October, 2005 Archive

October 25, 2005, 6:00 pm

I Can’t Get No…. Satisfaction

What is wrong with Nurse Bradley in this old Wyeth ad? Well…

Her uniform is wrinkled, her hat is not starched and for some reason they won’t let her in to the OR. Dr. Studley Intern stood her up last Friday, she can’t get Thursday off to attend the hemoptysis symposium and she’s had 40 patients on the ward instead of the normal 38 three days running. Dr. Ogre yelled at her for existing and her head nurse makes the Drill Instructor in “Full Metal Jacket” look like Mr. Rogers. She’s a good nurse but deep in her heart she knows she can be the next American Idol.

Maybe she’s tired of being thought of as a consumer product.

Think about it.

People are “health care consumers” who get their care from “health care providers”. Hospitals give their staff instruction in “customer service”. Those who are sick are “clients”, not patients. Hospitals are vying for business, trying to get the highest scores in “Patient Satisfaction” so some give meal service like a restaurant – on demand, like room service. Some advertise that it will take you longer to sneeze than to be seen in their ER.

Something is wrong.

I’ve taken care of patients ranging from the homeless to those who live in the most opulent areas you can imagine. I’ve been treated like a domestic servant by people with their nose so high in the air they hit it on the door on their way into the department and I smile and tolerate it in the name of “patient satisfaction”. I’ve been bossed around by folks at the other end of the spectrum whose sole purpose for coming to the ER was to get fed – and I’m the waitress – and I deal with it in the name of “patient satisfaction”.

It’s no better for the doctors. I’ve seen doctors order tests because the patients insist, not because it is necessary. Because their co-worker’s sister’s mother-in-law read in Reader’s Digest that someone in Macon, Georgia didn’t get this test back in 2003 and they died! Because the patient will perceive her care as “unsatisfactory” if she doesn’t get the test. Because they don’t want to get sued. A minimum of twelve years of hard work, study and sacrifice to become a physician and all it boils down to is being a conduit for getting tests ordered so the patient will perceive their care as “satisfactory”.


I’m tired of this. First of all, I am not a consumer product. I don’t provide “customer service”. I provide nursing care. My care is given because I am a Nurse and it is received by a Patient, not a “customer” or “client”. It is not consumed. My patients will perceive their care as “satisfactory” because it will be safe and their needs, both physical and spiritual will be met and their concerns will be addressed, and not because the hospital hires Emeril Lagasse to man the tray line or offers digital cable. My hospital, as wonderful as it is, is not Nordstrom’s. Health care is not the equivalent of choosing a pair of shoes. I’m in the best ER I’ve ever known, but sorry folks, sneeze into your hankerchief if you have to, but you WILL wait like everyone else unless you are having a true emergency, no matter what some PR firm decides to print.

Patients will be satisfied with their care because they are cared for by competent physicians and nurses who are educated to provide health care in partnership with the patient, understanding that the more information and patient education available, the better the patient is enabled to make their health care decisions.

And that results in “Patient Satisfaction”.

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12:47 am

Grand Round-abouts!

Gather round for this week’s Grand Rounds, hosted by Hospital Impact
I’m honored that one of Emergiblog’s posts is featured. Go check out what looks to be a great variety of topics this week!
By the way, the picture in the corner is from an area in Minneapolis that
takes you around lakes and parks – the pictures on the website were beautiful. I fell in love with Minneapolis on a short visit years ago and my love of the city was reignited when I discovered James Lilek’s web site.
The next time I’m there, I’ll be sure to tour the “Grand Rounds”.

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October 22, 2005, 3:30 pm

Hitchhiker’s Guide to the Emergency Department

As you travel among the galaxies, it is possible that you will require some form of health care attention.

On Earth, the primary means of obtaining such care is through what Earth inhabitants refer to as an “Emergency Department”.

It is well for you to remember the Hitchhiker’s motto:


It is in the Emergency Departments of Earth that you will learn first-hand the concepts of “sitting” and “waiting”.

You will first be directed to an area where you will “sit” and “wait” for a process called “Triage”, where you will be instructed to “sit” and give the Nurse your entire health history, unless of course the ED, as it is called, is horrendously busy at which point nobody cares about the nose bleed you had on Alpha Centauri last millennium.

You will then be instructed to a room where you will “sit” and “wait” to be assigned a planetary medical source number, or in Earth parlance, be “registered”.

Once you are called to “Registration”, you will “sit” and give the data collector your planetary information. As in Triage, this will have to be done verbally, as earthlings are not equipped with telepathic sensors.

(This does not, however keep some earthlings from assuming that nurses and doctors already know everything about them because it is “in the chart”.)

Do speak in English as Babelfish are not indigenous to the planet. However, if you land anywhere in the region known as California, Spanish is the main language of approximately 51.8% of the population.

You will resume “sitting” and “waiting”.

You will then be escorted to a cubicle where you will be instructed to replace your clothing with a garment of dubious construction.

The doctor will then arrive and, while you “sit”, proceed to ask you the same questions presented to you in Triage. It is important that you vary your story slightly in key areas, in keeping with the Earth tradition of never telling the same story to both doctor and nurse.

Should you need to see a specialist, who will ask you the exact same questions you have answered twice before, vary the story a second time, thereby insuring that the ER doctor and nurse look like, as they say on Earth, idiots.

Once the physical examination is complete, you will “sit” and “wait” for serum to be taken from your portals.

You will “sit” and “wait” for radiographic images and something known as Computerized Axial Tomography of your cranium. Having completed that, you “sit” and “wait” for the results.

It is possible that while “sitting” and “waiting”, you received a consciousness-altering plant derivative highly sought after by earthlings with cranial discomfort.

The Hitchhiker’s Guide to the Galaxy, Medical Edition suggests that you do not travel through hyperspace for 24 hours after reception of such derivatives and that you refrain from consuming Pan Galactic Gargle-Blasters for 48 hours.

Virgin Pan Galactic Gargle Blasters, are, however, permitted.

Ignoring these recommendations could result in quite forceful regurgitation of gastric contents. While this is considered a polite compliment on Seti Alpha 5, it is quite repugnant to earthlings.

Once the doctor releases you from the health care area, you will “sit” and “wait” for discharge instructions. They are rarely read or followed by the average earthling. You may find them of interest as a cultural artifact.

They are given on the theory of “covering one’s derriere”, although earthlings do not attach them to that area.

The precise origin of this theory is rumored to be related to an Earth game called “suing” where great sums of currency are given after a large competition to see who has the better attorney, the patient or the hospital.

The End

(My apologies to the late Douglas Adams. I was watching “Hitchhiker’s Guide to the Galaxy” on DVD last night and couldn’t resist a parody.)

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About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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