Recently, a close friend of mine, whom I’ll call Judy, suffered a heart attack and went into shock.  Without reversing the shock, she would die.  The on-call cardiologist saved her life by opening up the blocked artery and inserting a temporary pump to assist her heart until it was able to maintain a normal blood pressure on its own.  He saved Judy’s life for which we were all extremely grateful.

Exemplary care so far.  But…

My friend began to have misgivings about this cardiologist who didn’t see her the next day, and, when he did see her, it was difficult to communicate with him.  The nurses also indicated that they continually had communication issues with this doctor.  Based upon this, Judy was determined to find another cardiologist after her hospitalization.

More Questionable Quality

While she was in the hospital, several other incidents left Judy doubting the quality of the care she was getting.  One incident occurred while she was trying to get some sleep at night.  Because she was cold she covered her head with a blanket.  About an hour later a Nursing Assistant (NA) took her temperature with a device that measures the temperature of the patient’s skin.  It should be taken on exposed skin, ideally the forehead.  Instead the NA checked the temperature on my friend’s neck that had been covered by the blanket.  Naturally, the temperature was high suggesting my friend had a fever.  Rather than checking it again later after the blanket had been off, she charted that Judy had a fever.  Because an infection after a procedure can cause serious complications, doctors often write standing orders for their post-procedure patients specifying what tests should be performed and what treatments should be given if a patient develops a fever.  So, charting that “fever” set the ball rolling and that included a chest x-ray, blood draws for blood tests, blood cultures and getting a urine sample.  All this happened in the wee hours of the morning so Judy couldn’t get any sleep.

What added insult to injury was the fact that shortly after the erroneous temperature was recorded in the computer, a Registered Nurse (RN) rechecked my friend’s temperature and it was normal.  But the nurse said she couldn’t stop the testing once it was charted.  Consequently, Judy was needlessly inconvenienced and unnecessary charges were generated that her insurance will have to pay.

Here are the areas that raised questions about quality during this 3 day hospital stay from Judy’s perspective:

• Poor communication by the physician
• Lack of training & common sense on the part of the Nursing Assistant
• Either lack of training on the part of the Registered Nurse on how to override the computer, or
• Poorly devised computer system that doesn’t allow for legitimate overrides

Since it’s true that the most important thing was the fact this doctor and the care at this hospital saved Judy’s life, someone might say that these few quality concerns should be overlooked.  Indeed, most of these concerns really fall under the category of Customer Care or Service.  How important is customer care in the delivery of health care?  Does poor customer care trump technical clinical quality?

In my next post, I’ll explore customer service and health care.  Please share your thoughts on this topic.

For Your Health – Dr. Bob