In recent weeks, I have been personally involved in a medical situation that shows that healthcare providers need to bear this adage in mind. In the case I’ve seen, each doctor and nurse has done his or her specialist’s job well, but no one has considered the patient’s whole person or household environment. The result is that the patient and his family are suffering more than necessary.
This patient fell and incurred an orthopedic injury to his leg. The Emergency Room doctors and nurses did an excellent job of stabilizing him, then sent him home with the instruction to contact an orthopedic surgeon because surgery was likely to be necessary.
So the patient went home. With a spouse who weighed 70 pounds less than him. To a house without a bedroom on the main floor and with only a half bath on this floor that this patient couldn’t fit into with his leg immobilized. He managed to get upstairs, but could not get in or out of bed unassisted. Because he is up multiple times during the night, neither he nor his spouse has had a good night’s sleep since the accident. There is only so much that other family members and friends can do to help.
No one in the Emergency Room made any inquiries about the home situation the patient was going to, nor offered any help once the person left the ER.
The next morning, the patient contacted the orthopedic surgeon, someone who is highly recommended in the community. That office showed no sense of urgency in scheduling an orthopedic consult, even though they had the X-rays from the ER. It took pushing by the patient to get an appointment to see the surgeon that same week. After the office visit, surgery was scheduled fairly promptly, but it still took more than a week after the accident to repair the injury.
The surgery went fine. But in the Recovery Room, the nurses had the same approach as the ER staff had had—get the patient stabilized and out of here. No inquiries about the home situation or how to deal with the patient’s other medical conditions, now worsened by his lack of mobility.
In the post-op follow-up ten days after surgery, the patient mentioned another injury incurred during the accident (to his arm). The orthopedic surgeon took a brief look and ruled out a bone problem, but he made no inquiries that would diagnose a tendon or ligament issue. It was as if his approach was “I do bones; that’s it.”
During the time since the accident, the patient has seen two other specialists for other conditions. Both of them focused solely on their specialty, without considering the impact of immobility on the patient or his spouse.
Meanwhile, the patient and family members have learned to be more insistent on getting questions answered, such as “will this new treatment further reduce his mobility?” and “what can he do to improve his rest at night?”
But wouldn’t it be better if each of the doctors and nurses asked such questions and considered this patient to be more than a leg or a bladder or a prostate? Wouldn’t it be better if the medical profession saw the patient as a whole person?
The changes to the healthcare system in the last decade or so have only exacerbated the tendency to see patients as parts instead of a whole. Obamacare has not helped. Republican proposals have not helped.
Expertise exercised in a vacuum ceases to be expertise. And the system is perfectly designed to get the result it gets.
Have you experienced similar issues in your own medical situations?