Paternalism in the ER
Summer vacation leads many to places unknown. When I go on vacation, I don’t think about the quality of the healthcare that is provided in the area I am visiting. Healthcare is not even a blip on my radar. I think about activities, chances to relax, and adventures to be had. That is, until this past weekend. A conversation with a friend made me stop and think about what I would do if I were in her place.
My friend, while on vacation, was diagnosed with breast cancer. After the call from her doctor, she took the time to call doctors and cancer care centers to schedule appointments. Then she went back to her vacation knowing that there was nothing left for her to do but wait until the first appointment. A few days later she began to feel ill. As the pain worsened, she realized she couldn’t wait until she returned home to see her doctor. After a discussion with her husband, she went to the town’s Emergency Department (ED). Normally, she informed me, she would not go to the Emergency Department, but she didn’t have a doctor she could see and didn’t know where the walk-in clinics were located.
She walked into the ED, noticed no one was waiting, was taken in immediately processed, and given a room. She sat for several minutes wondering and worrying. The first nurse came in, asked her what was wrong, and then left. The second nurse came in and did the same. Then she sat. After a while, the doctor came in, asked her what was wrong, listened, and left the room. She wondered why no one had performed any exams or checked vitals. She sat in her room and watched nurses, techs, the doctor and others mill about, talking and laughing with each other. The other rooms were mostly vacant in the ED, and there was a slow, calm feeling in the department.
Several more minutes passed when the doctor reappeared; the lab came back on the sample she gave them and her guess of what might be wrong was correct. He told her he would prescribe medications for the illness, explained how to take the meds, and then left. The second nurse she saw came back, gave her the prescriptions, told her next time use a walk-in clinic, and brusquely showed her out. She found a pharmacy and filled the prescriptions. Once she was at the pharmacy, she realized there was a discrepancy in what she was told and what was written on her discharge papers. She was told she had one type of illness but the discharge papers said something else.
Throughout the next two days, she experienced recurring pain and finally, called the ED to see if the one test they took had any further results. The nurse she spoke with said the lab came back and showed no abnormalities, not even the illness she was prescribed medicine for. The pain was so great my friend decided to try to find a walk-in clinic. At the clinic, she was examined, sent for ultrasounds, and blood tests after they took another sample for the lab work the ED had already performed. The lab showed she did not have the illness the ED said she had, nor did she have the illness the ED wrote on her discharge papers.
Now, my friend wonders, did the ED pay any attention to her, her concerns, or her health or were they annoyed she came in and tried to placate her? The act of prescribing medication for an illness she did not have horrified her. She worried if they may have upset a precarious balance in her body. Her body is fighting cancer, isn’t able to fight off any other illness, and now, an unnecessary drug had been introduced.
I thought about how she felt, and the worries that must have been going through her mind while she sat there in the ED. Not knowing your health status is stressful, but not knowing when you’re newly diagnosed with a terminal illness is terrifying. For any medical provider to slough off her case and appease her with an unnecessary prescription is amoral. No one in the ED took the time to perform a physical exam or question her beyond the basic “What hurts?” questioning. They didn’t know if the illness that was presenting was asymptomatic or symptomatic of her cancer. They let her go without performing a thorough exam, with medication she didn’t need, and with pain that was still occurring. The doctor-patient relationship was violated because they didn’t respect her.