More than just a wheelchair
On the first day of my Internal Medicine posting – I was extremely excited to see, learn and help – I was ready to change the world.
So on my first morning round, I started early and took as detailed a history as I could. I was waiting to impress the consultant with my thorough history-taking across a list of medical, social, family, sexual and financial issues.
After I took the patient’s history, per protocol, I approached the house officer (HO), then the two of us went to the medical officer, then three of us to the registrar, and finally me and registrar approached the consultant. I noticed, however, that with every round, the amount of medical information in the electronic records (which everyone reads before seeing the patient) kept increasing while the history-related information kept decreasing.
Eventually, all ‘non-medical’ items were dropped from the problem list. Around this time, I also received feedback that I needed to be more concise in my history-taking and presentation. This seemed to align with the overall trend of focusing on medical data; and at some level I also agreed: after all this was a tertiary hospital, not a family clinic.
Until the following incidents happened.
The day of his discharge was drawing close and the patient, Mr K, was looking forward to go back to take care of his ailing mother. While medically he was fit to be discharged, he needed his motorised wheelchair, which was waiting at a workshop, to go back home.
A Medical Social Worker (MSW) was engaged three days ago to resolve the issue. Needless to say, Mr K was having problems moving around without a wheelchair even in the hospital. I could understand his frustration and assumed the delay was probably due to a financial issue.
I called the MSW for an update but didn’t get one. I then asked Mr K, who quickly gave me a number and name of the shop owner. I called the shop owner and asked whether the wheelchair could be delivered to the hospital rather than his home.
I was thinking I would pay it out of my own pocket, but the shop owner replied that the delivery was free and he confirmed delivery to the hospital next morning. When I told Mr K of the news, he was delighted.
What I couldn’t understand was that when delivery fee wasn’t an issue, why then it took so long to resolve Mr K’s wheelchair issue? I couldn’t find the HO so I updated the medical records accordingly. The next day when I saw the HO she said the whole team was amazed that I had solved the problem for Mr K.
Another patient, Mr V, needed to have the Automated Implantable Cardioverter-Defibrillator (AICD) for his heart checked, but the technician couldn’t perform the check as she didn’t know what brand the AICD was. Since Mr V got it implanted at another hospital, our records also didn’t have the details. Three days went by.
Not expecting a helpful reply, I casually asked Mr V if he had any details of his AICD. He opened his drawer and gave me his AICD identity card which had the device’s name, model, date of installation and number to call if there were any problems.
I wondered why he didn’t offer it to the technician who came by or the medical team. Apparently, nobody asked him. Needless to say the team was very happy that I solved another puzzle for them.
While I was happily grinning inside for impressing my team again, I was astonished that in both cases it took multiple days, a team of doctors, medical students, and allied health professionals to resolve something that would have taken a 5-minute phone call or a two-minute conversation respectively. I felt a bit ashamed with the system’s inefficiency.
In my mind, I was quick to put blame on inadequate history-taking which had prevented a conversation with the two patients regarding the wheelchair and the AICD respectively. Saving 5 minutes in the morning rounds ‘to be more focused’, had cost the system three extra days of admission and increased anxiety for the patients.
But who was really at fault? The HO who works non-stop and had rightly informed the MSW and technician in time, and was doing everything so that the patient can be discharged well and happy? The MSWs who dedicate their life to taking care of patients with numerous psychosocial issues, and probably were involved in some more emergent issues at the moment? Perhaps it was the patient who didn’t make a call to the shop himself because the medical team said they would get it done? Or was it me, who couldn’t understand the feedback I received and perhaps took it to an extreme?
Suddenly all these arguments were criss-crossing my left brain, while my right cortex was being stimulated by anger, disappointment and disenchantment with the whole system. This dilemma between logic and emotions is a never ending battle in the field of medicine.
All of us here are working tirelessly and selflessly towards to the same goal: better patient health care and outcome. But maybe in taking care of all the medical and administration problems, we forget that, after all we are treating humans who have lives outside the hospital - a life where a wheelchair is more important than an ECG, where they are well-versed in their own medical history (more so than their electronic records).
All we need is to be a bit more holistic (which doesn’t mean we can’t be focused) and ask the right questions.
The invaluable lesson I learnt from this rotation and one that I wish to take forward in my career is to take a detailed history of the person in front of me (and not just the patient), and then use my skill and knowledge to make a succinct presentation for the morning rounds. Unlike in exams, I can always go back and add on missing points to my records after I finished the morning rounds.
Regarding the dilemma between logic and emotions - this one I have to conquer slowly but certainly.This is a Public reflection which is publicly available for anyone to read.
Created on 23 October 2017 by Deepali Bang