Suggested Reading — ER Doctor Become ER Patient

It’s too bad that Dr. Charolotte Yeh, an emergency physician, had to get hit by a car before experiencing emergency medicine from the other side of the bed. But she learned an important lesson we hope will be shared widely among her peers.

Following are excerpts from “‘Nothing Is Broken’: For an Injured Doctor, Quality-Focused Care Misses the Mark,” a story in the journal Health Affairs that you’ll find disturbing, enlightening and maybe even familiar.

As a medical professional who became an accident victim and then a trauma patient, I was a participant-observer in emergency care, with a big-picture window into how well our health-care system does or doesn’t work. There’s just something about being boarded on a gurney in a hospital hallway for 15 hours that gets one thinking about paradigm shifts.

… I was struck by the uneven nature of my care, marked by an overreliance on testing and a narrow focus on limited quality metrics such as pain management or catheter care processes. Looking back, I believe that this approach fostered an inattention to my overall well-being. Instead of feeling like a connected patient at the center of care, I felt processed and disengaged. This is disconcerting, especially at a time when patient-centered care – that is, care delivered with me, not to me or for me – is becoming the new normal.

… Through my experience as a patient, I observed a bias in what the metrics track: toward the clinical and away from the personal. To help restore this balance and reassert the “art” of care, I see three areas that the medical community should address.

Beware the Culture of Testing
“When a test, such as a CT scan or a blood exam, is the centerpiece of care strategies, patient care can be compromised. As medicine and technology evolve, we may have become victims of our own success. We have become test-happy and technology-powered. These tools may provide us with good data on the patient, but this doesn’t mean we’re serving the good of the patient.”

Personalizing Care

“After I’d spent four days in the hospital, it dawned on me that not once had anybody come by to ask how I was doing, what I needed, what I wanted, or whether I had any concerns. I then understood something that my own patients had been telling me all the time: They don’t feel engaged in their own care. There is nothing personal about it.”

Patient-Reported Outcomes

“Patient-reported outcomes are a vital piece of the puzzle and are often overlooked, because of institutional inertia or culture. In my case over those first four days, the management of my reported pain was perfect, a 10 out of 10 – but it was the exception. Despite my requests for information and attention, it took a piecemeal evaluation over four days to sort out and diagnose the full damage to my body. My reports about my own condition did not seem to matter to anyone else.

“… (“what do you want,” “what are your fears,” “what matters to you”)…”

In a related story, see our blog, “Doctor Experiences Critical Care From the Patient’s Perspective.”

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