At last it was time for my cataract surgery. Having had one eye surgery done by a different physician in another New York eye and ear specialty hospital a few months earlier, I knew what to look for and could make comparisons from a patient perspective. As I noted months ago on this blog, I really had no choice of hospitals. If I wanted my trusted doctor to do the operation, I would have to go where he recommended. But my patient experience was much different this time and made me aware of how many places in the chain of care where mistakes can occur.
At admission that morning, I received a 25-page Patient’s Guide to Surgery. It was full of useful information for people facing surgery. But how is someone who is about to have an operation in a few minutes going to make use of stuff they should have seen weeks ago? That’s a good question for The Joint Commission, the hospital accrediting organization, next time they evaluate this hospital.
Then, while waiting for my surgical prep, I observed discourteous treatment of patients. An elderly man fiddled with the tie on his robe, but a brusque hospital worker sticking thermometers in patients’ ears and wrapping blood pressure cuffs didn’t help him as he struggled to get the ties in the right place. Hmmm, I thought. Is this the kind of patient-centered care the Institute of Medicine advocated for more than a decade ago?
My next encounter was with a distracted nurse who quickly put a bunch of drops in my eyes and asked questions about my medications. She was reconciling what was listed in the charts my doctor had sent over. Reasonable enough.
Then we hit a communications barrier. It was the first time I was speaking English about my medical records to another person who's English I did not understand. I got a flavor for what non-English speakers experience in medical settings. Frustration is the word that comes to mind.
The nurse, who could not clearly pronounce the generic names of eye meds, repeatedly asked me if I was still taking them. Finally, I asked to see the list and ticked off the current regimen. It was the only way to communicate.
How do patients and staff members communicate when the stakes are higher than stumbling over the word acetazolamide (Diamox) to lower intraocular pressure? With more people speaking English as a second language, this is a potential problem and all the more reason to have a list of your medications and clear pre-op instructions with you when you step into a hospital.
Next I was told to dress for the surgery. “Leave your blue jeans and shoes on,” the nurse instructed. That was different from the last time where the hospital was adament there were no shoes, jewelry or anything allowed in the operating room. The hospital had also given me a brochure from The Joint Commission called “Speak Up” when I checked in. It said I should ask questions. So I did.
“Why was it okay to keep my shoes on?” I asked an orderly. They were hardly sanitary having helped me tromp over foreign soils recently, not to mention dirty New York City streets. “We want to make it easier for people to walk,” he explained. He added that they would be covered with foot covers and that was good enough.
Maybe that was okay. But I had serious doubts whether the IV that was leaking blood and fluid down my arm was okay. I have had a few IV's before and knew this wasn’t the way they worked. The nurse anesthetist had not checked to see if it was placed correctly. I asked for her supervisor to check it out.
The supervisor found that the device needed to be tightened to stop the leak. When my doctor showed up, I asked him to check too. I have written about needless deaths from hospital inflections. If fluids were leaking out, could harmful organisms be floating in? I don’t know. But given the serious infection problems in hospitals, I wasn’t about to take a chance.
The last thing I remember before zonking out was an orderly pulling me backwards on the table. Apparently I was not positioned correctly. For a second I thought of a half-naked nursing home resident I met several years ago who was being pulled backwards in her wheel chair. That patient-centered care thing again.
I can’t give the New York Eye & Ear Infirmary high marks for patient-centered care. In too many ways that recent morning, their staff communicated a casual disregard for patients and an inattentiveness to both patients and process. Red flags both.