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Healthcare: Hospitals and Branding - Where is the care in healthcare?

Last Saturday night my father and I had to take my mother to Royal Victoria Hospital. The experience has left me wondering how a hospital can expect to build trust and respect with people, let alone provide meaningful care. Certainly little of this happened that night. The conversation, if it even remotely resembled that, I had with the doctor on duty was barren. I also had the opportunity to gain numerous insights into the backroom operations of the hospital through a conversation with a police officer (I will refer to him as Gary - not his real name) that opened my eyes to how things really work, at least in this particular hospital. I'll start with his comments since to some extent they help to clarify the abysmal experience my mom had (what follows is not a journalistic investigation complete with proper research - these are merely reflections on the experience itself)...

There we all were, strangers in need, sitting in a barren hallway that provided a waiting and collection space leading to the examination area. My mom, doubled over in wheelchair with dry heaves that had now gone on for 12 hours and severe pain from a back problem, sat trying to cope as best she could with the wait. She is 85 years old and, as it turns out, her condition was not life threatening as she was somewhat improved by the end of the next day.

Gary happened to be sitting next to my mom, and as strangers bonded by a common experience do, we started chatting. As it turned out, a large rock concert was on at Molson Park in Barrie, so the emergency ward was littered with youth. The receptionist, a very friendly and welcoming person, told me that a four-hour wait was quite normal and expected during concerts. Gary said, "I could tell you stories about this place..." (that's a close paraphrase). And naturally I encouraged him.

What Gary told me changed the way I understood how a hospital, at least this one, worked. Gary's opinion of the hospital was, to be diplomatic, quite low, and being a police officer he had inside knowledge of many hospitals. His mistrust of Royal Victoria Hospital was stated in calm and unemotional terms. He seemed to know the bigger picture, could clearly define a core problem, and just how hard it would be to change it.

Waiting time: This is one of the biggest topics of conversation in any emergency room. I could tell by the way people had almost literally camped-out in the hallway that the wait would not be anything remotely short or even moderate. One would expect a lengthy waiting period especially on the Saturday night of a large rock concert. However, one would expect that the hospital would plan for this as well and judging by the fact that I only saw one doctor in the examination area (this does not include the acute care area in which I am sure there would be many more doctors available) it seemed to me that adequate preparation and staffing was not part of the strategy. After a complaint born by stress came flying out of my mouth, Gary wryly answered, "What did you expect, it's Saturday night. Doctors don't like working weekends." One should avoid generalizing about an entire group of people like this, however, it was clear at least in the present moment that he could be right. But Gary's experience was quite different from mine - he had seen this exact same thing happen time and time again here at Royal Victoria Hospital, so his generalization carries the weight of experience.

20,000 people without a family doctor: In Barrie, Ontario according to Gary there are approximately 20,000 people without a family doctor. There are approximately 103,715 people residing in the City of Barrie, so approximately one-fifth of the people that live here have no access to a family doctor. I had thought the reason was a lack of willingness on the part of doctors to relocate to Barrie, but did often wonder how a city only 40 minutes from Toronto could constitute isolation. Gary told me that it had nothing to do with distance and he personally knew of doctors that had applied to Barrie but, after become aware of the politics of the hospital, decided to withdraw. He referred to something called The Big Six within the hospital, and interestingly enough, defended the provincial governments on-going support for health care. His opinion was clearly that the government has acted with integrity with respect to providing support for hospitals, but the executive management of Royal Victoria Hospital had not.

The Big Six: According to Gary, the Big Six are a group of doctors within Royal Victoria Hospital that have a great deal of power and influence, so much that they are able to leverage their positions to control the greater community of doctors within Barrie. Since, as far as I could tell from Gary's comments, they tend to act in their own best interests rather than the interests of the people and community they serve doctors considering relocation to Barrie usually wind up declining once they become aware of the political reality they would become part of. In addition, Gary talked about how the big six mandate billing practices, for example, not giving assistance over the phone when that would in fact be enough but instead demanding that patients come to their office. The reason for this is clear - they can then bill the provincial government for a visit whether it was truly required or not. Of course, there is no way to validate this nor is that my purpose here - it is mere hear-say. And again, this is a generalization and undoubtedly there are family doctors that do not lower themselves to a practice like this, but it at least made me aware that this is an issue with some momentum behind it. It seems that a new hospital director is about to or already has taken over the hospital, so it remains to be seen if this person will have any impact on this problem. But then Gary shared something personal about his own health with me...

Misdiagnosis: Last fall Gary had developed some heart problems. After a series of tests, he was diagnosed at Royal Victoria Hospital as having a serious weakness in the lower half of his heart - a weakness that would require him to retire early. So for five month he remained off work and decided to seek out a second opinion from a heart specialist in Toronto. After going through the same tests again, the heart specialist in Toronto could not understand how the original diagnosis could have happened since, in fact, Gary's problem was minor and his work as a police officer was not a threat to his health. Further, Gary told me that his attending doctor at Royal Victoria Hospital never once called him personally or asked to see him again. Doctors are incredibly busy people and make a vitally important contribution to society under what must be very stressful conditions, but even with this it seems that a follow-up call or appointment should have been done. Although Gary has a significant legal case, but he is not pursuing it further.

Kindness from a nurse: A while into the conversation my mother started dry heaving again and was sweating profusely. By then my patience was beginning to expire so I went into the examination area and sought out a nurse. She was understanding and sympathetic and soon brought my mother in ahead of some others. Not only this, she talked to my mother with authentic care and concern. My hopes for help had been rekindled. But, through no fault of the nurse, the single doctor on duty was busy with others and we still waited. The nurse returned a number of times to see how my mother was doing while, from what I saw, she went quickly from patient to patient. By now, my mother was unable to remain in one position, whether lying down or standing up, for too long while still suffering from dry heaving which seemed to have a timelime of its own. Dehydration, a virus, sleep deprivation, something else - we didn't know. In any case, for an 85 year-old any stress on the body such as this is of concern.

Enter the King: The doctor eventually made an appearance and proceeded in a very clinical manner. Nothing wrong with this, I wanted him to get directly to the heart of the matter. He asked, "What brings you in today?" and my mother tried as best she could to explain. After listening and asking a few more related questions, the doctor then asked, "And what do you expect us to do for you tonight?" Pardon? Excuse me? What kind of inane question is that? You tell us. I started to engage, but clearly the incredible level of arrogance was something I just didn't have time for.

But it was clear that because my mother had a local family doctor as well as a specialist, the attending doctor was unwilling to do anymore that give her a shot of demerol and gravol and send her one her way. While eventually submitting to the shot, my mother was frustrated since, in her extensive experience with doctors, she was once again being given a drug and sent on her way to fend for herself. She had thought, quite incorrectly, that this doctor in the hospital would maybe, just maybe, be able to do something more concrete.

Of course, my mother's health issues may not have an easy solution - but we had faint hope that this might be the start of something different. Doctors in emergency wards need to remain detached in order to focus on the vast range of medical problems they are bombarded with and handle them with skill. It's an ominous job. and, it seems, that doctors also must defer any opinion or further hospital assistance to the original doctors on file. This makes sense if the assumption that the family doctor and specialist can be deemed to have done the best they can do. Yet we were questionning that, and instantaneously the attending doctor put up a wall and refered my mother back to them.

After the Hospital Visit: On the way out we happened to pass by Gary again and he asked, "How did it go?" I told him that they gave her a shot and sent her on her way. His response was immediate, "Take her to Toronto." The ride home caused severe nausea for my mother again and once we got her home it took time to get her from the car and eventually to bed. She did eventually managed to fall asleep and had four hours sleep that night - not enough, but a welcome respite from what she had been getting.

The next day, my sister and I spent the day with our parents. The stress and lack of sleep on my father had also become apparent and for an 86 year-old who has survived two open-heart surgeries it was a kind of stress that caused concern. Our only recourse at this point is to go back, yet again, to seek help from the family doctor and my mother's specialist - a pattern we have already followed for a number of years.

Afterthoughts: I maintain no animosity toward the hospital since that in itself would be a waste of energy, yet I am left wondering where the care is in healthcare. Perhaps because it is my own mother that is suffering, and by virtue of that my father as well, my comments and perceptions of the experience are biased. Safe to say that I do not understand the details of running a hospital either, nor can I really fully appreciate the intense pressure an emergency room doctor must be under.

Yet I know that I am not the only one that has negative impressions like these and when I hear a veteran police officer calmly articulate the deeper issues it is a cause for concern. And when these deeper issues are reflected to some extent in a personal experience they carry weight. The nurse was a breath of fresh air and her sincerity was obvious. After the doctor's brief examination she was kind enough to ask, "What happened?" I responded that my mom was to receive a shot and go home she responded with silence. I tend to pay close attention to people's facial expressions and body language for this is quite often more revealing than the words they speak, and perhaps this may be reading in too much, but she was looking directly into my eyes when asking the question, and after hearing my response her eyes immediately looked downward, she paused briefly as if pondering something, and then left the room without a word. This was inconsistent with previous conversations. It may be she simply needed to go, prepare the shot, and get her job done as efficiently as possible. But I suspect not.

My concern is not only for my own family. We are all living longer thanks to medical science, but people are not merely biological entities to be diagnosed and prescribed to. Most doctors know and respect this. With the average age of society on the increase hospitals are going to place an increasingly bigger role in caring for older people. And these people deserve the best care possible - they have spent their lives working and contributing to society and we simply owe them the best health care possible.

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