Map of life expectancy at birth from Global Education Project.

Tuesday, August 10, 2010

This is absolutely, 100% true.

I swear on a stack of On the Origin of Species.

So I present at the ER with symptoms of acute appendicitis. A nurse has me disrobe and put on one of those notorious backless hospital gowns, then insists she has to take my temperature rectally. Okay. She goes. About five minutes later, a female doctor arrives, or at least someone who appeared to be a doctor based on her blue scrubs. She said she had to give me a digital rectal exam.

While she's got her finger up my ass she asks me "Are you sexually active?"
I thought, "I guess it depends on how you interpret what's going on now," but that's not what I said. Then she says, "Do you have sex with women or with men?" Only when she's satisfied with my answers does she take her finger out of my ass. She tells me I have acute appendicitis and she goes.

But this was not actually the official examination and conclusion. Ten minutes later another doctor comes in, male, with some sort of junior club member hovering over his shoulder. He also pokes my abdomen. He taps on the left side, and I report pain on the right. "There is an eponym for this," he tells junior. "It is called Rolfsig's sign." Then he just has to stick his finger up my ass. I told him the first doctor already did that. Didn't he trust her? Apparently not. Anyway, although his exam was as negative as his predecessor's, he decided that I still had acute appendicitis, and that I should be admitted for surgery that night.

No doubt this seems bizarre to you, as well it should. In fact the first examiner was probably not there for any reason having to do with my medical care. She was probably a first year resident, possibly even a medical student, who was just there to rehearse. That she evidently had some strange attitude toward men is just incidental. The second doctor, I soon learned, was in fact the Chief Resident in general surgery and yes, his examination and diagnosis were the real deal.

So if you go to a teaching hospital, you will find that several people often line up to violate your bodily integrity in similar ways. It is the more or less official ethical standard that they are supposed to tell you they are doing it for practice, not to benefit you, and ask your permission. However, most of the time, they don't, because they are afraid you will refuse and then the youngsters won't get to practice. You will also find inexperienced people doing actual real stuff to you that matters, such as inserting IVs, and believe me, undergoing inept venipuncture is not the way to have fun. This is a problem, to be sure, because they have to learn somehow. But still. . .

Although academic medical centers may offer superior care, especially for complex or difficult situations, patient experience is usually poor compared with community hospitals. This is a big reason -- you aren't just a patient, you're a practice mannequin. And you may well come across some trainees who are truly incompetent, or even bizarre. As I did.

This has not changed even one little bit in 20 years, although people do talk about it. They make rules, but they don't enforce them.

I don't have a magic solution, I'm just sayin'.


C. Corax said...

Same with veterinary teaching hospitals. Tufts in Grafton, for instance. When I told them I didn't want to subject my dog to twice-weekly three-hour round-trip commutes for chemo, they couldn't get me out the door fast enough.

When I had my colonoscopy, it took three nurses a total of six tries to get the IV into my vein. They kept telling me, "You have small veins!"

Cervantes said...

Possibly you do have small veins but a skilled IV nurse shouldn't have that kind of trouble.

viagra online said...

ey this the same that happen to me the last month, I have a terrible fever, so I decided to go to the hospital to be attended, and can you believe that I was sit for four hours waiting for a doctor? the worst part, no was a normal fever, was dengue fever!!!