Sunday, December 13, 2009

Healthcare Investigation


I decided this week to conduct my own one woman investigation to report on the state of Canadian Healthcare.

To start my investigation, Husband cooked steak for dinner on Tuesday. Knowing my tendancy to eat a little too fast and also my long standing propensity to get food stuck in my esophagus, I ate a large piece and made sure not to chew it properly. I also made sure to only drink a little

After dinner I drank a glass of water and painfully realized that the steak piece was lodged. Thankfully, my airway was secure. But I could not eat or drink anything.  I had a sleepless night when I would periodically try to dislodge the food, without success. Overnight I sought the assistance of Dr. Google as to what to do in this situation. Dr. Google told me to go to the ER if the food did not pass after 12 hours.

In the morning, Husband changed his plans and dropped the kids off at work and then drove me to the hospital where he works, dropping me off at the ER. By the time Husband had parked the car I was already registered, triaged and referred the the Fast Track registration desk. I had vitals taken and was ushered into a private room within 15 minutes.

Report: Grade for ER Triage and Registration: Fast and Efficient A+

I sat in the room for 45 minutes, which in a busy downtown hospital is to expected. I do think having someone check to see if I was, say, still breathing may have been prudent. Perhaps that was the role of the cleaning staff whose job seemed to be going back and forth endlessly by my door.

When I first saw Doctor Skippy, who seemed a little young and nervous, I was happy. Finally, I could talk to a doctor and get treatment. He asked me the problem and I told him. I think his first follow up question was perhaps an indicator of how the rest of the day would go.

"Where did the steak come from?"

Umm.

I did not know what kind of answer he was looking for. My first instinct was to say "Superstore" where I buy our groceries. I also considered "cow" "Alberta" and  "my dinner plate" but then wondered if he wanted to know the exact cut of meat so he was looking for "hind quarter".

I eventually settled with "I had it for dinner". He asked a number of questions but didn't ask quite a few I thought he might. Since I expected to see an ER doc with at least one wrinkle or gray hair in a few moments, I waited for him to consult and expected more questions.

About 15 minutes later he told me that they were paging ENT (ears, nose and throat doctors) for a consult.  Finally, I thought, someone who will know how to deal with this. And so I waited. Another 45 minutes.

At 11:30, Dr. Skippy told me that I had an appointment at the ENT clinic at 1:30 p.m. and was being discharged by the ER. I was dismayed. I was intensely uncomfortable and having to wait 2 hours for an appointment was not good news.

I might add at this point, to be a little graphic, that I could not even swallow my own saliva so I carried a large empty yogurt container as my own personal spittoon. I expressed a little displeasure over waiting 2 hours. I take it in ER time, that is actually the blink of an eye. "You're lucky you got an appointment today".

As I left the ER I met Dr. Skippy's supervisor, Dr. Funky-Glasses, who was the attending dispensing medical advice from his chair in front of a computer. He told me that it was possible that I had some sort of sac in my esophagus that can restrict food. Really, he was going on the precious little information Dr. Skippy had managed to glean. I honestly got the feeling he had watched a few too many episodes of House.

Dr. Funky-Glasses says to me, "ENT Clinic, 1:30:

"Right", I think, "GI Clinic, 1:30" [GI=gastroenterology]

I took my discharge papers and left.

Report: Grade for ER Treatment : C+  I was seen quickly and I was discharged within two hours, but I was not necessarily impressed that Dr. Skippy was the only doctor I saw apart from my parting words with Dr. Funky-Glasses.

The dilemma I now had was what to do with 2 hours. It is a little socially awkward to sit in the cafeteria near anyone when you're depositing your saliva in a yogurt container. Luckily for me, Husband's office was 100 feet away. I knew that he was at a meeting, but thankfully he had left his office unlocked so I shut the door and spent quality time with my yogurt cup. I honestly did not know how I would make it to 1:30. If only I had known.

Husband returned from his meeting and asked me how it went.

"I have an appointment at the GI Clinic at 1:30. I don't know how I'll make it."

I decided to try lying down on the floor of his office as fatigue from a lost night sleep was catching up with me. I did get a little bit of rest and when I stood up, I found myself in less need of my spittoon, which was a very happy development. The pressure and discomfort, however, from the steak was increased.

At 1:15 p.m. Husband escorted me to the GI clinic and then headed home to pick up our kids from school.

I told the clerk at the GI clinic that I had a 1:30 p.m. appointment. A slight panic flashed across her face.

"I don't have any more appointments for today."

This was not surprising. Late entries are not always recorded, I thought.

"I was referred from the ER." The clerk consults with others and comes back still looking perplexed.

"It's right on my ER discharge papers." I offered.

I fished it out of my purse and noticed that it says ENT Clinic. The GI people kindly direct me to the ENT clinic, where I get a similar reaction from the ENT clerk.

"I don't see your appointment."

The clerk was even more mystified and much less polite, which I should have attended to, that someone could be sent to the clinic from the ER. She asked why I was there and seemed highly suspicious that the ER did not manage to solve the problem without any inconvenience to her. She consulted with some residents and asked me to fill out forms and then asked me to take a seat down the hall with a half dozen other patients.

And I waited. And waited and waited.

After 45 minutes in the waiting area patients arriving well after me were being seen. I decided to let the heathcare system do it's job (mostly because I uncharacteristically did not feel up for a fight). A doctor noticed that I had out waited everyone else there and asked for my name and went down to check with the clerk as to the whereabouts of my chart. He came back satisfied and told me he'd be back in 2 minutes.

He was back in 2 minutes and saw the woman sitting beside me (he probably was speaking to her earlier, I was just desperate for any glimmer of hope). Another 20 minutes passed and he saw that I was still there. "Is someone going to see you?"

"I hope so." I whimpered.

"Can you go down and ask about your chart?"

I went to the clerk and asked about my chart.

"It's right here. You are not here for the ENT clinic. You're here for the Residents' Clinic. The doctors know where the chart it."  She was clearly annoyed by my interference.

"The doctor down there asked me to ask you."

She grudgingly moved my chart to a different box and after 5 minutes I was called into a room by a resident. They had all kind of fancy equipment, I felt sure that here my inquiry into healthcare would come to an end.

I told him what was wrong.

"Can you breathe?" he asked.

"Yes."

"Have you seen anyone in GI?"

"No."

"'Cause we're like for the airway. The rest of it is more GI."

"You know that is what I thought." I said, which is why I had actually made the mistake of going to the GI Clinic first.

The resident did look in the anatomy that the ENT's usually look at and saw that it clear and then went to consult with the ENT doc who came and delivered the same message: GI consult required. They (ENT) did say that they had a procedure that they could do, but it would require doing it under a general anaesthesia. The doc called the OR and found that he could only get me a slot at 2 a.m. Or the next surgical day.

A little back and forth and they decided to send me back to the ER where GI would consult and hopefully do an endoscopy (put scope down my throat) to liberate last night's dinner. This does not require general anaesthesia.  If that didn't pan out, they would do the ENT procedure themselves in the morning. I appreciated their commitment to help me.

As I waited for the paperwork to go back to the ER, the inconvenienced clerk consulted with the resident. She obviously was miffed surprised that I had seen the ENT doc.

"ER patients go to the on call doctor not the residents." she was told by the resident.

"All this time I didn't know that" she said lightly.

I wondered how many other ER patients have had to languish in that waiting hall.

I was sent to the ER for the GI consult, and the ENT resident said he would be down in a couple hours (!??!) to make sure that we had a game plan. In a couple hours I was hoping this whole steak episode would be behind me.

Report: Grade for ENT Clinic: D+. They would have received an F or lower but for the effort the resident and doc made to find a solution. The clerk gets a clear F as well as termination and two thumbs down not only for her mistake but her attitude. The low mark is also earned by whoever answered the page when the ER sought to make an appointment and didn't say "shouldn't she go to GI?"

I made my way down to ER. I actually got lost on a detour but ran into young GI resident or intern, or Dr. GI Pup, who was on his way to the ER to meet me. He happened to see my name on my paperwork and he escorted me. I really thought my luck had changed. If only.

He told me the whole 'team' was on it's way.

As instructed I went to the Fast Track Registration at the ER to check in and was told I was no longer in the system and I would have to go back to triage and registration.

Dr. GI Pup suggested that I just wait with him for the team and asked me a lot of questions, that were detailed and methodical. I was impressed. Where was he at 9:30 that morning?

I then went to be triaged and registered for the ER (again) and went back to the Fast Track Registration (I might add here that I was certainly glad not to be on the slow track). At almost the same time, an ER doc the GI team arrived.

The GI team was straight from TV. A gastroenterologist and 4 other residents/interns, all walking together. A medical entourage.

The ER doc, Dr. Kind-&-Competent said that she just wanted to check in with me and the GI doc said "No problem. Then we'll consult and you can discharge her."

I did not resist the urge to call after them "Not what I want to hear!!"

I told Dr. Kind-&-Competent my saga and she empathized with the long day I'd had and told me that I needed to talk to the GI folks and what I would need was a scope to look for the "foreign body". I said I was "all in" for that plan but wanted it to happen that day and not the next.

The Dr. Kind-&-Competent went to the GI team to warn them of my instability update them on my situation.  I was starting to lose composure.

The GI team, though initially intimidating in numbers, were also very empathetic to my plight. They did seem somewhat puzzled that I would not have been referred to GI right away. I indicated that I should have asked more questions or pressed the ER docs more but they assured me that it was not my place to do do.

The problem for my getting a resolution to my problem was that the OR was now closed and they did not have the staffing to do the procedure until the morning. Not news I relished, to put it mildly.

The gastroenterologist, Dr. New-Best-Friend, offered to do my procedure the next day before his scheduled patients. A quick phone call to Husband who said he could cancel his morning appointment and take the kids to school and I set up the appointment and reluctantly left for home.

It was a bit hard to swallow, if you'll pardon the pun, to learn that if ER had referred me to the GI folks at 10:30 in the morning, this would have been sorted. Or if the ENT chart-in-the-wrong-slot situation had not occurred, I would have had a shot at being seen the same day.

Report: Grade Reversal: ER Treatment Grade: F. They sent me to the wrong place which ultimately delayed the procedure. I add that had I seen the Dr. Kind&Competent at 10:00 a.m. instead 5:00 p.m. things would have turned out differently. She seemed to know right away that what I needed was an GI consult.

The next day though I had little sleep, I was actually more comfortable. I was at the GI Clinic early and while we started with the "I-don't-see-your-appointment" routine, Dr. New-Best-Friend had informed several of the staff of my addition to the slate so in no time, I was in a hospital gown and blood pressure cuff.

As promised, Dr. New-Best-Friend did my procedure first (ironically, the steak had actually passed by then) and diagnosed why I get food stuck frequently.

Report: Grade for GI Clinic A+ for not only treating me as soon as they could, but for being kind and generous to a less-than-gracious-slightly-irrational patient who had endured a hard day.

What did I learn from my one woman Healthcare investigation?  Despite the trauma of the delay to a hungry, tired, thirtsy and uncomfortably patient, I want to focus on the positive:
  • excellent care by the GI team
  • successful resolution to my problem, including the diagnosis of the underlying issue, which really is the point of healthcare
  • I did not have to mortage the house, rob a bank or sell a kidney to receive the healthcare that I did. I had my choice of hospitals with no co-pays, deductible, insurance limits or red tape (Go Canada!)

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