On breaking one’s neck
There is a piece in the NYRB well worth reading. The author, the distinguished physician Arthur Relman gives an account of falling down the stairs, and breaking a number of cervical vertebrae. He was on anticoagulants, and needed a tracheostomy, and suffered multiple cardiac arrests. He makes a number of very valid points, and highlights how the care provided by a personal physician out with the hospital can be integrated with inpatient care (not by sending emails, but by the primary care physician being on the staff of the hospital). He highlights not unexpectedly, the lack of contact between doctors and patients, and the harmful side-effects of computers and the data deluge. So, we are not surprised to read:
Reading the physicians’ notes in the MGH and Spaulding records, I found only a few brief descriptions of how I felt or looked, but there were copious reports of the data from tests and monitoring devices. Conversations with my physicians were infrequent, brief, and hardly ever reported.
But he then goes on to say:
In the MGHICU the nursing care was superb; at Spaulding it was inconsistent. I had never before understood how much good nursing care contributes to patients’ safety and comfort, especially when they are very sick or disabled. This is a lesson all physicians and hospital administrators should learn. When nursing is not optimal, patient care is never good.
Well said. But really, how on earth can any physician imagine it be otherwise?