Monday, March 22, 2010

Save The Scowl

During yet another busy shift in our emergency department, our staff was on the receiving end of multiple scowls by patients and their families. None warranted, mind you, and none were taken personally. But, nonetheless, it seemed to be the theme of the day.

What started the scowling? Simultaneously, we had three ambulances arrive to our ambulance bay, within minutes of one another. A chest pain patient, a stroke patient, and a trauma patient. Our staff, always ready to rise to the occasion, planned our divide and conquer.

I treated the stroke patient. A 60 y.o. male, normally healthy except for his smoking history, had a sudden onset of slurred speech accompanied by some extremity weakness. His symptoms had started within the past hour and were witnessed by his wife.

"We were sitting in our Lazy-Boys, watching our favorite show, The Wheel of Fortune, when he started having these problems," she said, frightened. "Is he going to be okay, doctor?

We called a "stroke alert." Similar to treating a multiple-trauma patient or an actively-infarcting heart attack patient, we have an emergency response team composed of ourselves, an in-house neurologist, multiple nurses, and the IV team. Our goal? To stabilize a patient, get imaging studies (especially a CT scan), and intervene as quickly as possible. With the right circumstances, we have several treatment options that can reverse such devastating symptoms.

Well, my patient did have a stroke. His CT scans were negative for any hemorrhaging and he qualified for tPA, a clot-buster used very cautiously but effectively to treat ischemic strokes. Simply, this type of stroke is usually caused by an embolus (or clot) that travels to the brain, occluding an artery and preventing blood supply to the brain tissue beyond. tPA can dissolve this clot.

It worked. Within the hour that followed, all of my patient's symptoms resolved.

The cardiac patient went to the cath lab. Unfortunately, the trauma patient died. And, all the while, patients began to back up, waiting for their emergency care. This, I'm afraid, was probably the moment when scowling became an epidemic.

Outside our triage station (the nursing station where a walk-in patient is first greeted and evaluated), patients lying on cots started backing up, lining the hallway. A bad sign that we were getting crowded. Between the patients and their accompanying family members, you couldn't walk down that hallway without having several people give you dirty looks. This, despite them being able to see how we were all rushing around, working hard.

Several patients later, I walked into a very unforgiving room. Lying in the cot was an elderly man with enough piss-and-vinegar to last me a lifetime. Pacing the room, his son. Sitting in the corner, his wife. They were upset with their wait. They had been sent to our ER by their family doctor (so they said) for a problem that was chronic in nature. Specifically, continued urinary problems from an enlarged prostate. Nothing new, they simply called for an appointment and couldn't get one for a week.

"I don't understand how you can make people wait like this," the patient started, before I even had a chance to acknowledge their delay. After assuring them that we were all working quite hard, I simply focused on this patient's history and physical. All stable. With the delays in care, the triage nurse had ordered a UA and blood work, also normal. I explained in detail my exam and the results of these tests, reassuring the patient and his family that everything looked okay.

Three scowls greeted that news.

Finally, just when I thought the scowls were slowing down, a mother walked out of her child's treatment room, quite gruff, while I was handing a chart to our secretary.

"Can someone give me the access code for the internet? For some reason, I can't sign on," she said, clearly annoyed with her wait, her eyes rolling.

Wait a second. We give out turkey sandwiches and lemon pudding. We pass out warm blankets by the dozen. We reimburse parking. And we even have a TV in each private room. When did we start having available internet access for patients and their families? Did I miss something? Do we have a coffee bar I don't know about, either?

"We don't have internet access in the ER, maam," our secretary answered the mother. "Sorry about that."

The mother bore her angry eyes into us. And scowled. "That's ridiculous," she mumbled, before turning and stomping back into the room.

Eventually, during that shift, we caught up with our patient-load and the scowls lessened. In fact, I might have even seen a few smiles. Always a plus

Truthfully, the scowls don't bother me. Well, okay, maybe just a little. But only because they seem to be accompanied with a sense of entitlement. Yes, I understand that when someone is sick, it might be hard for them to comprehend that their symptoms may be less urgent than the next patient. We aren't minimizing the symptoms, simply prioritizing them. We are an emergency department. We don't ask people to come in. We would never deliberately make a patient wait. The scowls being given to us are for things that we, the ER staff, can't control.

Well, short of getting internet access in the ER, that is.

As always, big thanks for post will be Wednesday, March 24. Interestingly, as I finished this post, the health reform bill passed...more scowls to come...


Gia's Spot said...

I give you big kudos for not punching anyone who continued to scowl at you! The last time I had to go the the local ER I was literally forced by my daughter the RN and other daughter. I was hit by a truck on my bike, I knew I had broken some ribs so why did I need to bother the staff at the ER, who were busy I was certain with true traumas. Well needless to say the Dr was very appreciative of my apologies and my SMILE (he mentioned it twice) and I was happy I was a quick one for them. I actually told the Dr that if he needed a break, I would stay in the cubicle looking like I was waiting if he wanted to step out!! Thankfully I didn't puncture anything and I am still sticking needles in the Voodoo doll I made for the jerk who hit me and left the scene without so much as an are you ok!! So if you happen to get a patient complaining of mystery pin pricks, its just Gia getting him back!
(sorry to hijack your blog! **hug** Gia)

Chrysalis Angel said...

I don't understand how people can "not" look outside of themselves, and see what is happening around them. Can't they see that the team that is there is busting their behinds to render care? When did we all become a nation of spoiled brats?

DreamingTree said...

I don't think that these people are able to look at the big picture. When people complain to me (up on the med/surg floor) about their wait in the ER, I smile & explain to them why it takes so long. I do the same for those who are complaining because their doctor hasn't seen them yet, or who are nagging the aide about why I haven't brought them their medications yet. My favorite response is that they should be thankful if they are waiting because it means that their condition isn't as serious as those ahead of them.

Heather said...

You've got to remind them....That BIG Red "H" on the side of the building stands for "hospital" not "Hilton!"

911RN said...

The scowls....aahh, know them well! What's worse, for me, are the loiterers. Those that hang in the doorway or outside their rooms watching and waiting to see if they are next or just being nosy. Like that is going to make them go to the head of the line-NOT!Makes me want to put THEIR chart one or two more slots back:)Love the nurses that tell these folks (with a smile)- "we ask that you stay in your room for confidentiality reasons- we don't want a HIPPA violation- I hope you understand" (sweetly, of course). Then they scowl even more and stomp back in their rooms!

Talked to a nurse from Canada that works in our dept- she reports ER wait times there can be up to 24hours. She still has family there- says average stay in hosp. after major surgery- total hip etc.- is 1.5 days. People are sent home with follow up from Home Health. She reports many "fall through the cracks."

With that in mind...the Healthcare Bill passed (sigh)...what will our entitled, "what do you mean you don't have ER internet access" populous do if the Canadian scenario plays out across our nation in years to come???!!!

All I can think is I am not close enough to retirement (another sigh).Scowls may then be a welcome sight, least we need riot gear to perform our jobs. The next few years should be quite interesting,for those of us providing healthcare... that's putting it mildly!

Thanks for "on target" post relevant to current events.

Anonymous said...

I just finished reading the March edition of Reader's Digest and the lead article in there was called "50 Secrets ER Doctors Won't Tell You" and the article addressed the intimidating stares and the entitlement mentality, neither of which will endear you to the ER staff or get you seen quicker. A little patience and a smile will get you a lot further.

Empress Bee (of the High Sea) said...

we are so fortunate. we have a doctor that tells us to go to the er and is there when we arrive. hubby is a cancer patient and has had several problems that took us to the er in the past year and having a private doctor to greet us is such a blessing. i realize everyone is not so fortunate and i am very thankful. i am betting the er staff isn't happy about it though. do they mind?

smiles, bee

Katie said...

I think this post really captures the impatience and self-absorption that is consuming this world. I hate it just as much as I've been a part of it. It's a post like this that reminds me why I didn't call my ResTech in the middle of my rage last night about not having internet upon returning to campus despite my computer staying here all week.

Note to self: don't "accidently" get injured so I can use the ER internet if my isn't fixed today.

Well done,
<>< Katie

Marcy Hall said...

hey, i wanted to pass on a comment about how AWESOME the ER staff is at your hospital. :) i visited a friend in your hospital a few days ago. she had been to the ER and had had to have surgery. she waited about 8 hours to see a doctor due to 3 accidents that had happened and tons of patients being brought in. she said she thought the staff in the ER was AMAZING-- efficient, friendly, and wonderfully caring despite the fact that they were obviously understaffed, overworked and exhausted.

i've been wanting to tell you that. not sure if that was your shift, but it wouldn't surprise me. :)

Patti said...

I remember a day several years ago where my ED was full to the gills (all 25 rooms full, 8 hall patients, waiting room backed up, and people standing at the doorways and scowling). All of a sudden the triage nurse comes running back with a blue baby (the parents lived across the street from the hospital and ran over when he stopped breathing). There was no where to put the kid, so we just started coding him on my desk while the staff made room. Basically, everyone in the entire ED was watching this code. Unbelievably, several people gave the nurses a hard time about getting up from THEIR stretchers (and one later complained to administration that she was rudely yanked from her bed). A couple of patients/families actually complimented me on how things went down, but most people just increased their grumbling and scowling about the wait. Oh and the baby did OK in the end. It really is a thankless job.

littlepretendnurse said...

Sometimes I wish HIPPA did not exist so that we could show the scowlers the patients or charts of said patients that made them wait. Of course it probably wouldn't help when we told them their broken toe had to wait for the heart attack victim AND the multiple GSW. They would get upset anyway. Such is the state of entitlement we must deal with on a daily basis.

Just wanted to say "Great job!!!" since no one that day seemed able to say it!

terri c said...

I do think greed and entitlement are enormous problems in the culture of this country today. We had a fire alarm in our building; lights flashing, awful buzzers--staff running from room to room to make sure patients were safe, close doors, etc., and firefighters swarming. One patient said, "What is THAT NOISE." Being told it was an alarm, patient delivered a MAJOR eyeroll and said, "So WHO is going to TURN IT OFF?" Ummmmm, can we see if the BUILDING IS ON FIRE first????

WWWebb said...

This ex-EMT goes out of his way to make up for [walking sphincters] like that.

I've been dealing with what started as an open tib/fib last May that developed complications.

I cut up with nurses, crack jokes at the doctors and tease the techs.

I've experienced "patients behaving badly" and can honestly say.that the only time I've been there was.when I was delirious with a post-op fever and was wearing an indwelling catheter for the first time in my life.

Classof65 said...

When you've done a good job and you know you have, it shouldn't matter whether ignorant people acknowledge it. They are too ignorant to know if you're doing it right or not. However, your co-workers, hopefully not ignorant, know what you did and should acknowledge your effort and skill. And you should be doing the same for them. A quick comment and pat on the back can make anyone's day -- take the time to do that for each other and it won't matter what the ignorant masses think, right?!

Anonymous said...

So if the scowlers are told to "F" off and to put a cork in it....would that really upset the Press Gainey scores?!?!?!
I wish the staff would finally revolt and just say what NEEDS to be said and hang it all with that nicety stuff.
Where are those entitled people going to go; the boutique hospital?


Rositta said...

"Wait a second. We give out turkey sandwiches and lemon pudding. We pass out warm blankets by the dozen. We reimburse parking. And we even have a TV in each private room. When did we start having available internet access for patients and their families? Did I miss something? Do we have a coffee bar I don't know about, either?"
Maybe your hospital is more like a hotel. Is it possible that if you didn't offer all of the above services, only people who truly need to be there will be? Somebody has to be paying for all those extras? Our ER waits are more than 6 hours generally which is why I avoid them at all costs...ciao

somedaydoc said...
This comment has been removed by the author.
Marie said...

Katie in her comment was so polite. She says people are consumed by "impatience and self-absorption".

This how I put it: people are asses. They are thoughtless, rude and inconsiderate.

Ok, with maybe a few exceptions.

I was the Director of Admissions at the second busiest ER on the East Coast for several years. The abuse my staff and the clinical staff took was jaw-dropping. And yet they were always professional, committed to giving the best care possible, no matter what. Even when it meant they went and cried afterward from the hurtfulness of it.

You are true unsung heroes, for so many reasons.

Anonymous said...

It is always easy to hack into institutional internet servers. Try the main phone number as a password and the acronym as the username. Next try the username in both locations. p@ss123 is a common one too ;p

(I'm not a hacker though).

Cal said...

So many people lack awareness of what surrounds them and of their actions... I guess their gaze rarely goes further afield than their bellybutton.

Gretchen said...

No scowls for health care reform passing, just a huge smile!!

t. said...

Thankfully it's not been often that I've had to be an ER patient. But I always try to smile, be courteous, say "Yes ma'am" or "Yes sir" becuase that's how my parents raised me.

Plus, I don't want the nurse to use the dull, square needle when she's putting in my IV or the doctor to give me a DRE for my migraine headache!

You and your staff deserve your own national Stand Up and Say Thank You to The ER Staff Day. Just because.

Leslie said...

Dang Jim, what kind of service are you guys providing over there? When I go to the ER I never have to wait, I get seen immmediately...of course shortness of breath and a history of PE will get you red carpet treatment in the ER (oh sorry Em. Dept., LOL).

Seriously, I'm sorry people are so and your staff deserve better for all that you do. If it helps, some of us patients are grateful! Thanks for all you do! Leslie

Neo said...

As long as you're withholding internet access, maybe you should try dampening cell phone signals as well! Love trying to talk to a parent while a family member chats away on their cell!
Ab incunabulis

SeaSpray said...

They just don't understand.

But'd think common sense would kick in.

I had people state it's not even busy here ..why is it taking so long? The volume may not be there but some patients can still take up a lot of time.
I think most people are nice ..and then there are some jerks.

I can understand if the person is in pain or very sick ..that can be all consuming for them ..but not enough to pull staff from a true emergency.

I'm surprised no one threatened to leave.

And the other thing they don't look at besides how emergent another patient may be ..staff does not want patients just hanging around. You want to have some down time if you can. If you could'd clear everyone out... quickly. :)

And then ..sometimes mistakes are made and people that should be looked at get passed up and end up waiting longer than they should. I made that mistake with patients a few times and then apologized profusely. They were nice about it.

SeaSpray said...

Empress Bee - that is nice your doc met your husband. Our private docs often meet their patients at the ER. (if significantly ill or if they happened to be on rounds, etc) Can speed things up sometimes. Although still wait for lab results, etc. Depends why the patient is there.

At our hospital, the docs will call ahead if they know a patient is coming in with a specific condition..particularly if there is a history and tell staff what tests they want done and then may or may not come in. Sometimes they just take the call from the ED doc if pt is being admitted and then follow-up with the patient in their room the next day.

FluffyBunny said...

It's human nature to be selfish, especially when one is in pain. My paper cut will always be more important to me than your broken leg. That's just the way we're wired.

It's also human nature to want to be appreciated for one's job, especially when one's job is as high-stress as working in an ER.

And I'm sorry, but I have to come down on the side of the people who are sick/in pain/worried/scared to death. So you got a few scowls. Suck it up. You're the professional here.

Peter said...

Hi! Some visitors to ED on sighting a doctor or a nurse only see a big red target unfortunately. If only THEY could work a shift to see what it was really like!

Over here when there are no beds in ED, ambulance officers remain with the patient. It is not unusual to have several of them waiting just inside the doors of ED as they patiently wait for a bed to be made available on transfers etc.

As for the Internet, I've only seen that in the Children's Hospital ED's - good idea actually as it not only keeps the little ankle biters happy but their parents as well!

Take Care,