With all the talk these days about health-care reform, I am surprised at how little each administration looks into the psychology of medical care in the United States. You can’t fix a system until you understand the heart that drives it and we have programmed some unusual behaviors into the minds of many would-be patients in the American medical system today.
Recently, I was at work in the ER when the nurses and I heard some yelling and screaming outside the doors. We got up in anticipation of what sounded to be a woman in great distress. Suddenly the main doors of the Emergency Department flew open as a woman walked in propping her sister up on her shoulder. Working in the ER, my definition of “sick looking” is far worse than the average person’s, and this girl looked very sick.
As I ran up to help the young woman, I asked what had happened. The answer shocked even me.
Her sister looked right at me and said in a loud and serious voice, “If you let my sister die, I’m gonna sue you!”. Talk about pressure. Granted, I wasn’t expecting her to say “Good morning, how are you today?”, but it would have been more helpful if she started out by telling me about her sister and why she was so sick. By the way, in case you are wondering, I had never seen either of these two women before in my life, so her statement wasn’t due to a previous bad experience – it was just a programmed behavior.
What does that mean? It means that we have conditioned so many people in our great nation to think of the medical system as God and that if something bad happens to you, it must be someone else’s fault. So why not blame your friendly neighborhood doctor? Before bank and auto-industry bail-outs ever hit the news, we in the medical system have been dealing with the idea of health bail-outs for decades now.
A woman can spend most of her pregnancy doing cocaine, see her OB/GYN maybe only once or twice during the whole pregnancy, show up at the wrong hospital to deliver and when the baby has a problem we don’t seem to be able to blame the drugs or the life-style or the lack of interest on the patient’s behalf for seeking medical care – it’s just the doctor’s fault because he should have bailed her out for her nine months of irresponsible behavior. He should have waved his magic wand and made it all better.
Getting back to my early morning nightmare though, it turned out that my very sick patient was unable to breathe. Here I was standing over a 25 year old girl who already had been diagnosed years before with high blood pressure, diabetes, and kidney failure and was supposed to be on a hand-full of medicines – which she was unfortunately not taking. While there are certainly young people out there who, through no fault of their own, develop such diseases, this patient in particular had developed them because of her history of drug abuse.
While I was trying to get some information out of her “I’ll sue you” sister and the nurses were frantically busy getting her hooked up to the monitors, we discovered that her blood oxygenation was 55%. Normal this number should be above 95% in most healthy people, in the 80’s someone is usually in a fair amount of distress, 70’s and the person is in serious trouble of respiratory failure and so it really wasn’t a surprise what happened next … she coded.
When a person codes, it basically means that their heart and lungs stop working and we need to do CPR right away or they will die. The good news for this girl was her young age and consequently her young heart. The bad news is that I wasn’t sure how long her blood oxygenation had been so low and how long her brain was deprived of getting enough oxygen. Long story short, we succeeded in getting her heart to work again within 3 minutes, put her on a breathing machine (ventilator) and I immediately contacted the larger hospital downtown to get her transferred immediately as she was sure to need specialized equipment and monitoring.
I spoke to a friend who was a kidney and Intensive Care specialist. I let him know not only about the condition of my young patient, but also to be careful since the family was already putting a big red target on the medical system. She left our hospital and arrived downtown safely and stayed in the Intensive Care Unit for three weeks. Unfortunately for this poor girl, she was brain dead from the first day most likely – the result of her brain being deprived of oxygen for too long before she ever got medical help.
You might wonder why, since she was known to be brain dead from the first day or so, that she stayed hooked up to all those very expensive ICU machines for three weeks. The answer is part of why our medical costs are so out of control. No one in their right mind was going to approach the family and tell them that even though her heart was beating she would never recover and risk getting sued. If you wonder why you “need” to have so many tests done the next time you are in the hospital, the reason is sometimes the very same.
We call it “CYA” for “cover-your-arse” and that means that in many cases you will receive hundreds if not thousands of dollars of testing that you don’t essentially need because the doctor is afraid you will sue him for missing something. This fear is not something imaginary though, but the result of being blamed too often for not being perfect, for not predicting the future and for not being able to wipe away the years of abuse we often do to our bodies.
There are no doubt cases were people should be held responsible for unacceptable negligence and irresponsible, unprofessional actions in medical care like “forgetting” scissors inside someone in surgery or giving a lethal dosage of a medicine; but our system is well out of bounds at the present time and our own behavior keeps driving this unending cycle.
I want to close this first part of this series by telling you briefly about another patient, incidentally the husband of one of our ER secretaries. He has severe back problems from years of laborous farm work and had to undergo a medical procedure that was intended to make his back feel better but instead made things worse for some time. When someone suggested to him that he sue the doctor for the bad outcome, which was a known risk and not the result of negligence, he simply said, “No, I could never do that. He tried his best and that’s all you can ask from anyone.” I just wish more people looked at medicine the way he does.