Friday, November 14, 2008

We Don't Live in a Perfect World...

When I decided to go into the field of medicine, I was a young naive high school student who was idealistic. Some of my idealistic traits still persist (perhaps one of the reasons why I choose emergency medicine - so that I could treat all who come to the ED). But part of being realistic is accepting the fact that not all health care providers are idealists.

As an example is the heart attack patient I cared for on my last shift. Physicians (and patients) not only rely on the physician in the ED to care for them but also the nursing, ancillary, and secretarial staff. Unfortunately, the staff may have other agendas. Where we all would like to believe that when you arrive in the ED with a chief complaint of, "I have chest pain and the last time I had pain like this was when I had my heart attack in 1980!" patients do not always receive prompt care. Indeed, this patient presented at the triage desk saying just that and was brought back to a ready bed. We really were not busy and yet for some unknown reason it took the staff over 20 minutes to perform an EKG. Excuses like, "The ED tech is not available, there is only one tech or we can't find the tech," somehow just doesn't cut it in my book when I really need an EKG to diagnose a heart attack. Time is muscle (heart muscle) and if indeed a patient is having a heart attack that can be recognized on an EKG, I need to know as soon as possible to optimize the patient's management. One of the physicians actually said, "Give me the EKG machine," out of his frustration, "I'll do it myself" (knowing full well that he had not performed an EKG since he was a student.

The patient finally had an EKG performed and to no surprise, it revealed he was having a heart attack. The federal government, by way of the Center for Medicare and Medicaid (CMS) tracks outcomes and treatments for certain disease including heart attack for the hospitals nation wide. In this particular case, the evidence is very clear...the earlier someone who is having an a cute heart attack and receives either a medication known as a "clot buster" or is immediately taken to a cardiac cath lab for emergency angioplasty (using a balloon to open up the clogged artery) the better the outcome. In this case, the patient went directly to a cath lab after notifying the cardiologist.

It ceases to amaze me why other people just don't do their jobs. I suspect some of what I see is related to a lack of motivation (an individual issue), perhaps burn out, or a need to feel empowered over others. Regardless, when it comes to taking care of sick patients, I have zero tolerance for such behavior. I might add, I'm embarrassed when I'm faced with such a situation, but sometimes feel helpless.

Fortunately, the patient did well...despite the staffs efforts to be obtrusive!

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