A Physician’s Story

  

I haven’t posted any stories about what physicians face when working on the front lines during the Covid-19 pandemic. Of course, my Blog is about nursing. In more recent years, the collaboration between nurses and physicians has grown. The professions work together with more mutual respect than when I began my nursing career. And physicians on the front line of the Covid-19 pandemic risk their lives just as nurses do. 

I have reblogged a story written by a physician who is working “extra on-call time” to care for the new admissions at a local hospital.  I read this essay in the online publication: Pulse: Voices from the Heart of Medicine.

I highly recommend reading Pulse, which publishes each Friday. There you will find stories that show the human aspect behind the practice of medicine. 

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In Need of a Prayer

Posted By Jo Marie Reilly On December 16, 2020 @ 10:44 pm In Stories 

The new patient’s name is Emmanuel. He was sent from his nursing home to our emergency room with a cough and fever. The oxygen level in his blood is well below normal, and he’s gasping for air.

It’s my third week in the local community hospital ER. I’ve been putting in extra on-call time during the COVID pandemic. It’s been rough to get back into the emergency setting while continuing my day job as a family doctor and medical educator. I’ve been sharing admissions with the hospitalist, who’s joined me in the on-call room.

“I’ll take him,” I tell my colleague.

“Sure?” he asks, eyebrows arched over his face mask.

The pager blares again.

Continue reading “A Physician’s Story”

The Physician Supports the Nurse 

I am following a physician’s blog: Suneel Dhand.

Reading his post for the first time, I had a gut feeling I would like this guy. I think he represents a new and steadily growing wave of physicians who are becoming more aware of the effects that good communication has on patient outcomes and improvement in health team collaboration.

After I read his blog today: Doctor, I am just double-checking that you spoke with the nephrologist before I give that? September 4, 2018, I was moved to write this comment:

Thank you for this very timely and important post. We older nurses have many unfortunate memories of altercations with physicians who were more concerned over their status than the welfare of the patient and the benefits of team collaboration. With a renewed interest to improve the patient experience and prevent medical errors your post shows what physicians can do to improve communication with co-workers, especially nurses.

Here is Dr. Dhand’s post:

(I highlighted what he said that so impressed me)

I was recently seeing a rather complicated medical patient in the hospital. We were treating both a heart and kidney condition, and things were not going so well. To spare anyone non-medical who is reading this the scientific details of the bodily processes involved, we were essentially balancing hydrating, with the need to get rid of excess fluid. After seeing the patient, I spoke with the nurse, went over the clinical dilemma, and mentioned that I would speak to the kidney specialist before making the decision—and would perhaps order an additional medication if appropriate. I went back to my desk, entered a note onto the computer, spoke with the nephrologist, and we decided to go ahead and order the medication. A few minutes later, the nurse came back to me and asked: “Dr Dhand, I saw your order and just wanted to double-check that you spoke with the nephrologist before I give that medication?”.

The way the question was asked, may have come across to some as slightly condescending. I could tell some of the other doctors in the room were surprised with such a direct question. After all, I’m a reasonably experienced physician—why would I order a medicine I didn’t want to give? And how dare I be asked so bluntly if I’ve double-checked with another colleague, after I’ve already said that was part of the plan? Did this nurse not trust me?! It wasn’t even a particularly strong or toxic medicine, but one that we use everyday on the medical floors.

I paused for a bit, and said: “Yes, I’ve double checked, and it’s fine to give, no problem”. The nurse, sensing this question may have come across in the wrong way, then said: “Oh, I just wanted to check because you said you were going to speak with the nephrologist…and I looked at your note, and you didn’t even mention the medication”.

Indeed, that was correct—I wrote my note just before I had the conversation.The nurse was spot on. Whether or not the question could have been phrased differently is irrelevant, and I actually found the fact that this nurse sought to clarify the issue with me, highly impressive. I passed on that compliment. Not to mention the fact that the question was based on the conscientious act of actually reading the physician’s note!A more junior doctor colleague in the room afterwards commented on how what was asked to me sounded like a bit of an affront. Actually, I said it was the opposite, and explained why. There’s no room for ego in healthcare, and that’s frequently how mistakes happen, and what the nurse did was outstanding.

That interaction interested me, because as someone who teaches communication, I know I myself would have handled that situation very differently 10 years ago. Indeed, many doctors would have snapped right back at the nurse or taken offense that they were being so directly questioned. Perhaps even with a sarcastic response. “Of course I have, do you think I would have ordered the medication if I didn’t want it?!” “Yes I’m a doctor too, and wouldn’t order a medicine for no reason (you dare question me like that!)”. Imagine if that had happened, what the effect would have been on the nurse of being chewed out, possibly leading to not double-checking an important clinical issue in the future if they felt like something wasn’t right. A bad thing to happen to a well-meaning professional! Many doctors I’m afraid to say would have responded very differently to how I did, and chosen the latter approach during a hectic day when they already felt overloaded with questions and issues. I’m sure if you ask almost any nurse, they will tell you about countless times when they’ve been needlessly talked to in a terse manner by doctors. That’s not to say these don’t represent a small minority of interactions, but certainly enough to remember.

The one thing I feel most proud of as I’ve (hopefully) matured over the years, is how I handle situations like that. I may have always had a relatively calm demeanor, but I was definitely much more of a hot-head around the time when I finished medical school. Not confrontational, but definitely more somebody who could get into needless conflict over things like this. For anybody not working in the high-paced and frequently emotionally charged healthcare arena, you may not realize that run-ins, disagreements and personality clashes are part and parcel of the job (frequently between physicians too). They happen every day, everywhere. I remember after one negative interaction I had with a colleague many years ago, I was talking to another group member, and was given some great advice. She said: “You know what Suneel, always remember the saying: Great Minds, Don’t Mind”. That saying, Great Minds, Don’t Mind, has always stuck with me. It’s so very true, in all aspects of our lives, and something I strive for every day. The very best of us don’t take offense, become hyperreactive, or needlessly be petty and escalate situations, when we could easily interpret something as a personal insult. Especially when we are all doing our best for our patients at the frontlines of healthcare.

 

Just to reinforce what older nurses experienced when we were considered the handmaidens of the physician, I’ve included this previous post of mine: Don’t Question the Doctor,February 19, 2017, describing my good friend Lois Roelofs’ altercation with Dr. Jericho:

 

One afternoon while making rounds, I dashed in to see, Mr. Barnes, my last patient, in 236-1, the triple ward next to the nurses’ station. He smiled when he saw me. “I’m going out for dinner tonight. Dr. Jericho is picking me up at five.”

“Oh? I didn’t know. He didn’t tell us at the desk,” I said, scanning his Kardex card in the vertical file positioned on my left arm. “I’ll check on it.”

Back at the nurses’ station, I checked the doctor’s order sheet for Mr. Barnes. Hospital policy dictated that patients could leave hospital grounds only with written orders from their attending physician. Dr. Jericho was not the attending physician; he was a personal friend. And there was no written order.

I faced a potential explosion. Dr. Jericho’s capacity to be short-tempered was well-known to the nursing staff.  We’d each had our experiences. None of us liked it, but we felt powerless to do anymore than endure. And I didn’t need the problem right then: I wanted to give report on time and get home on time, once.

I dialed his office. “Hello, Dr. Jericho, this is Mrs. Roelofs on Hall Two. Your friend, Joseph Barnes, told me you were picking him up for dinner.” I swallowed hard and took a breath. “I see no written order covering this leave. I’m calling to see if you’ve run this by his attending, Dr. Acorn.”

He barked into my eardrum. “I don’t need to check anything out with anybody. Do you hear me? It’s none of your business….who is this again? What’s your name?”

“Mrs. Roelofs. Head nurse. Hall Two.” I forced my voice to sound strong.

“I’m coming right over to clean your clock,” Dr. Jericho yelled into the phone.

My head and heart spun wildly into one big tuft of fear that settled in my throat. I raced to a friend working on the ward at the other end of my floor. We schemed to hide me on that ward when Dr. Jericho arrived. Then we stationed lookout nurses. Minutes later I got the message. I ducked into Room 214, a five-bed room on East, and hid behind curtains drawn around a vacant bed. When Dr. Jericho arrived, my cohorts told him I was off the floor on an errand. He strode into my nurses’ station across from Room 201, parked himself on my desk chair, and bellowed, “I’ll wait.”

When I was a student nurse a few years before, I had scrubbed to assist Dr. Jericho in surgery. He became irritated with something and kicked a metal wastebasket across the room. Anesthesia saved the patient from being startled off the operating table. However, my nerves, as a novice, vibrated with the intensity of the metal clanging against steel and tile. Now my nerves were vibrating once again.

Suddenly, my friend peeked around the curtain, wearing worry on her face. “He won’t leave until he sees you. He’s camped out. Slicked back hair, black suit, green paisley tie, and all. You better come.”

I returned to the utility room on my ward with its steel cabinets, stowed commodes and IV poles, soaking instruments and thermometers, and corner hopper – a large square toilet-like bowl for rinsing bedpans. Standing in the doorway to the adjacent nurses’ station, I said as confidently as possible, “Dr. Jericho, I’m back. I understand you want to see me?”

Dr. Jericho launched to a standing position. “You bet I do. Who do you think you are to question what I’m doing? To tell me I need a doctor’s order to take my friend out for dinner?” His words torpedoed through the nurses’ station and up the ramp to pediatrics.

He stomped toward me. I backed away, inch-by-inch, until I was flush with the hopper. One more step and I’d plop into hopper water. I was trapped. Only the smothering smells of disinfectant separated us. “It’s my responsibility to see that hospital policy is followed, sir,” I said. My breath stopped momentarily.

“Who are you to tell me what hospital policy says? You, young lady, are never to question me again. Do you understand?”

His words slapped my face like sleet on a winter walk. I could have punched him – he was close enough – but I thought better of it. “Yes, sir.” I held back a salute that he seemed to demand. He turned, clicked his heels, and marched out, as if on a military drill.

My meds nurse, LPN, and aides crowded into the small nurses’ station. “What happened? What’d he say? I’ve never seen him so mad. At least not this week.”

“Oh, the usual Dr. Jericho stuff. Nothing new.” I said, trying to sound nonchalant with a heart rate of over a hundred.

Reaching for the desk phone, I glanced at a list of phone numbers and dialed Mr. Barnes’ attending physician. He gave me the order. Why hadn’t I called him in the first place?

I determined never to let a doctor’s behavior intimidate me again.

Caring Lessons: A Nursing Professor’s Journey of Faith and Self, Lois Hoitenga Roelofs, 2012, pp 49-50

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Firing My Doctor

 

 

 

More Voices: Worry

 Firing My Doctor

Marianna Crane

31 May 2018

 

I didn’t decide to “fire” my doctor on the spot.

During my last appointment with her, I’d filled Dr. Green in on the details of my mastectomy. I happily reported that the surgeon had declared me “cured”–the tumor’s margins were clear and my nodes were negative. Because I had large breasts and wanted to avoid wearing a heavy prosthesis, I’d had a reduction on my healthy breast at the same time. A routine biopsy of that tissue had showed dysplasia–abnormal cells. As a nurse, I’d researched this finding and found scant evidence that it would develop into cancer. My surgeon had concurred.

As I sat on the exam table while Dr. Green stood by the sink drying her hands, I told her I’d decided not to worry about it.

Without making eye contact, Dr. Green said, “I’d worry.”

I froze.

Never one to have a quick comeback, I left the office without a word about her offhand remark. It wasn’t the comment itself that concerned me, but her apparent indifference to my feelings. Plus, what good would worrying do?

Having a potentially life-threatening illness had boosted my resolve to surround myself with people who would cheer me, not depress me. Dr. Green was a competent doctor technically but lacked sensitivity–something that I value in a patient-physician relationship. I decided to look for another primary-care provider.

After calling Dr. Green’s office to cancel my next appointment, I requested that my records be sent to my new doctor. The receptionist asked if I would tell Dr. Green why I was leaving. I agreed, and before I could get nervous Dr. Green was on the line.

I relayed the incident at my last appointment; I said that her “I’d worry” statement had left me shaken and disturbed. Whether I was right or wrong, what I wanted from a provider was someone who cared for my physical and mental needs.

Surprisingly, she thanked me. I hung up the phone feeling rattled that I had voiced such a candid assessment. Gradually, however, jubilation replaced anxiety. I realized that I had control over my life and those whom I allowed into it.

I can only hope that my forthrightness with Dr. Green improved her communication skills.

Marianna Crane
Raleigh, North Carolina

Don’t Question the Doctor Part 2

I posted last week about my friend Lois’ run in with a nasty doctor soon after she graduated nursing school in the 60s.

Here is my story about working with a difficult physician that took place in the mid 80s.

The medical director, Doctor X, sat me down in her office on my first day as a nurse practitioner in a home care program at a large VA Medical Center and said, “When the doctor and nurse disagree, the doctor WINS.” She repeated this twice with a glare to discourage whatever protest I might be considering.

I can still see her fleshy face framed by cropped curly hair and a white lab coat stretching over her heavy shoulders. We sat in two chairs in her warm office facing each other without a desk between us. Did she know something about me that prompted this confrontation? Or was she always so caustic with nurse practitioners? She was a rising star in the organization. I didn’t expect this intimidating behavior.

I nodded my head as if I agreed with her dictum. What good would it do to argue since I hadn’t a clue what kind of disagreement we would have? What could happen in a health care setting that would be black or white, right or wrong, a doctor wins and a nurse loses?

What reassured me that Dr. X and I might never have a run in was that I would have autonomy when I made home visits. And I would call another doctor on the team if I needed advice, not the medical director.

One day, while visiting a patient his wife stated, casually, that Dr. X had stopped by on her way home from work. She felt flattered that the medical director would take the time to see how she and her husband were doing. What reason did Dr. X have to visit and not tell me? Not wanting to involve the patient’s wife in a conspiratorial alliance, I smiled and said nothing.

images-1

Dr. X visited a second patient. The scenario was the same: wife mentions the visit, I smile and say nothing. An uncomfortable sense of being under surveillance hounded me. What was Dr. X looking for?

Shortly after, Dr. X was promoted to a leadership position and left the home care program. There was no fallout from her clandestine visits to my patients. Would there have been if she stayed with the home care program and continued her unorthodox conduct?

I am grateful that I didn’t need to confront her—for surely I would lose.

Don’t Question the Doctor

My friend Lois and I were talking on the phone the other day. We both graduated from diploma nursing schools in the early 60s. It was a time when the nurse was considered the “handmaiden” of the physician. We played the Doctor-Nurse Game* and even stood up when a doctor entered a room. Feeling powerless to confront their authority, not surprisingly, caused us to harbor much resentment towards the medical profession over our long nursing careers.

I told Lois that my volunteer work at a local hospital has exposed me to the improved interactions between nurses and physicians. Of course, having more female physicians has leveled the playing field somewhat and the emphasis on “team” encourages the professionals to respect and work together to care for the patient. I have fresh insight into the challenges physicians face in the health care delivery system that restrict their practice and autonomy. While I do feel more sympathetic toward physicians, I cannot forget the unbalanced relationship nurses once endured.

 

Here is an example from Lois’ book, Caring Lessons.411isrlw3gl-_ac_us320_ql65_

One afternoon while making rounds, I dashed in to see, Mr. Barnes, my last patient, in 236-1, the triple ward next to the nurses’ station. He smiled when he saw me. “I’m going out for dinner tonight. Dr. Jericho is picking me up at five.”

“Oh? I didn’t know. He didn’t tell us at the desk,” I said, scanning his Kardex card in the vertical file positioned on my left arm. “I’ll check on it.”

Back at the nurses’ station, I checked the doctor’s order sheet for Mr. Barnes. Hospital policy dictated that patients could leave hospital grounds only with written orders from their attending physician. Dr. Jericho was not the attending physician; he was a personal friend. And there was no written order.

I faced a potential explosion. Dr. Jericho’s capacity to be short-tempered was well-known to the nursing staff.  We’d each had our experiences. None of us liked it, but we felt powerless to do anymore than endure. And I didn’t need the problem right then: I wanted to give report on time and get home on time, once.

I dialed his office. “Hello, Dr. Jericho, this is Mrs. Roelofs on Hall Two. Your friend, Joseph Barnes, told me you were picking him up for dinner.” I swallowed hard and took a breath. “I see no written order covering this leave. I’m calling to see if you’ve run this by his attending, Dr. Acorn.”

He barked into my eardrum. “I don’t need to check anything out with anybody. Do you hear me? It’s none of your business….who is this again? What’s your name?”

“Mrs. Roelofs. Head nurse. Hall Two.” I forced my voice to sound strong.

“I’m coming right over to clean your clock,” Dr. Jericho yelled into the phone.

My head and heart spun wildly into one big tuft of fear that settled in my throat. I raced to a friend working on the ward at the other end of my floor. We schemed to hide me on that ward when Dr. Jericho arrived. Then we stationed lookout nurses. Minutes later I got the message. I ducked into Room 214, a five-bed room on East, and hid behind curtains drawn around a vacant bed. When Dr. Jericho arrived, my cohorts told him I was off the floor on an errand. He strode into my nurses’ station across from Room 201, parked himself on my desk chair, and bellowed, “I’ll wait.”

When I was a student nurse a few years before, I had scrubbed to assist Dr. Jericho in surgery. He became irritated with something and kicked a metal wastebasket across the room. Anesthesia saved the patient from being startled off the operating table. However, my nerves, as a novice, vibrated with the intensity of the metal clanging against steel and tile. Now my nerves were vibrating once again.

Suddenly, my friend peeked around the curtain, wearing worry on her face. “He won’t leave until he sees you. He’s camped out. Slicked back hair, black suit, green paisley tie, and all. You better come.”

I returned to the utility room on my ward with its steel cabinets, stowed commodes and IV poles, soaking instruments and thermometers, and corner hopper – a large square toilet-like bowl for rinsing bedpans. Standing in the doorway to the adjacent nurses’ station, I said as confidently as possible, “Dr. Jericho, I’m back. I understand you want to see me?”

Dr. Jericho launched to a standing position. “You bet I do. Who do you think you are to question what I’m doing? To tell me I need a doctor’s order to take my friend out for dinner?” His words torpedoed through the nurses’ station and up the ramp to pediatrics.18064403-angry-doctor-in-glasses-with-notebook

He stomped toward me. I backed away, inch-by-inch, until I was flush with the hopper. One more step and I’d plop into hopper water. I was trapped. Only the smothering smells of disinfectant separated us. “It’s my responsibility to see that hospital policy is followed, sir,” I said. My breath stopped momentarily.

“Who are you to tell me what hospital policy says? You, young lady, are never to question me again. Do you understand?”

His words slapped my face like sleet on a winter walk. I could have punched him – he was close enough – but I thought better of it. “Yes, sir.” I held back a salute that he seemed to demand. He turned, clicked his heels, and marched out, as if on a military drill.

My meds nurse, LPN, and aides crowded into the small nurses’ station. “What happened? What’d he say? I’ve never seen him so mad. At least not this week.”

“Oh, the usual Dr. Jericho stuff. Nothing new.” I said, trying to sound nonchalant with a heart rate of over a hundred.

Reaching for the desk phone, I glanced at a list of phone numbers and dialed Mr. Barnes’ attending physician. He gave me the order. Why hadn’t I called him in the first place?

I determined never to let a doctor’s behavior intimidate me again.

Caring Lessons: A Nursing Professor’s Journey of Faith and Self, Lois Hoitenga Roelofs, 2012, pp 49-50

 

 

* Doctors and nurses: new game, same result

Mark Radcliffe, deputy features editor

BMJ. 2000 Apr 15; 320(7241): 1085.

“In the beginning the relationship between doctors and nurses was clear and simple. Doctors were superior. They had the hard knowledge that made ill people better. The nurses, usually women, were good but not necessarily very knowledgeable. They were in charge of folding pillowcases and mopping brows. . . .

In 1967 Dr Leonard Stein first outlined the doctor-nurse game. He said that the interactions between the two were carefully managed so as not to disturb the fixed hierarchy. Nurses were bold, had initiative, and were responsible for important recommendations. While being bold, however, they had to appear passive. In short, nurses were able to make recommendations as long as they made it look as if they were initiated by doctors. So the nurse was responsible for the wellbeing of her patients and the nourishment of the doctors’ sense of professional self.”

The Compliment

 

Two weeks ago I flew to Sioux Falls to visit my good friend, Lois, in her new home. She and her husband left a Chicago condo off Michigan Avenue facing the lake to settle in a small town with less excitement than a big city. That weekend we attended the South Dakota Annual Festival of Books, a free conference that would be rare in a big city like Chicago. There are pluses for small towns. And I might add, anyplace that is home to one’s grandchildren holds excitement.

Back to the weekend and the Festival of Books. The keynote attraction on Saturday was Jane Smiley on the main stage in conversation with a local radio personality. Smiley came across as a composed, self-assured woman, emitting an occasional monosyllabic answer to the delight of the audience. She was comfortable in the spotlight and seemed to harbor no insecurities. Of course, why not, since she has won a Pulitzer Prize, studied in Iceland as a Fulbright Scholar, and written many books—the most recent a trilogy covering 100 years.  screen-shot-2016-10-07-at-4-18-29-pm

Earlier that day, Lois and I had spotted a solitary tall blond with a bright red jacket, jeans, and matching red running shoes striding briskly toward the Larson Memorial Concert Hall where the festival was held. A few minutes into Smiley and the radio personality’s conversation, Lois nudged me. The lone walker had been Jane Smiley. Lois recognized the red shoes.

On Sunday we had a difficult time choosing which of the various breakout sessions to go to, except for Robert Olen Butler’s discussion of his new novel, Perfume River: A Novel. I like his writing. In fact one of his small pieces, Nostalgia, was in Self in 1994. That piece impressed me so much so I cut it out and saved it all these years, and even included it into a post: So What’s Nostalgizing, that I wrote on February 2, 2015.

Once when a writing instructor asked us to bring a copy of what we considered a good piece of writing, I brought Nostalgia. Others brought longer, more nuanced examples but Nostalgia, to me, was perfect. And it spoke right to my heart. It was like a painting or photograph or snippet of music that trips open a trap door to expose a forgotten memory—soft and misty—unclear to the brain but familiar to the heart.

img_2967Butler sat in a folding chair facing his audience and directly in front of Lois and me in the first row. He and I were eyeball to eyeball. If he moved up a foot our knees would touch. There was the man who wrote words that always caused my breath to catch in my throat whenever I read them. I needed to tell him. I got up and leaned down to speak into his left ear.

“I just want to tell you I Iove your writing,” I said. He smiled. Then I added, “There is something you wrote in the 90s, a short piece about nostalgia. I have read it over and over again for years. It is so well written. Not an unnecessary word. I have carried it around with me all this time.”

He looked pensive. “I don’t remember it.”

I gave him a synopsis as he stared at the floor. He nodded.

Maybe he didn’t remember after all. But, back in my seat, I felt content in finally telling Robert Olen Butler how much his writing has meant to me. And maybe, just maybe, some day someone will give me the same compliment.

I can only hope.

 

Addendum:

I am delighted that my story, Baby in the Closet, has been reprinted in Hospital Drive: A literature and humanities journal of the UVA School of Medicine. “This anthology is our editors’ choice of work published since the first edition of Hospital Drive in 2007.” It is the first print edition.hospitaldrive-1024x717

 I Am Grateful to the Nurses

In 2013 I toured the new intensive care units back at the hospital where I volunteer. At the time I was acutely aware how outdated my nursing skills were and realized that I wouldn’t even be safe to flip on a light switch. The state-of-the-art machines were daunting. I never thought that three years later I would have a family member, my husband, in the new unit.

It did help my anxiety that I knew what the ICU looked like. I remembered there was a sort of bench under the window—all the rooms had a window—that could be converted into a bed for family to stay over. I had decided before Ernie’s surgery I would spend the night and as many nights with my husband as needed. So many errors occur in hospitals. In my mind, hospitals are not safe places to be sick. I would be the sentry for safety.

After my husband’s six-hour surgery, two heart valves replaced, my daughter and I found him in a high-tech Hill-Rom bed, unconscious, intubated, and surround by snakes of IV tubing and lines attached to various machines.Hill-Rom bed

The nurse caring for him introduced herself and gave us a “tour” of the landscape, that is, what medications he was getting, what fluids were draining out of what orifices and what the monitors were monitoring. The breathing tube, she said, will come out soon and he would be awake and alert tomorrow. Really?

That was when I decided to spend the night in a hotel room. Fatigued from worry about the outcome of the surgery, I knew a good night’s sleep would be more helpful than spending the night with beeping machines. Besides, I felt an immediate sense of comfort knowing that Ernie would be getting excellent care.

As I look back on this event, I am reminded of the post I wrote on February 23, 2014 about Dr. Arnold Relman, the former editor of The New England Journal of Medicine. He had just turned 90 and fell at home, cracking his skull and breaking three vertebrae in his neck. After he had made a full recovery, he confessed that he had never made the connection between good nursing care and the patient’s outcome.

I had never before understood how much good nursing care contributes to patients’ safety and comfort, especially when they are very sick or disabled. This is a lesson all physicians and hospital administrators should learn. When nursing is not optimal, patient care is never good.

This he found out at the ripe old age of 90!

The next morning finding my husband alert and sitting up in a chair beside the bed without his breathing tube and looking surprisingly good brought me close to happy tears.

It’s been two months since Ernie’s surgery. He is getting better, slowly, every day. I continue to be impressed with the surgeon and his team that stopped my husband’s heart, touched, repaired and restarted it with skill and accuracy. They bring big bucks into the hospital coffers. They get the accolades and attention. At the end of the operation, they take off their surgical scrubs. Go home. Have a good meal. Get a good night sleep. But it was the nurses that watched my husband’s battered body around the clock, monitored his fluids, medicine, breathing, pain and his heart and put him on the road to recovery.images

And I am grateful.

A Physician Finally Gets Nursing

I couldn’t write better coverage about Dr. Arnold Relman’s comments about nursing, so I’m reblogging this Post. The comments he made are both “good” and “bad.” Good: Dr. Relman, physician and former editor of the New England Journal of Medicine, stated “When nursing is not optimal, patient care is never good.” Bad: Dr. Relman finally recognized this at age 90!
This just reinforces my belief that nurses need to make themselves more visible (see my post “I was the only one.” )

DOCTORS

A Patient’s-Eye-View of Nurses

By LAWRENCE K. ALTMAN, M.D. date published FEBRUARY 10, 2014 3:37 PM

 

February 10, 2014 3:37 pm

 

Dr. Arnold S. Relman, 90,  fell in June and suffered multiple fractures.

by Tony Cenicola/The New York Times

 

Last June, the month he turned 90, Dr. Arnold S. Relman, the eminent former medical educator and editor, fell down a flight of stairs at his home in Cambridge, Mass. He cracked his skull and broke three vertebrae in his neck and more bones in his face.

By the time he arrived at the emergency room, blood was flowing into his brain and impinging on his windpipe, leading to severe choking and dangerously low oxygen levels. Surgeons cut into his neck to connect a breathing tube from his trachea to a mechanical respirator.

Amid the disciplined medical havoc, his heart stopped three times. Resuscitation efforts saved his life, but at the cost of several broken ribs. His condition remained precarious as he developed complications and endured still more medical procedures.

Astonishingly, he lived to write about all this. After a painful 10-week hospital stay and months of rehabilitation, he can walk — gingerly, with a cane — and is largely recovered, with his mental faculties intact.

His riveting account of the medical adventure, in the Feb. 6 issue of The New York Review of Books, is a testimonial to the best emergency medical care and a tremendous will to live. At the same time, however, it betrays a surprising lack of awareness of some critical aspects of the medical profession and the nation’s fragmented health care system.

Despite decades as a medical educator, researcher, author and editor of The New England Journal of Medicine, Dr. Relman confesses that he “had never before understood how much good nursing care contributes to patients’ safety and comfort, especially when they are very sick or disabled.” Nor did he appreciate the hypnotizing effects of technology, which robs patients of the physician’s bedside manner and affects the training of younger doctors.

How is it that a leading medical professor like Dr. Relman — who has taught hundreds of young doctors at Boston University, the University of Pennsylvania (where he was chairman of the department of medicine) and Harvard — might not have known about the value of modern-day Florence Nightingales?

A number of doctors who have talked to me about Dr. Relman’s article suggest that the culture of medical education may be largely to blame. For example, younger doctors in hospitals spend part of the day on rounds, following professors in their long white coats. Many of these august figures are supremely confident in their observations and opinions; others are more compassionate.

What professors impart on those rounds can have a major effect on the behavior of younger doctors when they go into practice and teach succeeding generations.

Dr. Relman’s initial care was in a major teaching hospital, Massachusetts General in Boston, where the kind of doctors he taught — students, interns and residents — provided the round-the-clock attention that kept him alive. Yet he did not write directly about their role, referring to them only as “a team.”

On their rounds, some medical professors prefer to talk in a hallway just outside the patient’s room as they discuss test results that are crucial in planning further care. Such behavior appears impersonal, perceived perhaps as a way of shielding bad information.

But many doctors see it as efficient, because they can note the information they deem most important — like heart rate, blood pressure and rate of intravenous drip — by standing at a patient’s door and looking in at the monitors. Feeling no need to go to the bedside, they do not. Instead they rely on nurses, failing to recognize that such behavior omits crucial elements in patient care — the physical touch and the personal touch.

Dr. Relman owes the extension of his life to drugs and devices that did not exist in their present form, if at all, when he was younger. Over the years, the surge in the number of such advances, and most importantly in their hazards, has made work vastly more complicated for doctors, nurses and other health workers. Despite the advantages of technology, tender, loving care from family and nurses is priceless, as is the bedside manner of a sympathetic doctor.

But technology’s monitors, images and devices can deflect that doctor’s attention, as Dr. Relman learned when he reviewed his hospital records and the notes he wrote to nurses and his wife, Dr. Marcia Angell (particularly while he was unable to speak because of the breathing tube).

Instead of descriptions of his appearance and feelings, the doctors’ progress notes in his electronic medical records were filled with technical data. “Conversations with my physicians were infrequent, brief and hardly ever reported,” he wrote, adding:

“What personal care hospitalized patients now get is mostly from nurses. When nursing is not optimal, patient care is never good.”

Many hospital administrators have cut nursing staffs. They say it is to make ends meet; many doctors say it is usually to increase the bottom line.

Nurses’ observations and suggestions have saved many doctors from making fatal mistakes in caring for patients. Though most physicians are grateful for such aid, a few dismiss it — out of arrogance and a mistaken belief that a nurse cannot know more than a doctor.

In many ways, Dr. Relman’s insights reflect changes and generational gaps in training doctors, nurses and other health professionals. Because these disciplines have traditionally been taught in separate silos, they often do not work as tightly as they should.

Now, as health care financing changes and doctors spend more time training in outpatient settings, a growing movement demands coordinating the education of health professionals to prepare them to work more smoothly in teams. If these efforts succeed, perhaps the next generation of doctors will no longer be surprised at the importance of nurses and other allied professionals.

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