A Residue of Anger

I have been sorting through my journals. A while ago, I ran across an entry which just plain made me mad. It was written March 23, 2008, a mere sixteen days before my father died, primarily of sepsis, although he had been diagnosed a year or so before with bladder cancer. I put it aside. Tonight, while working on bills at my desk, I ran across it again. I am going to transcribe it here for whatever posterity there is on the ether that is the net. First the entry, then the unavoidable commentary.

Call to Dr. U.

I have gone to all but two of my father's treatments.  One of the ones I did not go to, he was sent home because of infection.  He has had several infections (urinary) over the course of the treatments.  At least two or three times, when I went there, they seemed not to know why he was there.  He has seen the doctor maybe three times, the first for a quick discussion of what would be done (oh, and the stents being put in*), a discussion after the surgery and the recent cystoscopy, in which they had a conversation "the tumor is angry.", but because it was during treatment I did not hear what was said.

On Friday, there were some different receptionists and they had him give a sample, but did not seem to know why he was there again.  The woman at the desk asked me.  I told her.  I got called by (the technician) after he asked reception whether someone was with dad.  I have met (the technician) before and I guess I understand why he does not remember-so many people--but that is the problem with this assembly line. He told me my father had an infection (previously they haven't called me in for this sort of discussion) and gave him some meds.  Said to call him on Monday, which I did.  But I also asked to speak to the doctor.  The doctor called me back. I told him about my father's weight, that I had just seen how thin he is yesterday.  I asked him about the tumor.  Stuff that should have been told to dad, or to me, without our urging was revealed.  "He has good kidney function, but the stents have to be replaced."  I told him I wasn't questioning that necessarily, but I did not know if he would survive it.  I got the response. "It has to be done," rather than alternatives, if any.  He has elevated blood sugar.  I told the doctor dad had been misdiagnosed with diabetes a few years ago, and instead of allowing me further discussion, seized on it, that maybe it was diabetes.  But then, he said, "if he isn't eating". . . .  No solution, just a comment. "There are no active tumor cells."  The problem isn't the tumor.

I asked him what should be done.  And he said that, effectively, that wasn't for him, but for his regular doctor.  Apparently, if it is outside his particular activity, the rest of my father's health is not his bailiwick.  He did not want him to take any more antibiotics, though I said that my father believes he still has an infection.  "Well," he said, "we'll do a culture when he comes in and see."

So, I called (dad's internist) who he has to see before he has the stents removed anyway.

So, we did go to Dad's internist, who was as expected, non-empathetic and non-responsive, blaming my father for missing an appointment some time before this. He was there now, and there was little indication of anything other than indifference and arrogance. He saw how thin my father was, and said, with great authority, "I don't like what I am seeing!"  That, of course, was the point of trying to talk to the great healer. I'd ask something. He'd ignore me. But he wasn't doing much for dad. I got angry. I offered my unvarnished thoughts. Suddenly there was a hand around my left wrist. Dad intercepted me. Later, he said, he thought I was going to hit the doctor. "Dad," I said, "I have never hit anyone, why did you think that?"  He said, "You looked like you were advancing on him. He'd move back and you moved forward."  My father was pushed forward to the procedure--which was for kidney stents that neither he, nor I, actually understood the reasons for as he had bladder cancer and hadn't been having apparent trouble with his kidneys. He didn't want me to argue or push. I held my tongue after that. A mistake.

The day of the procedure, both before it and in one of those procedure prep rooms, dad kept telling me that he was cold. I should have realized something. Once, when he had a urinary tract infection, he had been shivering with a fever. I noted to the Dr. "he says he's getting cold."  The doctor, in his well pressed lab coat, looking at his check list, said, "He won't be in a little while," or something like that. This is when I should have read a riot act, but I wasn't the expert. That's what I tell myself. And this was an "outpatient" procedure. I didn't think it should be, but there it was. And Dad was eager not to stay in the hospital anyway.

Dr. U told me, after the procedure, that he had cleaned it all out. I didn't ask what it was exactly he had cleaned out. Infection? Dad did not feel well when he got back home and he was disoriented. I mistakenly assumed that it was because of the ambien he had been taking. I got his anti-biotics. I don't know if he ever took any. He went to sleep. "That's good," I thought. He hasn't been sleeping. At that point, when he went to sleep, well, not to be indelicate, but the product of his catheter, looked as I had been instructed it was supposed to be, normal. But when he awoke a few hours later, disoriented to the extreme, it wasn't. Ambulance. Emergency room. Seemed as if the testing was for anything other than what, in my mind having heard a lot about sepsis since, should have been obvious to the "experts". By the time he was in ICU, they had finally figured it out. Dr. U and the internist NEVER talked to me, and when they came, at least one time I know of, I was ushered out of the room by the ICU staff. I only learned after the fact that they had come. Four days after the outpatient procedure, my dad died primarily of sepsis.  This was April 8. When I saw the entry from March 23, my blood boiled again. He probably had that infection or some version of it, the one that became sepsis and killed him before the bladder cancer--and oh, yes, he had a long time heart problem, even quadruple by-pass nearly two decades before his death--on March 23.

Medical professionals or facilities, whether they be your internist, your surgeon, your urgent care, your ER, your hospital, they dismiss you, even when they don't really intend to do any harm. They get compassion fatigue. They think they have seen it all, so they miss what is right in front of their eyes. What do you know? You're just the family. And they succeed in too many cases, and there are still days, a decade after Dad's death in believing I was one of the people to whom it has happened, by their explicit or implicit annoyance or superior knowledge, to react to you for looking like a crazy person by insisting that what they thought or wanted to do, is profoundly incorrect. If they had listened back on March 23; if they had kept Dad in the hospital after the procedure--he would have let them if they made it clear the alternative was life threatening for Dad was tenacious about life--he probably would have been like his sister, who died after him at age 100.  But then, that's the other problem. Our society is indifferent to the idea that a 90 year old should live until 100. There is a sort of institutional attitude of inevitability that creates a medical and empathetic laxness.  And if you suggest it to them, they get their backs up.

I find that after a number of interactions with the all too imperfect medical maze, I am suspicious of every opinion. Much like I feel about car mechanics. I don't know enough to be sure that what they are saying is correct or not. They know that. And here's the thing. They are just as human as you or me.

What's the answer? I don't know. Become a professional advocate before the fact? I don't have the energy and I fear my anger at their lack of urgency about other people's lives that probably would not make me effective.

Oh, well. I am putting the original entry of March 23, 2008 away. My father is dead long ago.  As to him, that ship sailed back then.

Study: Doctors who are jerks are bad for patients, hospitals

February 18th, 2017by Steve Johnsonin Local Regional NewsRead Time: 3 mins.

POLL:Have you had an encounter with a rude doctor?

• Yes
• No

 

As Dr. Gregory House in the TV drama "House," actor Hugh Laurie crafted a compelling portrait of a rude, arrogant and self-destructive physician who upset his superiors, peers and patients in every episode only to redeem himself in the show's final moments with his brilliant solutions to his patients' illnesses.

But while a Dr. Jerk may make for fascinating television, it doesn't make for good patient care, and can be a magnet for medical malpractice lawsuits, according to a new study from Vanderbilt University Medical Center.

Vanderbilt researchers looked at complaints against surgeons from 32,000 patients who had operations at seven academic medical centers over the past two years, including Vanderbilt, Emory, the University of North Carolina, Wake Forest, Penn, UCLA and Stanford. They identified the surgeons with the most complaints, and then looked at whether their patients had suffered complications within 30 days after their operations.

They discovered that patients of the surgeons who had the most complaints were 14 percent more likely to have a problem post-surgery.

Dr. William Cooper, the study's lead author, said he believes the reason for the discrepancy is that surgeons who are rude or disrespectful to patients treat their operating room team members in the same manner, resulting in poor treatment for the patient.

"You think about a nurse in the operating room who says, 'It's time for the time-out procedures. Let's make sure we have the right patient, and are operating at the right site.' This is a standard safety procedure," Cooper said. "But if the surgeon says, 'This is a waste of time, let's keep moving,' over and over again, the nurse may stop bringing it up, and we know those are important. If in another setting a surgeon speaks disrespectfully of someone, they may be distracted and worrying about what the surgeon will do next and pay less attention to the task at hand."

While a 14 percent difference in complications from surgery may not seem significant, Cooper said on a national basis that would add up to $3 billion in extra costs to patients, hospitals and insurers.

Surgeons who get a lot of patient complaints also draw the majority of medical malpractice lawsuits, Cooper said.

"We know that 3 percent of physicians nationally account for 50 percent of patient complaints," he said, "and those same physicians account for 50 to 60 percent of the malpractice risk. So what that means is that patients are picking up something in their interaction with their doctor that did not sit right with them."

Cooper's work is not just academic. Vanderbilt has been working with 140 hospitals across the U.S., focusing on those who have a high number of patient complaints and medical malpractice cases.

"We have peer interventions with them and they drop their number of medical malpractice complaints," he said. "We have worked with 27,000 physicians and done 1,600 interventions, and 80 percent of those doctors have responded."

While this latest study focused on surgeons, Cooper said its conclusions apply to other health professionals as well.

"We do this work with advanced practice nurses and find very similar patterns," he said.

The Vanderbilt study is not news to local hospital executives.

"Medicine is a team sport nowadays," said Dr. Helen Kuroki, chief medical officer at CHI Memorial. "As physicians, we rely on nurses and other colleagues to watch our patients closely and advise us of any change in status. That requires a comfortable conversation in which nurses have to feel they can bring things to our attention that later don't turn out to be serious without any fear of reprimand."

"If a nurse feels that she has been treated dismissively or disrespectfully," Kuroki said, "she is not only less likely to report a problem, she is also less likely to share it with colleagues."

Both Cooper and Kuroki emphasized that getting feedback from patients is critical.

"We do surveys of many of our patients," Kuroki said. "We are looking for their input, their perception of the quality of their care while they are hospitalized. With physician behavior issues, we look for complaints from patients, plus behavioral changes from the physicians."

"This highlights the importance of the patient's voice," Cooper said. "If they have a health care expert who doesn't meet their expectations they should speak up and let the doctor and hospital know."

Contact staff writer Steve Johnson at 423-757-6673, sjohnson@timesfreepress.com, on Twitter @stevejohnsonTFP, and on Facebook, www.facebook.com/noogahealth.

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