The patient was already doomed as I became jaded, cynical and wondered what the health care system or we as physicians could do with patients like this.
Let’s be clear, I still had never met her. I have no idea what she looks like nor why this was her 13th trip to my emergency department in the year 2014. Regardless, as I walked into the room, I had expectations and preconceived notions which proved to be wrong, right and very right. Before I go into particular assumptions or the underlying meaning of my reaction, let’s take a step away and think big picture.
There are three parties in this situation and I argue that none of them have the same perspective on the situation. First, the patient is complaining of another abdominal pain flare up—she hurts and she is nauseated. Second, the health care staff is fed up by her frequent visits, lack of compliance, poor insight and unwillingness to take responsibility for her condition. Third, the health care system is using significant financial and organizational resources at the highest possible cost in the acute care setting. You can’t blame anyone in this situation for their views, but you can readily admit that nobody is benefiting in this situation.
So, back to my place as a fourth-year medical student hearing the banter among the staff about my patient. What comes to your mind when you hear “frequent flier?” If you are willing to engage with me in this exercise, let’s have an open and honest conversation about snap judgments and stereotypes and their impacts on us.
There were a handful of thoughts that immediately came to my mind: uninsured, non-compliant, drug-seeking, exaggerates pain, fibromyalgia-like syndrome, underlying psychiatric disorder, alcohol or illegal drug use. I readily admit the harshness of these words and I would be disappointed if someone referred to me like this.
More importantly, although my clinical acumen remains the same, my empathy has plummeted. After spending three years in the ED conducting clinical research and many days and nights in said ED during medical school, I’m left with these cynical, racing thoughts. This is yet another thing not to be proud of, and one that may reduce the overall quality of the care delivered.
But sometimes it’s difficult to shake that line of thinking because, remembering that classic phrase, room 10 was no zebra. She was a horse, and the same horse on her 12 previous visits this year.
To shed hope on a seemingly hopeless situation, let’s briefly talk about what those same three parties can do moving forward now that we have readily admitted the dire circumstances we are in.
First, a significant part of health care reform is focusing on coordinated care where health care workers literally manage an individual’s care and address anything that comes up such as transportation to appointments, medication refills and acts to connect all the dots between the primary care physician and the series of consultants. Some emergency departments implemented this support staff and longitudinal care method last July and are already reporting fewer ED visits.
Next, as for the health care team, we must remember why we ended up as caregivers rather than a cynical group who anticipates the flyer’s return visit. We ultimately take great pride in taking care of the sick and I challenge us to be involved equally in both our emotions and medical knowledge.
Finally, the patients will inherently benefit from the above but the defining question for each patient is what are they willing to do to get better. The health care system can be set up to succeed, the hospital staff can provide the ultimate care, but the patient must follow suit and work towards a healthier lifestyle. They must take responsibility and ownership for their health.
As I continue my time in the emergency department and prepare for another shift in the morning, I can promise myself to be more open-minded and most importantly, lend that helping hand and talk to patients about hope rather than failure.
Patients are the true storytellers. They come in with pathology, we interpret physiology and prescribe pharmacology, but their stories are what we remember. They shape our experiences and how we practice medicine.