Tuesday, May 5, 2009

No-one is Looking After Me!

One of the things that irritate me to no end is when patients complain, “it has been __ hours and NO ONE is looking after me!” In fact, there’s a giant team of people working to get things done for them.

For example, if you come in complaining of abdominal pain and end up getting a CT, you have an ass ton of people looking out for you –they’re just not in the room standing by your beside holding your hands because they wrongly assumed that you are an adult and can handle the fact that people have to work on your behalf where they have access to needed tools and supplies. You get the triage nurse to assess you, determine how sick you are, and assign you to an area of the department. You get the registration clerks who put you in the hospital’s electronic system and get your insurance info which means that you don't pay out of pocket. Then you get a nurse in the area that you’ve been assigned who does a thorough assessment of your symptoms and makes sure that any relevant concerns are passed along to the charge nurses and the physician on call. S/he also takes blood samples which are sent to the lab for analysis. Lab techs are analyzing your blood along with many other patients’ blood samples. They prepare a report that can be accessed by your nurse and doctor so they know what to do with you. The physician assesses your medical emergency and prescribes a course of treatment which could involve diagnostic imaging.

Now getting back to the aforementioned CT – the doctor places a request to the radiology department who are not only covering in and out-patient scans, but emergency scans as well. Depending on your need for contrast, you get a tech to deliver it to you. If you don’t understand what to do with the contrast solution, your nurse comes and explain it to you while assessing your condition (again). You may also get medications drawn up and administered to you. When it’s time for your scan, a porter takes you there and brings you back. Meanwhile, the techs send the images to the radiologists who read your scan (while dealing with a million other scans) and send the report back to the emergency doctor who saw you. During this time, you’re still being assessed by your nurse frequently (especially if your bed is in front of the nursing station). If you end up staying for a long time, you have the kitchen staff preparing meals which are again delivered by the porters. When the doctor finally gets your results from the radiologists, s/he comes back and explains them to you. If you are discharged, the nurse prepares your discharge papers and if necessary, arranges outpatient follow-up appointments for you and quite possibly dumbs down everything your doctor told you so you can understand what is going on with you. If you get referred to another service (say for example, medicine of general surgery), your nurse is constantly on their ass to make a plan of care for you. If you get admitted, admitting clerks handle your insurance. Once again, porters deliver you to the floor while your emerg nurse gives report to the floor nurses to assure continuity of care.

So think about all of this when you decide to act like a petulant child and say that no one is looking after you. There are an enourmous amount of people who work their ass off to the point of exhaustion just so get the care you sought. Also, don’t bitch at your nurse when things get a little slow – you’re not the only one in the department and there are a multitude of variables that are completely out of our control. Oh, and you don’t have swine flu.


Anonymous said...

I recently came accross your blog and have been reading along. I thought I would leave my first comment. I dont know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often.

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GingerJar said...

I once had a patient in ICU that complained no one checked on her all night (how would she know...she actually slept that night thanks to good drugs and my efforts to keep her door closed, lights dimmed, ect...). I sat outside her room, in my assigned area with my 2 patients to care for her. I charted on her, turned her, and woke her up for her 6 a.m. oral medications. (no I did not feel the need to wake her up every time I hung an IV antibiotic). I was called in the Supervisor's office...where I explained all of this. The next night, I made a point of waking her up each and every time I entered her room, so she would know she was being cared for. I think she got the point. Since we were required to go into the room and take the vital signs from the monitor at the bedside and visualize respirations and such, she was awakened at a minimum every hour.

Anonymous said...

HAHAHAHAHA oh geez. I once had a family complain that I didn't check on them for over an hour, when there was a code blue happening in the room next door! You'd think that the huge crowd of people and a rush of crash carts and supplies would mean something! I guess not.

- Samosa :)

Angry Nurse said...

Within my experience what these people are really saying is your not paying constant attention to me personally as I am the centre of the universe.

Even my cat's attitude doesn't suck that badly!

Love the blog btw!

therapydoc said...

That was me you weren't attending to. (Just getting a kick out of your disclaimer).

Maha said...

@GingerJar - I'm impressed and inspired by your commitment to q-hourly patient checks! I'll definitely try that next time I get a really demanding one!

@ Samosa - Sadly the code blue means nothing to some people. That's when I just tell them that in the time they haven't been checked on, they haven't died while the other one could have. Mean, but fair I think.

@ Angry - thanks :)

@ Therapydoc - I'm glad you enjoyed the disclaimer!

Anonymous said...

Ginger Jar:
Waking her some sounds like a good thing. Remember, part of being sick is feeling endangered. As social animals, many people feel lonely and want human contact. Waking her too much, so that she isn't getting enough rest, especially in an ICU, is a bad thing I suspect you are not getting the comfort you need personally, because you are out of balance enough that you are treating a vulnerable one in your care without your heart open to their pain. There could be other outcomes for both of you. You could be posting how you comforted a patient by reassuring them and how good it felt to you when she smiled at you and thanked you.

Philippine Prudential said...

Nice article. very interesting, thanks for sharing.