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Linda’s story

October 2009

If you haven’t seen this video, watch it and make it one of your “favorites.”

It is a reminder to all of us in health care, but especially those of us in hospital medicine, that we have an enormous responsibility to our patients and their families. It is a story of an elderly woman admitted to a Boston hospital that was obviously overcrowded and operating above capacity. It details the patient’s hospital course and her preventable death, as told by her daughter. It reveals the family’s frustration with the system in place and the care that was provided.

I’m not pointing fingers at anyone, but my reaction was one of disappointment and fear that something like this could happen. Disappointment that pleas for help from the family could be ignored and that a patient could have a disastrous outcome as a result of them not being heard. Fear of something similar happening in a facility in which I work. It prompted me to reflect on ways to prevent tragedies such as this:

– Listen to the patient (or his or her family). I vividly remember a mentor of mine in med school telling us on rounds one day, “Listen to the patient. They will tell you what is wrong with them.” We have become a highly technical profession, and we rely heavily on imaging and lab studies to guide our diagnosis and treatment.

But we can’t order the right study if we haven’t taken a complete history. This has made the difference in my practice more times than I can remember. Countless times, I have been called to the ED to see a patient with symptoms described as “vague” or “non-localizing” by the ED doc, and after a full history the picture became much more clear. We can’t ever be too busy to let patients tell us their story.

– When in doubt, err on the side of going to see the patient. We have all been there: Lots of calls from the floors at night about patients whom we are cross-covering, and inevitably, there is a call about a patient with a story from the nurse that just doesn’t add up. Go see the patient with your own eyes, listen with your own stethoscope and make your own judgment on the situation. The instrument in our practice with the largest liability is the telephone. Recognize that and when in doubt, be willing to lay your hands on the patient.

– As hospitalists, we are immediately behind the eight-ball when attempting to establish trust with a patient and family because we have no pre-existing relationship with them (except for “frequent-flyers”). The most convincing sign of your concern for patients and their condition is the amount of time you spend with them. The time spent with patients by physicians has overwhelmingly been linked to higher patient satisfaction scores and lower liability and risk.

I don’t live in a world without outside pressures. I have worked in enough hospitals and been exposed to many different hospitalist programs, some very busy and some not so much. I have felt the pressure to see more patients, and I have worked the nights with 15 admissions. I realize that there are only 24 hours in a day and 12 hours in a shift. But we all occasionally need to be reminded of why we do what we do. So watch the video.