My sister, who I wrote about recently, took the photograph in this post when I asked her, “What inspired you?” because she inspired me. I remembered visiting her a year ago, while she was working on the case, and how resolved she was to make sure that Tyler would not be imprisoned unjustly because of his disability. Last week, she was successful.
This picture hangs on her office wall – you can see the Denver skyline in the background. On the bottom of the photo you can see 3 years of work to save one person, Tyler Sanchez. On the top of the photograph is the inspiration (read more about the origin of the expression here).
The picture shows what it takes to save a life. Sometimes it doesn’t take much work. All of the time, it takes the ability to care.
The people who serve in the health care system, who are uniformly exceptional in my experience (you have to be to do a job this hard), have an incredible ability to care.
Why does our health care system not let them?
What happened last week – Kait and Ted’s story
On Tuesday, Kait sent me an e-mail with just the subject : “Advice?” In it, she described acute withdrawal symptoms she was having from her anti-depressant because her mail-order refills had not arrived in time, and did I have any ideas that did not involve an emergency room. There were a few complications – she was not in DC at the time, she was in Baltimore visiting her girlfriend. Her primary care physician, based in Maine, was not available because of a state holiday there.
I immediately called her and proceeded to do my best to help her get care urgently.
I contacted the Baltimore Medical System and reached a medical center manager, who said Kait could not be seen that day. She escalated the issue to the Medical Director of the entire system – could she be evaluated quickly and given a refill of her prescription to arrest the acute withdrawal until her regular supply arrived?
She called me back and said the answer was no.
I was told that all of the care providers were full that day and a new patient would not be seen that day. Now, I have been to Baltimore Medical System (see my blog post from the experience: “A resilient population” – Baltimore Medical System”) and I believed what they told me. I was told that she would need to go an Emergency Room or attempt to book for the next day, with no guarantees.
I gave these options to Kait. Johns Hopkins ER it was going to be. Again, I tried to assist by calling the Johns Hopkins ER to facilitate the care for them and for Kait. It usually makes things easier/faster for everyone, if the receiving physician can know what’s going on – the “warm handoff.”
I called the Johns Hopkins Physicians Access Line, for an emergency physician referral, which is what I could find on their web site. I was transferred and then hung up on.
I asked Kait to keep the communication up by texting me her experience as it happened. Here’s the interaction between us:
See something interesting? As she gets closer to a human being in the system, the “care” part of health care becomes more apparent.
If you think this only happens to people without access to care, you’re wrong.
I am breaking the silence on an almost identical incident with someone very close to me, my mother, who, as a medicare beneficiary has access to too much care.
She was referred to a sub specialist for a superficial nerve block for severe pain – the kind of nerve block that a family physician can easily do (I have done many myself). When the injection did not work and she called the office of the sub-specialist in severe pain, she was told by the office staff, “Go to the emergency room, we are full this afternoon.” They were adamant, she told me.
I know what would have happened if she went to the emergency room -> narcotics, maybe an admission to the hospital, maybe an infection, a medication error, a fall. All because of a failed superficial nerve block.
I called the sub specialist’s office from 2,500 miles away, got the physician on the phone and asked him if it was possible that the injection was misplaced and could he try again (it is possible to miss the nerve). He agreed this was possible and pleasantly and helpfully said he would be happy to and could my mother come right in. She did, he performed a re-injection and the pain was completely relieved.
Commonalities – amazing people, less than amazing system
With all of the talk that the emergency room is overused and medical homes are the answer, where’s the walk?
In Kait’s case it was made clear to us that this medical emergency, easily treated in the outpatient setting, would not be managed anywhere but an emergency room, against her wishes, and really against appropriateness. What if she was hemorrhaging blood instead of serotonin, would the outpatient system turn her away before stabilizing her? Acute anti-depressant withdrawal due to lack of medicine is a complete waste of Kait’s time. It could have wasted her life.
My family’s entire experience could have started and ended in a family physician’s office, without any intervention from me.
Making every day count
I’m going to reveal something in this post that Kait doesn’t know yet. I was able to receive her e-mail and act on her behalf because of a mistake I made right before she contacted me. I read the time wrong on a flight and arrived too late to the airport. I missed the flight, I would lose a day of travel, and it was all my fault. As I walked away, I said to myself that I would make sure that this day counted for something. Now, I am so happy that it did.
People who know me know that I do not use my physician credentials to facilitate care for myself – I don’t even like being called “Dr.” When it comes to other people, though, I will leverage the credentials to the max (just the “MD” part, which I own, not my employer’s name, which I don’t own). That’s why society provides those credentials to us, to be used to lessen suffering.
I really want more than to lessen suffering for just Kait or my family, though. I want our health care system to change. For real, not pretend.
And…. the only solution I have found, the only one, after 20 years in medicine, that will solve this problem, is to have the patient in the room.
Kait Roe has given explicit permission to share details of her care experience on this blog:
Ted, I LITERALLY have no secrets. If someone doesn’t hire me because I have a mental illness (which this episode clearly shows is controlled phenomenally by medications) I don’t want to work for them. And wouldn’t that be a fun post! As for the choices. Print it all, again. I mean that – and I’ve been back on my meds for two days and feel quite myself again. No crying for two days!