April 21, 2009

Triage verses

A trip to the University of Chicago Medical Center reveals serious flaws in the system.

[img id="77620" align="alignleft"] The emergency room is not a place people go just for kicks. So when I found myself in the University of Chicago Medical Center’s (UCMC) emergency room about a month ago, attending to a friend with a history of kidney issues who was in so much pain he could barely walk, I knew I was in for a long night. We took SafeRide to the E.R. at 1 a.m. in the morning; by the time we returned home, the state of the E.R. in particular and our health care system in general had made me nauseated enough to want to seek treatment myself.

Upon entry, my friend and I were greeted by three armed police officers—a charming display of great trust toward the community. “What do you need, guys?” one asked grumpily. I thought to myself, “What do you think we need, a place to study? It’s the damn E.R.!” I nearly lost it. The front desk at an E.R. should not be occupied by armed guards: it should be occupied by a nurse doing triage. We then had to wait at least 20 minutes to even explain my friend’s symptoms to a nurse. That was the shortest wait of the night.

All waiting rooms suck, and the U of C’s is no exception. My personal favorite item in the U of C waiting room? The sign by the TV that reads, “Channel can only be changed by the officer.” Imagine having that nightly assignment on the police force––channel changer in the hospital waiting room. After an hour or so, during which it seemed like not a single person had been called up, the triage nurse announced, “I am going to do a roll call to see who is still here. We are very busy tonight and some people have been waiting as long as nine hours.”

I understand that some folks overuse the E.R., but can’t we trust people a bit more than to assume they will just become impatient and leave? At this point, my friend had received absolutely no feedback about how serious his condition was, so I decided to check his status with the triage nurse. I hoped she would have looked at his test results without my nagging, but I wasn’t sure. His sample was highly abnormal and he was immediately moved toward the top of the prioritized list.

When my friend finally got some medical attention, it was outwardly evident that the doctor had not even bothered to read his file or look at his file. “Have you been eating beets or drinking cranberry juice?” was the first question she asked, in what was at best a dismissal and at worst pure ignorance of the test results: The lab had come in showing abnormal levels of blood and protein in his urine, and the doctor wanted to blame it on juice.

I could go on about the impersonal and inattentive care in the U of C E.R. But what struck me the most was how different the attitude toward patients at the U of C E.R. was from that at the Northwestern E.R. During a rugby game last year I received a serious cut between my eyes. I went to the Northwestern emergency room and was greeted by a nurse, not a police officer. The triage nurse was attentive and did her best to inform me about the E.R. process. The doctors and nurses made sure I understood my condition––oh, and they read my file before trying to treat me. I was out in two hours, not after nine hours like my friend, who ended up receiving less treatment than I did as well as less face time with either a doctor or nurse.

This comparison really isn’t fair, is it? Northwestern is a suburban hospital while the UCMC is urban. I had a bleeding head wound and my friend only had a leaking kidney. But the differences in attentiveness, bedside manner, and trust were incredible. And this shouldn’t be an unfair comparison. The attitude toward the patient shouldn’t be better in affluent suburbs than in the gritty inner city.

A woman recently died in the UCMC waiting room. She was not even triaged, just ignored. I won’t condemn the Medical Center, as many caring folks work there, but something is wrong. It is as much the result of a flawed health care system as it is of the treatment at the UCMC that leads to overused emergency rooms. But, this does not excuse such a blatantly cynical attitude toward E.R. patients.

One argument against government-provided health care is that, if enacted, the emergency room would look like the Department of Motor Vehicles. Frankly, I hope the DMV is never run like the UCMC emergency room.

Henry Phillips is a second-year in the College majoring in economics.