This is a true story. I have changed the names of the CEO and the hospital. Mainly to protect the innocent - my daughter and her husband. In a couple of weeks we're throwing her a baby shower for her second child; happiness abounds.
It wasn't always like that.
Mr. David Thompson, President/CEO
XXX Medical Center
Somewhere in
Nevada
Dear Mr. Thompson:
Last week, my daughter presented at your ER with a fetal demise, which, as you know, is the medical term for a baby dying in utero. She had learned of the death at a routine sonogram that had been performed that same day and was understandably distraught. I knew that the situation was not truly emergent, but she was determined to have a D&C as soon as possible as it was, as she put it, “horrible to walk around with a dead body inside you.” She was 21 weeks pregnant and had not, as yet, established herself with an OB due to financial problems. Her father and I have helped her and her husband as much as they will let us, but they are proud and determined to make it on their own. I would be the first to admit that she is not a “good” patient, but certainly NOT a “gomer”* either. She was born (at your hospital, incidentally) to a 14 year-old addicted mother. We adopted her at birth and have dealt with her many problems – FAE (fetal alcohol effect) being the primary diagnosis. She has done well (after a lifetime of difficulty), is married and was thrilled to be expecting her first child following a miscarriage in January. However, she is one of the working poor. Both she and her husband have two jobs, but they still cannot afford health insurance. On this day, she only wanted to end her agony. She was told that if she could pay more, they would refer her to a surgeon who could remedy the situation immediately. Otherwise, she’d just have to tough it out, wait her turn and go to the local abortion clinic and have the procedure done. Cash only accepted, please be prepared.
On the day she presented at your hospital, she was given a cursory examination and told that there was nothing that could be done. There was little warmth or compassion or suggestion as to what she might do to assuage the grief she was feeling. She was simply another uninsured, hysterical young adult. In fact, when her husband escorted her to the restroom while we were waiting for the doctor to return with information on the abortion clinic, they passed the nurse’s station where the physician was busily entertaining the staff with his impersonation of her. I probably don’t need to tell you he wasn’t giving her a rave review. He found her high emotions and inability to pay quite amusing. She felt shamed and mocked. She could not wait to get out of your hospital and neither could we.
I have no other motive in writing this letter than to ask that you remind physicians that medicine is not just a business, it is a calling that requires compassion. I do not wish to have my name or my daughter’s name used. I don’t even really expect a reply to this letter; I just thought you should know of our experience at your hospital. Hopefully, as a result of this letter, the next time someone like my daughter visits your ER she will receive more kindness, empathy and concern.
My father was a GP who saw medicine as being about people first. He lived by this quote which was posted prominently on his office wall: "To cure sometimes, to relieve often, to comfort always -- this is our work. This is the first and great commandment. And the second is like unto it - Thou shalt treat thy patient as thou wouldst thyself be treated." Anonymous. If only it had been true in your hospital.
My daughter had her D&C a week ago. In order to enter the clinic, we had to go through barred and locked gates and doors. Abortion clinics are grim places and this was no exception. Beforehand, we went to the bank in order to bring cash (no checks or credit cards accepted) as they would not admit her until payment was received. It felt like a sleazy, back-alley scene. If only she could have been spared the long week of waiting, the horrors of knowing the baby she so dearly wanted was dead, and the atmosphere of the clinic she was forced to go to. She sat in a waiting room full of women who wished to end their pregnancies, which is their right, but that was not why she was there.
She only wished that she had been able to keep her pregnancy or receive timely treatment to end the agony of the loss. And staggering loss it was - my daughter, her second dead son, my grandson - the heartbreak and anguish - indescribable. As her mother and the baby's grandmother I desparately wish she had been given the care any human being in grief is entitled to receive.
Perhaps that is reserved for the insured?
Thank you for listening.
*gomer= "Get Out Of My Emergency Room
Is health care an issue for me? An issue of life and death.
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Comments
So sad.
And loved the quote in your father's office. To comfort always - should be required practice!
The particular problem you describe - late and/or incomplete miscarriage - is one that can plunge even insured people into a nightmare. The reason for this is that fewer and fewer physicians have the skills to perform abortions. As a result, one friend of mine suffered irreversible damage to the uterine lining. The wife of a friend of mine had trouble finding a physician who would perform a D&C; the doctor who finally did it was pretty incompetent and she suffered a lot of pain.
All this is the result of "pro-life" influence in medical training. I don't know if that could have been one element in your daughter's experience. It sounds as though her lack of insurance was the main sticking point. But I wouldn't rule out deskilling as part of the reason why the hospital preferred to refer her to the abortion clinic.
I wish you lots of joy with your grandchild!
When something like that happens you should insist that the hospital discipline the physician, and receive written confirmation of that. In the event that the hospital decides not to discipline the physician you should let the hospital know that you will file a complaint against the physician with the State medical board for unprofessional conduct.
Where I live the State medical board has defined the obligations of the physician to the patient in the context of the physician/patient relationship. These include
* Respect for, and careful guardianship of, any intimate details of the patient's life which may be shared with the physician.
* Respect for the privacy and dignity of the patient.
* Compassion for the patient and his or her family.
A physician ridiculing a patient is not just rude; it's unprofessional conduct, and needs to be dealt with one way or another.
For future reference, most hospitals have a "Patient Advocate." Among other things, the Patient Advocate is the first line of defense against lawsuits, and they tend to take things like what you describe very seriously.
I realize this occurred a while ago, but I think you should send a copy of the letter to the nursing director of the ER, to the Medical Staff office of the hospital and to the physician Chief of Staff. Include the physician's name (it will be in your daughter's medical record)
Ask for a follow up - this doctor should be subjected to disciplinary actions (and I don't take that recommendation lightly)
Congratulations on the new baby!
...and in this case, orneriness wasn't the issue, except maybe on the part of the mocking physician.
I agree with Mishima and Ann. That "doctor" should be disciplined. For one thing, he was setting a terrible example for everyone else, some of whom might have been there to learn.
I am so sorry for your losses and the terrible treatment your daughter received. It is an outrage.
Being someone who comes from a medical family I know how care should be delivered and this sure wasn't it.
I can understand as a grandparent you don't have alot of standing to do this. Perhaps send a copy of your letter to the doctor who did the offending conduct and any internal investigative arm the hospital has?
Then there are some like this asshole your daughter had the misfortune of dealing with.
Training physicians to do abortion care has so many roadblocks, especially for second trimester abortions. This means that the procedure is pushed out of the hospital setting to stand-alone clinics that often are forced to demand cash so they can stay in business. (Abortion clinics are subjected to sky-high premiums and the small number of procedures that are reimbursed by private or state-sponsored insurance plans are at a below-cost rate.)
There is little incentive for other physicians in hospitals or clinics to provide decent care. Patients have so few options, what else are they going to do? They have to put up with abuse and inconvenience.
Feel fortunate your daughter lived in a state where she could get an abortion within a week at 21 weeks. In many parts of the country, a patient would have to go to another state and possibly wait even longer.
There are many issues that lead to these roadblocks. Training of medical students and residents is the number one hurdle. Groups like Medical Students for Choice and the Abortion Provider Expansion Project are leading the way to open up the pool of doctors who provide abortions and nonjudgmental referrals.
The main point I'm trying to make is that there needs to be affordable health care for all.
If this is the medical center I think it is, based on where you live, I can tell you that my mother-in-law, who was insured, had a horrible experience there as well. Before her death she was diabetic, with major cardiac issues. She was a nurse in a major teaching hospital for many years, so she knew what was what, probably better than half the doctors. While on a mini-vacation with her daughter, she became ill and was admitted to the hospital. The cardiac specialist who saw her there was an arrogant ass who complete changed ALL of her meds with out consulting her regular doctor back home, and without a complete medical record. He also bit her head off when she asked him to call her regular doctor back home before making these changes.
Once she was back home, she visited her regular heart specialist, who immediately put her back on her old meds. She felt better in days. Her regular heart specialist recognized the name of the Dr Ass as a former student of his, and you can be sure that Dr Ass got a chewing out from his old teacher so severe I’m surprised the phone did not explode.
Listen to Ann, as a physician she doesn't suggest bashing other doctors unless she feels it's totally right and the doctor needs educating. Who better than a grandmother to start the ball rolling?
Words can't express my sympathy for your daughter's--your whole family's--loss. But Mazel Tov on the new addition! Thank god life goes on.
Regarding my daughter's situation, as a physician's daughter, I'm aware of the chain of command and I will probably revisit the incident with the people you have all mentioned. However, this happened nearly 5 years ago now (fairly ancient history with regards to this medical center which has grown like topsy in the interim), and my daughter was even unhappy with me writing the letter at the time. But, as I told her at the time, it really is not just about her, it's about all the others like her.
When did lack of medical insurance become a synonym for pariah? It's shameful.
Also your statement on no insurance equaling a pariah. Hardworking people as pariahs. Go figure. When I retire and have to pay my own health care premiums, I may become such a pariah myself. Having spent every dime on my daughter's treatment as she was growing up (see post), there's not much left for me to retire on. I will probably not be able to retire, actually. They'll find me slumped under a collapsed stack of ungraded papers, red pen still clutched in my rigor mortis hand...