Friday, October 11, 2013

who in the hell are you?

Have you ever heard the patient say: "Who in the hell are you now?"

I was thinking today how coming into a hospital is a ridiculous experience for the patients.  They tell their stories to people over and over.

First they tell it to the triage nurse.  Then they tell it to the nurse in the room.  Then they tell it to the physician assistant or NP.  Then they tell it to the ER doc. The ER doc tells it to the hospitalist or the resident who ask the patient the story.. The ER nurse tells it to the inpatient nurse who asks the patient the story when they get to the room. The resident may have a medical student come to see the patient.  They tell it to the  1st year resident who tells it to the the 3rd year resident.  The doctor, be they resident, hospitalist, intensivist, brings in the specialist.  The speicalist asks the patient again for the story.  So far the patient has told their story to eight people.

Now lets talk about how many people the patient comes in contact with just in the ER:

triage nurse
ER nurse
PA or NP
ER doc
lab person
xray person
CT or ultrasound person
charge nurse?
transport person

That is a potential 13 people going in and out of the room.

The lack of efficiency is astounding.  Why do so many different people have to ask the patient their story, espeically in this day of electronic records?  Why can't we read the story on the computer and not ask the patient the same questions?  Is it because we don't trust each other?  Is it because we are afraid of losing our little piece of the pie?

Its insanity the way we practice. I wonder if it will ever change.


Alison said...

But how many times have you asked the patient a question then heard them answer the SAME question differently 10 minutes later?? Sometimes the patient hasnt thought about relevant hx until we ask a couple times.


Anonymous said...

Yes,what Alison said. As a patient with no prior experience to the medical system, I just presumed it was deliberate, to help med staff ferret out the truth. Cross-examining, or something, to catch lies, deceit, fraud, drug-seeking, etc. I even presumed the same, as a nursing student. (Never finished RN school. Can't stand motherhood or child-rearing. Hate it. That's the kiss of death for any female nurse, LOL)

Ivan Ilyich said...

I went through the ED three times within a couple months, and the only times I had to explain what was going on were the first time, to the triage nurse, and the third time, to a doctor or nurse (perhaps both). Everyone seemed to know what was going on and what needed to be done, and this was before the hospital switched to electronic records. I guess it depends on the situation.

Mathi Bear said...

I wondered this 20 years ago. Seriously, I have been tempted to just record one of those 2-3 minute voice play-back stuffed animals with the injury history and occasional problems I have had since I was 18. The last time it involved telling the nurse, PCP, the nurse for the place I was referred to, the specialist, and the MRI tech, and the specialist again since he asked again. All irrelevant really since no one is going to believe anything until they see it on imaging anyway.

Nichole Brock said...

It does kind of suck that patients have to say the same thing over and over to so many people. But, I think cross-examination is necessary- just perhaps by not so many people!

Anonymous said...

Oh for Christ's sake...what better have they go to do?

Anonymous said...

ah, that would be "got to do" not "go to do". Hrumph. Can't even blame auto-correct.