One ER Visit; Two Contrasting Stories

My latest NPR article was about conflicting accounts of the same ER visit. I presented the case of a man who came in with chest pain. He was deeply upset about his care, but the providers had a very different perspective.

Heart of the Matter: Treating the Disease Instead of the Person

I had no idea that that this article would draw so many comments (nearly 300,000 at last check). Scott Hensley, NPR’s Shots editor, posted a compilation of the comments, along with my remark:

"While I'm gratified that so many readers appreciate the time pressures of working in a busy ER, I am saddened by how many respondents accept that efficiency must come at the expense of humanity. Our health-care system needs to change to bridge the disconnect between what patients need and what hospitals do. All of us — as providers and patients —need to speak up, and demand a system that values both competence and compassion, and enables doctors to practice true patient-centered care."

I’d love to hear your thoughts. What can be done to improve our healthcare system?

The Effects of Obamacare

One of the most popular provisions in the Affordable Care Act (ACA) is that of allowing young adults to obtain healthcare through their parent’s policy until they are 26.

This week, my friend and colleague Dr. Kao-Ping Chua, a pediatrician and health policy researcher at Boston Children’s Hospital, published a research article in the Journal of the American Medical Association that shows young adults report improved health and lower out-of-pocket costs after implementation of Obamacare.

"I decided to do the study because young adults have had the highest rate of uninsurance in the United States, leading to poorer health and a higher risk of catastrophic health costs," Dr. Chua said in an interview.

As an emergency physician, I am delighted to see young people take advantage of this aspect of the ACA. I also look forward to more research findings on the impact of Obamacare on health costs and outcomes.

A Simple Act of Kindness

As an emergency physician used to working in busy, urban ERs, I like to think that I’m not easily surprised. The other day, someone did something that really amazed me.

Our patient was a young woman who had a headache and requested medications to take it away. On an average ER shift, we see dozens of patients with similar complaints to hers. On busy days, the evaluation and treatment become rote: take a history, do a physical exam, administer treatment, fill out paperwork, and so on and so forth.

I had finished the evaluation and was typing my note when our ER tech, Emily, came up to me. She held a baby in her arms who was gurgling and sucking his thumb.

“Do you remember this one?” she asked me.

I vaguely recalled that there was a crying baby in the room with my patient. Emily confirmed, “It’s hers. I just took the baby to give her a little break.”

Emily figured out something that I didn’t. Over the next hour, she entertained the baby while its mom slept, all the while carrying on with her other busy duties. When my patient woke up, her headache was much better.

In today’s medical world, it’s so easy to forget the human aspect of care and to neglect the low-tech solutions that are so important. As my hero, Dr. Bernard Lown says, you should always feel better after having gone to see the doctor. We are so used to making people feel better through medications; we must not forget the other simpler, and even more critical treatments.

When I complimented Emily on her excellent care, she blushed. “It was nothing,” she said. (She was so hesitant to accept credit that she didn’t want her real name to be in this article.)

But it’s not nothing. It’s a bright spot, a simple act of kindness, something that can and did make a difference in someone else’s life. She didn’t do it because she wanted recognition or praise for it; she did because it was the right thing to do.

All of us have the opportunity to inject a little bit of brightness into someone else’s day. 

What will your act of kindness be? 

(Addendum: After I posted this article, the wonderful provider who was the source of inspiration for this article told me she was fine with having her first name here. Emily's real name is Dana.)