An Unfortunate Error in the IR Suite

When one thinks of success in medicine, they likely think of it in terms of objective data: cure rates, length of hospital stays, number of post-operative complications, and more. A good surgeon is measured by his or her ability to remove a gallbladder through a few small incisions without causing bleeding or infection. A competent family physician is measured by average HgA1c levels among his diabetic patients. And a hospitalist is measured by how well he or she can handle acute sickness in the hospital leading to safe and prompt discharges. What if, however, this train of thinking misses the mark of true success? What if real medical success is  based more on the subjective than on the objective? On the satisfaction of the patient, rather than just the numbers? Now, I must admit, going too far down this road could be dangerous. I am not suggesting that we forego data and replace it solely with a patient’s feelings; this would be detrimental to the patient, provider, and overall health-care system. What I am proposing, however, is more of a balance between the data and the visceral experience of a patient when they are in the hospital, clinic, or surgery center. In other words, I think we as medical professionals have a tendency to overlook the human aspect of medicine. While not easy to measure on a piece of paper, a purposeful attention to humanity is something that I believe can make a world of difference in the lives of our patients.

It was a routine visit to the ER. The patient in room 15 was presenting with back pain that started months ago and was now acutely worsening. He was an older gentleman who, to be frank, clearly did not like the hospital (or doctors, for that matter). He was an army veteran with morbid obesity and evidence of multiple previously treated ventral hernias scattered across his abdomen. I offered to take the lead on  his care, and he was admitted to the floor shortly after our first encounter. Over the next few days, my team and I worked to form a plan to evaluate and treat his  back pain. We drew labs, ordered radiographs, and performed daily physical examinations. We carried out our respective duties as his primary providers. However, there was a persistent, intangible wall between the patient and our team. We were cordial and respectful, of course, but the all-important aspects of authentic human connection and rapport were lacking. He did not seem to like or trust us, and we struggled to break that barrier down. As a result, the humanity portion of his care was suffering.

Radiographs suggested osteomyelitis of the lumbar spine, and a trip to the IR suite for a bone biopsy was scheduled. Coordinating an IR procedure can be quite difficult, and we were feeling extremely proud to have made a strong enough case to get our patient a slot. We expectantly waited for the results, frequently refreshing his chart in Epic. Alas, a note from the IR physician was uploaded, which read,  “biopsy not performed due to patient discomfort and respiratory distress with prone positioning.” This was the last thing we wanted, and expected, to see. Even worse, we were all aware of how the ensuing conversation with our patient would go. Unsurprisingly, we were met with anger, yelling, a few swear words, and a promise that our patient would never step foot in a hospital again.

I deserved every bit of contempt directed my way. Why did I not see this coming? Why did I not think to reach out to IR about the potential complications of an awake procedure considering our patient’s unique abdominal condition and underlying COPD? Why didn’t I consult anesthesia? These questions bounced around my mind as I swallowed the reality that I failed to provide him the care he deserved.

No matter how standoff-ish this patient might have been, it was my responsibility to immerse myself in his care to the same extent that I did with the kind lady next door who thanked me wholeheartedly every time I saw her. To be completely honest, the potential for discomfort and outright inability to tolerate the biopsy did not even cross my mind, and I can only attribute that to my lack of personal connection with this patient. He was the “patient on the 7th floor who hates doctors”, and I let that perception get to me. As a result, my lack of attention caused him pain, humiliation, and hurt. In addition, the paucity of communication from my behalf led to asynchronous care between our team and our interventional radiology colleagues, as I had critical information about the patient that I did not share, which left them unprepared and without the necessary resources to successfully carry out their job.

There is hope, however. We were able to make amends with the patient and he underwent a biopsy under general anesthesia the following day. I apologized and promised him that I would learn from the situation in order to better serve my future patients.

The potential ramifications of making an authentic connection with patients span farther than simply making someone feel comfortable while in the hospital; it leads to better medical care. It pushes us to go the extra step, to think about the little things, to cross every T and dot every I. And in a world where success is measured by data, numbers, and statistics, I would like to propose that maybe it is the crossing of T’s and the dotting of I’s that are the true determinants of medical success.