Doctor Mom is a physician who lives in Ontario*
It’s March Break, which means last chance to do winter activities for some families in Canada. Unfortunately, I’m not Winter Fun Mom so I booked Son #2 – the only person in our family who is interested in winter sports – on a bus-in snowboarding camp. On day 1 I warned him to be careful and to try not to injure himself. On day 2 I forgot to warn him. So at 2pm on day 2 I got a call from the snowboard instructor to tell me that my son had fallen and would soon be on his way to hospital in an ambulance.
I know I should be more encouraging of adventure and more accepting of risk-taking in my boys. And I’m not UNfun Mom, by any means. Yet years spent as a Casualty doctor and then an anesthetist rather reduced my tendency towards happy-go-luckiness. And having lived my entire adult life with the sport-limiting and general functional consequences of knee injuries incurred in childhood means I’m loathe to encourage risk of traumatic injury in my own children.
But it’s the way that hospitals operate that really makes me want to avoid having to visit to them. I even refused to give birth to my children anywhere but at home, much to the annoyance of my husband. For patients and relatives hospitals are frequently places of indignity, frustration and tedium. Although individuals are often kind and friendly, a public hospital system is frequently inhumane. And Emergency is the zenith of surrender-all-control nightmares. My sons have no concept of this because they have been largely healthy and injury free (and having a doctor mom means that sometimes mom makes the call that a doctor would make so you don’t have to go to the doctor); They don’t have the antibodies to hospitals that their mom has. But one does now!
Son #2 – who is 9 years old – was brought to the hospital’s emergency department at 3pm in the afternoon and his dad and I arrived shortly afterwards. We found him alone in an examination room lying on his back wearing a stiff collar. The novelty of going to hospital had already worn off. He’d dropped the buzzer he’d been given. He was feeling caged and ready to whine.
There followed 90 minutes of restless wriggling, some drinking of water through a straw, and lots of “I’m soooo booooored!”
I was encouraging. It won’t be long. Emergency departments are busy. Waiting is normal.
At 5pm we let our son press his call button to ask if he could go to the washroom. The nurses said he couldn’t sit up or walk so he peed in a bottle.
With the help of an audiobook and some mental math problems we weathered another 90 minutes of absolutely no attention from anyone although we could see many staff milling around outside the door of the exam room.
“Have you got a joke for us?” we asked Son #2.
“Sure,” he said, “Knock knock!”
“Not a doctor!”
We laughed; it was better than the alternative reactions to our situation.
After Son #2 – who is 9 years old, remember – had lain on his back staring at the ceiling for nearly four hours without seeing a physician or being sent for imaging, we said it was okay for him to press his call button again so that we could ask when he was likely to be examined by the doctor. The nurse said he was next on the list to be seen, and that there were only two doctors and one was ‘seeing urgent cases and busy saving lives’.
The second doctor, it turned out – because later when he did come to examine our son we put two and two together – was sitting at the desk right outside our exam room door, and there he continued to sit For 45 Minutes, slowly enjoying a venti Starbucks and a sandwich…! Folks, forgive me, but that’s the medical care equivalent of the server peeing in the soup of a restaurant patron who dares to complain about the slow service! Everyone who works deserves a meal break – even doctors – but have the grace to take it out of sight of the patients waiting for you to see them!
Not that we had even complained; by the time we asked politely when our son might see a doctor we had been in that airless exam room for 4 hours and our son, who had been staring at the ceiling, was crying with boredom for us to let him go home.
Also worth mentioning is that Son #1, aged 13, was alone at home. We’re lucky; he’s resourceful. He fed the pets and took himself to a local restaurant for dinner.
At 8pm the doctor, fully victualed at last, came into the exam room. He did not greet my husband or me, or even acknowledge us. He began taking a history from my son. He removed the hard collar from my son’s neck and asked him to sit up.
And then a code was called and he left. I immediately jumped up to put the collar back on my son, but the doctor called to the nurse tell her to tell me no. He told her to allow Son #2 to sit up. Then he left.
Was I worried about my son’s neck, which had been so carefully immobilized for several hours? No, not really. I’d already examined him myself and come to the conclusion that the neck injury – if he had one – was minor. But as a medical parent it’s not for me to make that call. Was I furious? You bet! What kind of a system triages a child to be not-a-priority and then leaves him lying on his back in a stiff neck collar for four hours without coming to explain to either the child or his parents what’s going on?
I turned to my husband and said, “This is absolutely unacceptable!” At which point the nurse asked me if I didn’t understand what a ‘code’ was. So I had to go for a walk to cool off and to avoid becoming ‘a verbally abusive patient’.
We waited another hour but the doctor didn’t come back. I’m sure he was busy and that there were lots of priority 1 and 2 cases that were taking up his time. There were certainly lots of people in the waiting room when we left; it was a busy night in Emergency.
And the outcome of this evening of fun was simply, and anticlimactically, that we left.
After Son #2 was free of his neck support and allowed to sit up it was nigh impossible to prevent him from walking around. The waiting started to become ridiculous. He began to beg to be taken home. He was tired and hungry and wanted to get enough sleep to be able ‘go to camp tomorrow’. Husband and son both turned to me. Could we please just go? Suddenly Doctor Mom became The Doctor. In the face of an indefinite wait to see a physician I had to make the physician’s call. It was somewhat less than ideal. I believed my son was okay. But there was a small chance I’d be responsible for making a mistake. I didn’t want that responsibility. But I took it so that we could all have our human dignity back. We paid the $15 parking fee and drove home for an hour in a snow storm, relieved to be free – and everyone was too tired to eat any dinner before going to bed.
“What did you learn from this experience?” I asked Son #2 on the way home, thinking he might say that he had learned that it makes sense to be really cautious when participating in winter sports.
“Next time I fall I won’t say I’ve hurt my neck or my head even if I have,” he replied.
This is not the outcome that the health service should want, but, sadly, reluctance to seek care is the result that does follow the delivery of care that is not kind or dignified for the patient.
** Follow up note: I submitted a formal complaint to the hospital in question, stressing that the feedback was given in the spirit of offering constructive criticism.
I have few answers. Only sympathy. And I don’t think that doctor moms are alone although they actually are, when it comes to their own child in the room with them.
P.S Us junior medical practitioners can forget this. It might be better not to. The best doctors do everything for everyone at all times with simple prevention and cures. However it does take the combined works of millennia to get even this far, and getting further may take longer. It is nice to see that as a patient sometimes I can access the public healthcare system simply by being a human and living as I do where I do at any given moment. That is comfort. Doctor means teacher not healer (that is physician or iatros I believe.
1. I think it unlikely this would have been written had a serious injury been involved.
2. Small emergency departments (like the one at my hospital) can easily be overwhelmed by even one or two sick patients.
3. Physicians eating and taking breaks on the job should be encouraged, not criticized.
While I do not support keeping patients in spinal precautions for extended periods we are only getting one side of the story here (and anonymous at that) It is very disappointing to see this published by CMAJ at a time when physicians are feeling increasingly overwhelmed and downtrodden. The fact it came from a physician just adds insult to injury.
W Wallace Watson
One cannot impugn an entire system after one encounter of exemplary incompetence. Interesting , it appears you never indicated early in your story that his complaint was his head and neck and that you had evaluated him. There is a place not to treat one’s family. There is also a place to relieve the suffering of a family member such as #2 being unnecessarily constrained for a prolonged period, particularly after one has evaluated the clinical condition.
However, that does not abrogate the department from severe criticism for the poor performance of all those in the ’emergency’.
One would expect that a complaint has been registered with the appropriate authorities to rectify this abominable situation so that it is less likely too happen again.
Dear CMAJ, I read with disappointment today, your doctor mom blog of March 16, titled: ‘moms son learns healthcare system is best avoided’. I wonder what the point of publishing such an article actually was? Did you mean to infer that this mother’s experience was representative of care in EDs throughout this country? I realize that you cannot control what your contributors write. However, I would encourage you to read the piece and check for veracity. In most EDs there are guidelines about the removal of the C spine collar and every attempt is made to get people out of the collar as quickly as possible. Clearly, there were extenuating circumstances and high patient volumes that contributed to this delay. Further, in 17 years of doing EM, I have NEVER had time during a shift to spend 45 minutes eating, let alone at the desk in view of patients. I find this recounting of events to be potentially exaggerated and harmful. My ED colleagues and I, frequently go the entire shift without a visit to the bathroom due to the acuity of patients and the lengthy wait times caused by an under resourced health care system, let alone sitting down for more than 15 minutes to eat. If Canadian doctors could be seen as a brand, the publishing of this article has done immense harm to this brand. We are a highly skilled labour force who are being defiled in the media, by politicians, and by an often demanding patient population. For our very own association to join the angry mob by ridiculing EM providers shows a deplorable lack of judgment. In future, before allowing one very biased opinion to taint the good work that Canadian doctors do, I encourage one of your editors to shadow an EM physician during a shift. I guarantee you will have a different perspective on the kindness and dignity of the care we do our best to provide.
Well written and honest post. As an Emergency Physician of 15 years experience, I have no satisfying explanations to offer regarding this all-to-common scenario. Our system is overtaxed. ER supply and patient demand will likely always lead to frustrating waits in a publicly free-access health care system.
I would hope that ER doctors can offer up better bedside manner (introduce themselves, acknowledge everyone in the room, offer understanding of the frustrating wait: ‘It’s must be tough being in that collar for so long, let’s see if we can safely take it off”). If a doctor can’t make a habit of incorporating patient’s feelings into their assessment and treatment, well that makes them mediocre physicians (or worse) in my view.
I have a related anecdote: Years ago, after many hours of efficient work on a night shift, I needed coffee and snack. I decided to have that break at the nurse’s station. The break was not long, but the demanding friend of a patient having a panic attack made a big fuss about the wait, highlighting that they could see the doctor ‘not doing anything’. When I saw the patient, they got angrier, and I had to leave to help defuse the situation. I returned a bit later, we listened to each other and we were all able to come to an understanding of each other’s point of view. They left shaking my hand, and thanking me. I was proud of my ability to resolve tense ‘challenging’ (read:difficult) patient encounters.
Days later, I received a notice that the patient made an official complaint to the chief of staff about me. I was quite frustrated.
What did I learn? Patients can endure long waits and difficult scenarios as long as they know everything possible is being done. Those working in the health care industry know that we’re not giving 100% all the time. It’s impossible. We’re human. And many are ‘burnt-out’. But as professionals, we must give patient’s the impression that we’re doing the best. That means casual conversations, meal time, iphone checking should be discrete or done outside of the view of others. That means dressing professionally. That means being on time (I’m guilty of that one).
As physicians, we have priorities, but I believe patient’s dignity as stated in this post should be one of them.
Get my free ebook on time management. email me at firstname.lastname@example.org.
I was an emergency physician for 20 years and would never be seen eating or relaxing in front of the patients if I was on break. I always introduced myself to all in the room and apologized for the long wait. I taught medical students and residents to do this too. I never had a complaint.