Today I am turning over my blog to Linda Schwimmer, Vice President of the Quality Institute. Linda recently had a personal experience that sheds light on flaws in our healthcare system. I asked her to share her story with us.
The summer evening was warm and breezy as my husband and I rode bikes around our town of Princeton. We were coasting at an intersection when we collided. I fell, smacking my hip and shoulder on the concrete. I immediately felt excruciating pain in my neck and shoulder. I sat on the sidewalk while my husband went home to get the car and drive me to University Medical Center of Princeton at Plainsboro. We arrived around 7:30 p.m.
Upon arrival in the ER, we were asked a few intake questions, including one about the level of pain, which I placed as a 7-8 on a scale of 10, and we were directed to sit in the pleasant, light-filled waiting room. We continued to sit. And sit. I can describe the pain as second only to childbirth. At one point my husband went to the nursing station and asked if we could at least have an ice pack, which the intake person provided.
After about 45 minutes, a triage nurse brought me to an intake bay and asked many of the same questions while taking my blood pressure. Again, I explained that I was in tremendous pain. Still, I received no offer of pain medication, not even a Tylenol. This stop in the ER conveyor belt ended after about 15 minutes and I was sent back to the waiting area. At about 9:30 pm, I was directed to the actual ER, presumably to be seen by a doctor. Another wait. After about 20-30 minutes, another round of intake type questions, and another waiting period, the doctor arrived. He gave me a quick examination, diagnosed a likely broken clavicle, and told me that I would need an X-ray.
I was then wheeled over to X-ray and wheeled back. After three hours in the ER, the doctor told me that I had a broken clavicle. He said he would write a prescription for pain medicine. I waited another 30 minutes for the prescription, making my total stay at the ER three and a half hours. Just before my discharge at 11 p.m., a technician tried to fit me for a sling, which cut into the damaged part of my shoulder, causing so much pain the nurse had to quickly jerry rig a new solution. Then the nurse hastily handed me a prescription for a painkiller, a command to follow up with an orthopedist, and wished me good luck. As I was being shown the exit door, I again said I was in a great deal of pain and asked if any staff knew where I could get a prescription filled after 11 p.m. The question seemed to be one they had never considered before, as if being asked how to calculate the volume of the Pacific Ocean. They had no idea where I could fill my prescription.
We found an open CVS, but the pharmacy was closed. We realized the prescription was not going to be filled that evening. I knew I needed something to get through the night so I called a friend who recently had surgery and he offered to give me a powerful painkiller. Yes, I know I should not take another person’s medication. But after being in excruciating pain for over four hours and knowing that I could not sit, much less sleep, I was out of options.
What I received was the opposite of patient-centric or compassionate care at the emergency room. But the situation worsened. At 6:00 a.m., I woke up to see my face and lips swollen as if I had just stepped out of a boxing ring. My husband took me back to the Princeton hospital. This time the health professionals sensed the urgency of my situation and responded quickly with intravenous allergy medications. And this time they gave me a painkiller — the one I should have gotten the night before — and waited to make sure I did not have another reaction. I was in the hospital for much of Saturday.
But my journey into our fractured health system was not over.
On Monday I obtained a 10:15 a.m. appointment with an orthopedic surgeon, but first I needed a referral from my primary care physician at Princeton Medical Group. I called and called and was promised calls back with the referral number. Finally, with 10 minutes to go before my orthopedic appointment, the nurse called and refused to give me a referral because I had not seen the doctor in two years. I said I visited my ob-gyn, got my flu shot at the drug store, and there had been no reason for me to see the doctor. I explained that I had an order from a hospital to follow-up with an orthopedist, had all the paperwork needed to show that I had just fractured my clavicle, and that this was an emergency. She insisted I make an appointment with my primary care doctor before the medical group would issue a referral. By now I had missed my appointment with the orthopedic physician.
I went to Princeton Medical Group on Monday and they weighed me and took my blood pressure, which, not surprisingly, was high because at this point I was seething. When the doctor came into the room, I told him I was angry. I told him I should have been home resting or seeing an orthopedist, but instead his office had dragged me in for an appointment under the charade that I needed to visit a primary care physician before receiving a referral. The doctor apologized profusely, said it was the first he had heard about my case, and advised that he would write a letter to his CEO to make sure this was addressed. He promised to return with the referral and quickly left the room. The nurse came in with the referral and I asked where the doctor was. “He’s with another patient,” she said. I went home and followed up the next day with the orthopedist who was kind enough to see me on short notice. At last, I am on the mend.
I am sharing this story because as policy makers we frequently look at the big health care picture. My experience showed me, on a personal level, just how broken our system is and how far we must go to create patient-centric care. I saw firsthand the waste in our system and the bureaucratic hoops that become roadblocks to care. The blame can be spread around — to physicians, physician’s offices, insurers and hospitals. Something is wrong when patients with broken bones must advocate for themselves just to get an icepack.
I experienced poor quality health care that did not promote healing. In truly patient-centered care, the hospital would have addressed my pain quickly and helped me arrange follow-up care. Electronic medical records would easily transfer my information to the specialist. My primary care physician group would implement a common sense referral process and train employees to understand that referral process and always consider the needs of patients. I met some caring professionals during my experience, but I also saw up close that patients must navigate a disjointed system at a time when they are suffering. I know that my experience was not unique and that’s why I am more energized than ever to move forward with my work at the Quality Institute to push for a compassionate health care system that puts patients first.