Map of life expectancy at birth from Global Education Project.

Friday, June 18, 2010

Participant Observation

I don't think I mentioned it here, but yesterday I had minor outpatient surgery. There's no reason for secrecy -- I had a lipoma removed. These are basically harmless fatty tumors. Usually the best thing to do is just leave them alone but this one had gotten quite large -- much bigger than the typical 1.2 inches mentioned in the linked article -- and was in an inconvenient location just below my belt. So I decided to get rid of it.

The procedure itself was no big deal. It took about 25 minutes, using local anaesthesia. It was quite painful as it turned out -- the tumor had encapsulated a nerve and even though they kept pumping in lidocaine it was ineffective. I expect a lot of people would have freaked out, but I have a high pain threshold. However, once it was over I had surprisingly little pain. I'm at work now, walked to the subway as usual, and I'm not taking any pain killers. It's barely sore at all.

That said, as a patient advocate I have plenty of items for the suggestion box. They made me show up at 12:30, for surgery scheduled at 2:45 and ultimately done at about 3:45. In between, the total amount of stuff they had to do to me required about 15 minutes, dribbled out in 3 minute doses with immense gulfs of nothing in between. They also had absolutely no concern for my dignity. This is quite typical of the medical institution: procedures are organized for the convenience of staff with essentially no consideration for patients.

First I had to see an "admitting officer." This guy has a private office all his own. His job is to ask me sensitive questions such as my name and address and emergency contact information, and to get me to sign a form consenting to surgery -- which is not actually the informed consent form, which comes later. This one had almost no content and required no explanation. Then they had me go and sit in the waiting room for 30 minutes. They provide no reading material, but I'd been smart enough to bring my own.

Eventually a woman called my name and had me go to a changing area where I had to remove all my clothing and put on two of those open cotton robes they make patients wear, one open in back and the other open in front; pajama pants; and cloth slippers. Then they sent me back to the waiting room to sit for another 30 minutes in that humiliating costume. I finished the NYT and the Boston Globe and now all I could do was sit there.

Then another woman called my name and escorted me to the surgical suite, where I sat alone for another 20 minutes in a room painted with childish cartoons of underwater creatures featuring big googly eyes and bright smiles, including a sea star wearing sun glasses. Again, no reading material. Finally a nurse came and asked me some questions: did I know why I was there, where was the lesion, was I allergic to latex or any drugs? She went away and 15 minutes later a resident came in who asked me the identical questions. He went through the informed consent form -- the real one this time -- and had me sign it. Then the surgeon came in and asked me the same questions for the third time, and marked the tumor with a sharpie.

After a briefer time alone, another nurse came in, to ask me the same questions again. When I told her that I was a medical sociologist, she got very interested. She is really honked off about medical students nowadays. They show up for rotations sloppily dressed, unkempt, and unshowered. They stand around the foot of the stretcher chewing gum and texting. She described young women with their white coats open to reveal bare midriff, people who didn't bother to comb their hair or brush their teeth (I guess she detected halitosis). I was surprised -- I would have thought they had a dress code -- but I'm going to pass this on to some friends at the medical school. She was also apologetic about all the pointless waiting. She explained they have to leave slack in the schedule in case of emergencies. So at least one person gives a shit, for what it's worth.

Anyway they finally got around to cutting me. They positioned a drape so I couldn't see what they were doing, which I suppose is generally a good idea but they didn't ask my preference about that. They did respond when I expressed pain and tried pumping in more lidocaine though as I say, it didn't work. The surgeon was generally very businesslike and brusque with me in all our interactions but she did briefly apologize on her way out of the room -- with me lying strapped to the gurney and appropriately infantilized -- leaving the resident to close.

The nurse met with me again in the room with the cartoon fishies to give me follow-up instructions and make a follow-up appointment. Then they all just split and left me on my own to find my way back to the changing room -- actually I had to figure out that was the thing to do, it was unclear whether there was any other next step. The changing area was unattended, but fortunately I was not in any pain at that point and I didn't have much trouble changing. I then had to take the initiative to go to the reception desk to ask for a pair of scissors to cut the ID band off my wrist.

So, the bottom line for me was, technically a good result and I'm glad I went through with it. I'm a self-sufficient person and I didn't need a lot of reassurance or hand holding, but I expect a lot of people are anxious or confused in these circumstances and they would not have gotten much help or comfort. It seems to me it would be quite easy for them to do better. I'm not entirely sure why they don't.


kathy a. said...

that's just a terrible wait time! for that matter, if they are well enough staffed to ask you questions 3 or 4 times, maybe they could manage to speed things along. and wtf with no reading materials?

one thing i'll say about the fancy-pants mam center i've complained about -- they do have separate waiting rooms for people who have gotten to the gowning part of the process.

i've had a lipoma on my shoulder for about ever. it doesn't cause any problems, but makes my shoulder look lumpy. i don't favor surgery for cosmetic purposes, so i wish those clothing manufacturers didn't think that sleeveless is the way to go for all women.

roger said...

glad it went well technically.

but wait a sec. you got pj pants as well as the stupid smocks? i didn't. tho i suppose pants wouldn't be so good for a colonoscopy.

hope i don't have to put up with med students with bad attitudes. i might say something.

robin andrea said...

I'm a very impatient person. I think I probably would have gotten up and talked to someone. That kind of wait time is really unacceptable. If there had been an emergency, it would make sense, but sans emergency, it just sounds like bureaucratic incompetence.

Cervantes said...

I did indeed appreciate the pants. They aren't always that considerate.

But no, pants don't really work for colonoscopy. I did see an ad in a medical journal once though for "Moon Pants" -- they have a flap in the back that unsnaps. Could be a step forward.

kathy a. said...

i think robin should be in charge of med students with bad attitudes. roger can sing harmony, especially if he's on the good stuff.

kathy a. said...

but more seriously, i think it makes a huge difference if someone is with the patient the students and interns are observing on rounds. i saw this most clearly with my nephew, when he was in a PICU ward at a teaching hospital. patients who had someone with them were treated much more respectfully, due to the hairy eyeball factor.

Jay's music world said...

Lucky that your original cloths were there when you went back to change!