Chapter XV: Is Medicine Still for the Patient?
Fenigsen, Richard, Fenigsen, Ryszard, Issues in Law & Medicine
The Patient Is Our Priority. In 1991, I said the following in answer to a question from an interviewer: "In a hospital, the sick person may be taken aback when confronted with all those machines and with an organization which seems so impersonal; but this organization is conceived to serve the patient, functions for the patient, and is manned by caring people. (106) am not sure I would repeat this statement now, having watched the developments in American health care and the daily workings of several hospitals.
I recently spent a month, every day including weekends, in a large hospital in the Boston area, watching the proceedings. At some specialties' outpatient clinics all patients had to wait at least forty-five minutes, and often up to two hours past the scheduled time of their appointment; and this was not an exception, due to some emergency, but the rule. Lack of realistic planning? Certainly, but the underlying cause was a lack of concern for the patients.
In the wards, the intercom operators immediately answered a patients' bell, but actually getting to see a nurse, or a nursing assistant, could take anywhere from twenty minutes to twelve hours, especially if the patient was known for making frequent requests.
One night, an elderly patient with a grave ailment felt terribly sick, was afraid of dying, and begged a nursing assistant to stay with her for a while. This was refused, and the patient was given the usual lecture: "There are many patients on the floor, most of them sicker than you, and we have our priorities." Whatever their priorities, which I respect, there were behind the nurses' station, at all times, several nurses and nursing assistants engaged in lively conversation.
Procedures for which the patient must fast after midnight were scheduled for the next day's afternoon and then further delayed till late in the evening. The patient was given no explanation, and was kept waiting, hungry, thirsty, and exasperated. In two instances which I witnessed, even after the procedure the patient was denied food and drink, because the order "nothing by mouth" had not been cancelled.
A procedure involving some risk of infection was supposed to be done "under the cover of an oral antibiotic," but "nothing by mouth" had also been ordered, thus, the antibiotic was not given to the patient.
Another time, an antibiotic, augmentin, was ordered, and was to be given twice daily by mouth. The nurse scheduled it for 8 a.m. and 8 p.m. It was already 9 a.m., therefore, the patient was left without the antibiotic for the whole day.
Facing omissions and mistakes, the frightened patient begins to distrust the staff, the organization, and everything that is being done, and demands to see the attending physician. Such requests are seldom granted.
Spending Money on Palaces, Not on Nurses. Fund-raising activities and the pressure to cut costs have produced bizarre results. Wicked tongues say that brass plates with sponsors' names can only be put on buildings, not on nurses. Therefore, millions are spent on new, huge, magnificent buildings in which people get lost and transporting a patient to a lab becomes a long and difficult journey. Meanwhile, the nursing staff, found to be too expensive, is reduced to a skeleton. Nurses are replaced by semi-qualified and unqualified employees. The change is not only unsafe for the patients, it also is terribly aggravating.
Nursing, a Job Just Like Any Other? Nursing is understaffed and many nurses are no longer the conscientious, dedicated care-givers they used to be. But there are exceptions. A distinct generational divide has appeared. There still are, in the large hospital which I have closely watched, several nurses in Florence Nightingale's tradition, scrupulous, never tiring, unswervingly protective of the patients. They are now in supervising positions. Even among the younger hospital nurses there are exceptions to the general rule, for example, Miss Estelle d'Arcy, R. …