After years of disillusionment with regard to the bureaucratization of medicine and dissatisfaction with my increasing inability to care for patients appropriately (issues I wrote about frequently on this site), I retreated, retiring from the practice of medicine in 2014. Having lived a healthy life-style, I hoped to avoid contact with the system, an intention made more possible by the recent trend towards elimination of preventive care practices. Nevertheless, within months I found myself catapulted inextricably into the morass of modern day medicine, experiencing, full bore, the horrors of the system from the other side—from the “patient” perspective.
My first observation: in a system that has sought to improve safety through technological means, errors are prominent. Over the course of two hospitalizations, at least seven medical errors were intercepted and avoided, only because of medical knowledge that enabled me to appropriately question tests and procedures. While most of those errors would have been relatively inconsequential, primarily increasing fiscal costs, two of the errors were potentially dangerous. Moreover these errors occurred despite the use of EMR, instituted to eliminate such errors, since “to err is human.”
But just as alarming was the transmogrification of nursing. As I sat alone in my room and pondered the new role of nurses, I began to wonder what part of their “job description” a robot could not perform? Nursing aids appeared at the door with their self-contained wheeled “companion” to assess vital signs three times a day: they slapped a blood pressure cuff on my arm, put a pulse oximeter on my finger and a digital temperature probe in my mouth; and in 15-20 seconds were wheeling their companion out the door with a cursory look back, questioning, “Need anything?”
Nurses were no different: unless I requested additional pain medication I saw them twice a day for distribution of medications and their “nursing assessment.” They, too, appeared at my door with their “computer on wheels,” scanned the barcode on my wrist band, verified my name and birthdate, distributed the medications, performed their nursing assessment (not determined by the patient condition but by fulfillment of “meaningless use“ criteria) and wheeled their companion away, again with a perfunctory, “Need anything?”
Despite careful gloving and gelling in and out, there was little contact—physical or visual—outside the required interactions.
The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.