By Norman Silverman, M.D.
I was reading the other day in a magazine the personal account of a woman who had a “perfect example of a mitral valve click” (a type of heart murmur) that was so textbook in sound that she was asked to be a listening post for a class of medical students. She was pleased to help, but was disappointed in how of the 15 examiners no one treated her like a person. She was a murmur. As I shook my head at the indignity imposed on a patient willing to subject herself to teaching, not just diagnostic testing, I was reminded how easy it is for medical practitioners to fall into this trap.
Ever see a cardiac surgeon meditate? They cannot sit still long enough. These folks worship busy. Their frenetic activity is best observed during their morning rounding ritual on hospitalized patients before going to the operating room. I recall a younger surgeon who once lived inside my skin surrounded by an entourage of residents, medical students, physician assistants, nurses and pharmacists sweeping through hospital corridors, snaking into patients’ rooms spouting medical jargon, shouting instructions and transcribing orders. A meek nursing student summons the courage to ask why the group spends so little time actually talking to and examining their patients, and the cocky chief resident sneered sarcastically that if they did that the ritual would be called “stops” not “rounds” as if perpetual motion was a desired outcome.
As the horde swept into a room occupied by a young man who had his congenitally deformed aortic valve replaced five days ago, the time for discharge planning was presented to him and his wife, assignments designated to effect follow-up and referring physicians identified for forwarding medical records. After 120 seconds of focused activity, the recessional for this patient was sounded. However emerging from the door our path was blocked by the patient’s wife who politely asked if we had time to answer one question. Displaying a trace of patience and compassion, I acquiesced, and mentioned how gratifying it was that her husband had such a rapid and uncomplicated postoperative course. Well, she stuttered, if you say so, but how come he does not remember his own name and who I am? This stopped the lemmings’ migration in the next heartbeat. Redirected, the throng quickly diagnosed and initiated treatment for the occult infection causing the mental status change. The patient did ultimately have complete recovery, thanks to his wife.
Impossible, you ask? No, because in the hyperactive world of cardiac surgery otherwise responsible and competent medical staff lose focus and forget that the most important thing in their universe when they approach the bedside is that particular patient. There is no next event horizon until all questions have been asked and answered, all tests reported and ordered and examinations performed. Or provisions for accomplishing these tasks clearly defined. Patients and their families must be educated that they should take nothing for granted. They are their own best advocates. Hospitals are populated by professionals, but they are imperfect. Though quality assurance teams doggedly try to correct systemic errors, mistakes or omissions are not 100% avoidable. Patients and families have the right for accountability and must be tireless in expressing any frustrations or complaints. And what self-chastising revelation did I glean from this experience? I could tell you, but I have not got the time.