health Care System evolve over the past years, I couldn’t have said it better. Scary to think people know more about their motor vehicles than their bodies. Americans are reactive to illness instead of proactive for wellness. Government agencies making rules and regulating health care is a BAD thing.
Chaos explained. Truth told. Thank you. Putting into words what we all see and also know to be true. You, Edwin, are the spokesman for this generation in this business. The experience to notice the shifts in care and the snark to make it readable. In terms of how medicine has changed, I’m only 10yrs out from residency but I once wrote an order that simply said, “d/c when no longer homicidal”. Try to find that in your expansive electronic COPE database. Imagine the trouble that order would cause today. He was a pt well know to all who “was… Read more »
Texas actually refused the medicaid expansion… and probably has the public infrastructure of a 3rd world country.
Thank you Ed for posting this. Each commenter has a point. However, Andy also has an interesting point. Looking at it from a patient point, it feels like patients are no longer in the equation, and this is all about money, bureaucracy and technology. It is scary to think that I’m just a number, not a human being. Most of us dread the ER and don’t even want to go in. However, we have no choice when it is a state of emergency. Over the course of years, statistics have proven that most people die in the E.R before even… Read more »
The Texas ED failed patient zero? We will ALWAYS miss patient zero! The first patient that presents dying from anthrax, Marlberg virus, radiation poisoning, pneumonic plague, Hanta virus will still always die. The incidence of these illnesses is infintismal compared to a common illness such as the flu. When a pattern emerges, then we can follow it. When you hear the beating of hooves in the hall, you do not think of zebras! The author makes the point that we need to pay more attention to patient care and not filling out stupid matrices and paperwork. Believe me, that would… Read more »