I work as a physician in a hospital. As much as we wish it were New Amsterdam with a little”Grey’s Anatomy and Dr. House in the background diagnosing — I can tell you the reality is much different.
Every health care article comments on how overworked and tired our health care workers are. I can tell you this is true. It’s not a TV show where the staff performs neurosurgery while simultaneously reading the MRI yet manages to have a glass of wine at a bar. It’s not that kind of tired.
We are tired for other reasons. The truth is that both patients and systems can have a massive impact on the general morale of staff. I can’t change the politics of medicine, cost, prior authorizations, or insurance approvals (or lack thereof). I can’t change an a la carte menu of shared decision-making where a little PEG tube, some dialysis and a trach in end-stage dementia will ever feel like the standard of care. I cannot change those things. I can’t change the lawsuits or burdensome complexity of documentation and endless clicking. I do wish patients and families understood some intricacies of hospital medicine.
1. Testing takes time. I know. It feels like forever to get that MRI or lab work, but the truth is it does not only require staff to make sure that the test is done safely and correctly. Some questions need to be verified before many tests can be completed. Are you allergic to dye? Are you claustrophobic? Can you lay in this position? An MRI is a giant magnet, and sometimes pacemakers and other devices are not compatible. All these are safety issues before the test can be completed.
After a test is done, a radiologist, a highly trained physician, needs to read that imaging. They are busy trying to read each test in context, sometimes calling the ER physician or hospitalist directly to give results. It all takes time. Even with lab work, if there is a question, it will be repeated. Sometimes the pathologist will manually review slides. We are waiting for the results, too. Yelling at us or demanding answers will not make it go faster. Certain tests may not be available on a weekend or holiday. This is how hospitals work.
2. Please know your medications. I don’t mean the little white pill for your blood pressure. I can tell you we don’t know that one. We also don’t just “have a list on the computer.” If there is one thing you can be responsible for before you come to the hospital, please know your medications and their dosages. Sometimes people have medications on their “list,” but they aren’t actually taking them, or they reduce the dose because their blood pressure is running low, etc. The dose and the medication: please make a list, write it out, keep it in your wallet, keep it updated, and help your parents with it. As health care workers, we spend a lot of time on medications, which is frequently a source of medical errors. There are many interactions and side effects to medications. Often we don’t just re-order everything in the hospital until it is all verified.
3. One family member. Please. I would love to talk with all of your family, but sometimes we need to communicate with one person in the family and have you disseminate that information. If I have 15 patients and spend 10 minutes talking with each family, and then you double that amount of time … well, you get the picture. We need your help. Please designate one person, we will call them, but we can’t call you on the phone, come to the bedside to talk with that family and then talk with your Aunt Sally as well because she “also has some questions.”
4. DNR/DNI does not mean we’re trying to kill your loved one. We ask this question of every patient that comes to the hospital. Many people have living wills or DNR forms that express what they would want at the end of their lives. When you are older and have multiple comorbidities, the chances of returning to a baseline level of functioning that you are at now after requiring a “code” and CPR are slim to none. That is why we ask. It is not like the movies where a person is “shocked” and suddenly comes back to life eating ice cream after. Often a code situation happens after a person is already critically ill, and if they are sick and ill to begin with, doing CPR and intubation often will not “save them.” However, this is a personal decision and you should discuss it with your family members closely.
5. Sometimes, there isn’t one diagnosis. I know they say medicine is an art, but I wish they would say that medicine isn’t a math problem. We can do all the testing and diagnosing. Sometimes there isn’t a straightforward answer. It doesn’t mean we don’t know anything. Sometimes there is more than one answer. Your shortness of breath may be due to some heart failure and pneumonia. We won’t pin it on one diagnosis. Other times, we can only do our best to make sure that we rule out any catastrophic cause for your symptoms. I may be able to tell you that your chest pain is not an acute MI, dissection, or a pulmonary embolism. Can I 100 percent say that it is due to acid reflux? No, I may suspect that, but I am hoping that you can have some peace knowing that you didn’t just have a heart attack, dissection, or pulmonary embolism.
There are many more to add to this list, but just a little understanding and kindness will go a long way on your next hospital stay.
Emily Stanford is a hospitalist.
