Contrasting Patient Narratives

As we learn how to become better physicians, I think it’s helpful to hear and read what patients have to say about their experiences. In today’s New York Times, there’s a piece by Holly Bruback describing her experience in an Italian hospital to which she presented for a dislocated hip. One of her main observations was the relatively casual manner in which she was treated. The nurses didn’t quite believe her claim of 8/10 pain. No one scrambled to get her to the OR, which ended up being necessary to reduce the dislocation. Her point wasn’t so much that her care wasn’t appropriate, but that it was, perhaps, reflective of the overall culture in which she found herself–a different one than prevails here in the U.S., where we’re more demanding and expect a certain level of service.

Reading this reminded me that there was another patient narrative in the popular press fairly recently–an essay by the late Dr. Arnold Relman, about whose illustrious career you can read here. It’s a very engaging piece–I highly recommend it (the essay, not the obituary, although that’s worth a read as well). Here’s a few illustrative excerpts (emphasis added):

During the day I was visited on rounds by teams of physicians. They spent most of their time outside my room, studying and discussing the data on their mobile computers. 

. . . [N]either [rehab] physician seemed to be actually in charge of my care, or spent much time at my bedside beyond what was required for a cursory physical exam. They did, however, leave lengthy notes in the computerized record, full of repetitious boilerplate language and lab data, but lacking in coherent descriptions of my medical progress, or my complaints and state of mind. 

Attention to the masses of data generated by laboratory and imaging studies has shifted [doctors’] focus away from the patient. Doctors now spend more time with their computers than at the bedside.

What personal care hospitalized patients now get is mostly from nurses . . . I had never before understood how much good nursing care contributes to patients’ safety and comfort, especially when they are very sick or disabled. This is a lesson all physicians and hospital administrators should learn.

Then he goes on to analyze the costs of his care and put these into the context of the overall financing issues in U.S. health care. Really, go read the whole thing, which is even more poignant for his having died just a few months after publication.

About Justin A. Sattin

I'm a vascular neurologist and residency program director. I created this blog in order to share some thoughts with my resident and other colleagues, and to foster my own learning as well.
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