Consult-Liaison Education Lessons Medicine Observations

Red Herring (II).

My patient was exhausted. She tried to drink the soup the nurses gave her, but said it tasted bad. She curled up on her right side and her eyelids drooped. I watched her fall asleep.

I wanted to talk with a doctor. Though I knew that it was unlikely she would die at that moment, I nonetheless worried that she would.

At least we were in an emergency room.

In an effort to “do something”, I brought my document to the clerks’ desk. Could you make a copy of this and put it in her medical chart?

“You have to give that to a doctor or a nurse and then they can give it to us.”

“No doctor has seen her yet and I might have to leave before she is seen. Can you please make a copy and put it in her chart? It has a lot of useful information that—”

“Listen, I can’t take that. You have to put the patient’s name and medical record number—”

“I have.” Anger made me speak louder. “I’m her psychiatrist. I have information that I want them to see. Can you please—”

“No. You have to give that to a doctor or a nurse—”

“Fine. Thank you.”

I don’t know why I thanked her. I wanted to yell at her, tell her that I was a doctor and she wasn’t. Didn’t she realize that, as a doctor, I might have some idea what the physicians would want to know? Could she only cling to a policy that made no sense in this situation?

But my condescension wouldn’t have helped my patient. So I bit my tongue and returned to her. She was still sleeping.

A voice announced over the intercom: “To help ensure that patients are seen in a timely fashion, we ask that all family members please leave the emergency room at this time.”

I did not budge. My patient would not be able to explain what had happened. I needed to speak to the doctors directly.

A security guard ambled over.

“Excuse me, miss, I have to ask you to leave.”

“My name is Dr. Yang and I am her doctor. I must speak to her physicians directly. She has not been seen yet.”

“She can talk to the physicians herself.”

“Actually, she can’t. I must speak to her physicians directly.”

“Why can’t she speak to herself? Is she mentally retarded or something?”

“No.” That’s none of your business.

“I’m sorry, but you’re—”

The security guard who saw me come in with the patient hours earlier passed by. I looked at him with hope.

“She’s fine. She can stay.”

“Thank you,” I said. Both guards walked away.

More time passed and no physicians were in sight. I began to think about quality improvement. What if hospitals implemented a system similar to that at the DMV, where you took a number and had some idea where you were in the queue? Why not build that into emergency rooms?

I knew why. Emergencies come in. People are seen out of order. And whenever staff saw the chart for my patient—“Woman with schizophrenia, weight loss in past year”—I knew that they would consider her a low priority.

Because, in many ways, she was. My patient wasn’t actively dying. She would not lose significant weight in the next few hours. Furthermore, she wasn’t making any noise. At this point, she was asleep, unperturbed by the cacophony in the emergency room. To everyone else, she was Not A Problem.

Though I wanted to believe otherwise, experience had taught me that when people saw a diagnosis of schizophrenia, they often did not take the patient’s—or my—concerns seriously.

(Part two of an ongoing series.)