Teachable Moments in Health Care

Valdemar Lopes de Moraes, 39, suffering from an earache and muffled hearing, thought that his name had been called by the nurse in the waiting room at a clinic in Brazil. The nurse had actually called out the name Aldemar who was there for a vasectomy, not Vlademar. 

Thinking he had been called, he went to the consulting room where a doctor was waiting to perform a vasectomy. When interviewed, the doctor said he wondered why the patient hadn’t been properly shaven—but went ahead and did the surgery.

 

“The strangest thing is that he asked no questions when the doctor started preparations in the area which had so little to do with his ear,” said the clinic manager. The patient said he thought it was a really bad infection that had spread to his testicles. Huh??

 

Health care lesson number one: Communication! Both ways.  Doctors and patients need to know that it’s really OK to talk to each other. We must talk, and we must ask each other questions and be willing to take the time to understand. There were many assumptions made about who knew what.

 

When I was a resident at a busy major teaching hospital, there was a case where two patients got mixed up in the outpatient surgery center. Both were men with the same first names. One was there for a colonoscopy and the other for a bronchoscopy, but they got what the other was supposed to have.

 

It took four people: two doctors and two patients to not talk to each other to accomplish that. All it would have taken is one of the four to say something or ask a question.

(This is about where my wife says, “It’s the same reason why men don’t stop to ask for directions—you men all kinda deserve a colonoscopy”—brutal, but with a hint of truth.)

So—when you’re told that you’ll be having a scope in your lungs and the doctor asks you to bend over….that might be about the time you say “excuse me”?

(Later, the gastroenterologist complained about how lousy the prep was for the colonoscopy…. uh, maybe because the patient was expecting a bronchoscopy?)

 

In both cases the specialists never talked to the patient about why they were there, nor did the patients ask the doctors what they were doing. (In fact, the specialist didn’t know what had happened until, much later in the day, the incredulous family doctor of one of the patients caught up to the specialist and told him that he had scoped the wrong end of the wrong patient.)

 

Even worse, there ensued some debate about whether or not to charge the patients. Some felt that by writing off the charges there would be an admission of guilt: “It wasn’t my fault I got directed to the wrong patient to do the procedure.”

 

At first, no one felt accountable for the mistake. It was the nurse’s fault. It was the receptionist’s. It was the patient’s fault; he should have said something.

 

In fact, it’s all of our faults. We’ve allowed the medical system to get so depersonalized that it is acceptable to walk into a patient’s exam room, never speak a relevant word and do some type of invasive procedure. It’s the way we set incentives in our health care system that values technology and procedures, the latest and greatest, over simple human contact and caring.

 

So, as patients, the lesson is that we also have responsibility and accountability in taking care of ourselves. We need to try to understand what the doctors are doing and why they are doing it. Almost all doctors will say that they really appreciate it when a patient tries hard to understand their disease process and engage as a partner with the doctor.

 

If that level of communication between doctor and patient were to happen, when you’re one day there to get a lung scope and the doctor says, “bend over,” you wouldn’t just say   “Okee-dokee…..”