Garth Rattray | Improve emergency room experience (Part 1)

The recent dust-up between a concerned and irate mother and a doctor on duty at the Bustamante Hospital for Children sparked innumerable public, mainstream and social media discussions and comments. The mother brought her sick, eight-month-old son to the emergency room of the hospital because she thought that he had a very high fever. With the incidents of dengue fever causing many deaths across the island, especially in the young and elderly, the mother wasn’t taking any chances.

Her baby was seen very quickly but, after triage, she was told that he was not an ‘emergency’. Her child was being sent home without treatment. She ‘lost it’, barged in on a duty physician while the doctor was seeing another patient, closed the door behind her and obstructed it to prevent the doctor from leaving. When the doctor (rightfully) tried to exit, she unleashed a barrage of expletives. She rattled the duty doctor and staff, caused the vital institution to lock down for two hours – she could have been arrested and charged – became infamous and got into hot water with the hierarchy of her political party.

She eventually apologised publicly, albeit reservedly, for her inexcusable and horrid behaviour. However, she persisted in partially justifying her actions by maintaining that, “…the first person I spoke to at the hospital had a bad attitude”. She also said that she needed answers to what was wrong with her baby. She reported that the next day, she took her child to a paediatric medical facility and that she was told that her child had “…conjunctivitis and a cold that had drained on to his chest …a bronchial infection and was wheezing.” None of the above is any sort of emergency, and colds can’t drain on to the chest.

However, as Jamaicans say, “Out of every bad comes good”. The highly publicised incident has led to frequent and open discussions about the relationship between medical staff, doctors in particular, and the public. Whether real or only perceived, some individuals have expressed bad experiences and unkind interactions between medical staff and others at public and semi-public institutions. Sadly, we have a history of discussing events to death and then doing absolutely nothing to remedy them. However, if the Government is serious about improving the health service, it must do something to improve the relationship between medical staff and patients. Currently, the environment at public health emergency rooms is extremely stressful (for everyone), toxic and volatile.

Treating diseases, not people

With the notable exception of psychiatrists, doctors used to be trained to take care of the sick who are people, but not the people who are sick. We were trained extensively in treating diseases, not in treating people. However, we were always instructed never to refer to any patient as, for example, the diabetic on bed four. We were told to refer to the patient as Mr or Mrs, or Miss or Ms So-and-so on bed four, who has diabetes. But of late, our medical school has a compulsory, graded course in empathy. It is partly interactive, with actors playing the roles of ailing patients. Additionally, in this course, students are graded more on empathy than on making the correct diagnosis. And, a lot of emphasis is placed on bedside manners during clinical rotations and ward rounds.

The attributes and tools necessary for good doctor-patient relationships are being instilled and not left up to individual personality traits or chance. Even something as straightforward and terrible as pain is known to have a psychological component to it. We are physical, emotional and spiritual beings; treatment of the ‘sick’ works best when it addresses more than just the physical aspect.

Next week, explanations of the triage system and possible solutions.

Garth A. Rattray is a medical doctor with a family practice. Email feedback t0 columns@gleanerjm.com and garthrattray@gmail.com