Michael Abrahams | Emergency room rage
When I learnt of the explosive clash between a medical doctor and the mother of an ill child at the accident and emergency unit of the Bustamante Hospital for Children, my initial reaction was empathy… for both the doctor and the mother.
According to reports in the media, the woman took her eight-month-old son to the hospital because he was having a fever but was told, after triage (assessing patients to decide degrees of urgency), that his case was not an emergency.
The mother, however, was dissatisfied with her child’s assessment and subsequently stormed into the examination room in which the doctor on duty was working, closed the door behind her, and braced it with a stool. When the physician attempted to leave, the irate mother blocked her path and launched into an expletive-laden tirade.
The doctor eventually announced that she would not be seeing any more patients and left the compound. Police were called to the scene and the unit was shut down for two hours. The mother later apologized for her behaviour.
There have been a lot of comments in the public domain regarding the incident, and I have reserved my comments until now, as not only do I know that there are always several sides to a story, but I am also a physician AND a parent.
I empathize with any doctor who works in an emergency room (ER). It is a powder keg of pressure, anxiety, fear and physical and emotional pain. Violence is not unheard of in ERs, and Bustamante Hospital for Children is not exempt. Just the week prior to this incident, a senior physician employed by the facility informed me of recent instances where members of staff were physically assaulted. One person was even struck with a chair.
A physician working in an emergency room at a place like Bustamante Hospital, a public facility and the only children’s hospital on the island, will face significant challenges. The unit is understaffed and simultaneously overwhelmed by a deluge of patients.
To make matters worse, at this time there are dengue and gastroenteritis outbreaks, in addition to the fact that it is also flu season. The accident and emergency unit at the hospital is an emergency room, not a clinic or health centre. Therefore, if a child is brought there with a condition that is not an emergency, priority will be given to children who need to be attended to more urgently.
Children with acute appendicitis, severe asthma, burns, convulsions, fractures and sickle cell complications such as painful crisis, for example, will be treated with greater urgency.
On the other hand, being a parent, I know what it is like to have an ill child. The mother in question did not know what was wrong with her child and was probably fearful of a dreadful outcome.
Also, she sited insensitivity and lack of compassion as catalysts for her toxic reaction. To be honest, this is a complaint I hear too often about my profession. Sometimes, the attitudes of some doctors and nurses leave a lot to be desired.
I recall an incident when I came within a hair’s breadth of telling a colleague of mine a long list of “textiles” and “fabrics”, in addition to a brief dissertation about his anatomy, when one of my children was under his care and I felt he was being dismissive to me and not acting in the best interest of my child.
So, what is the solution? In my opinion, the behaviour and attitudes of members of the public, as well as medical personnel, need to be addressed.
WHAT IS AN EMERGENCY
Firstly, the public needs to be educated about what an emergency room is for and understand how triage works. Grasping these concepts will lead to more realistic expectations.
If your child gets hit down by a car and is unconscious, that is an emergency. If your child has a cold, it is not. For less urgent situations, there are other options, such as government clinics and health centres and private practitioners.
A colleague of mine, who conducted a survey in an emergency room at another government hospital, found that 24 per cent of patients stated that their complaints were “concerning but not urgent”, and nine per cent admitted that they were there for “routine” visits.
In the case of this recent kerfuffle, the doctor who initially assessed the child has been vindicated as, by the mother’s admission, the child was later found to have conjunctivitis and a cold, conditions which are not medical emergencies.
Secondly, the mindsets of medical personnel need to be addressed. In my opinion, this ought to start from the selection of candidates for medical and nursing schools. Some persons are academically brilliant but lack the attitudes and aptitudes to be compassionate caregivers. And even when we are filled with empathy, working in an emergency room can test the best of us and push us to our limits.
Sensitivity training, seminars on interpersonal skills, and counselling services should be available for staff working in emergency rooms, as they will need psychological support when working in such stressful environments.
Emergency rooms will always be stressful, but it is important for all sides involved to understand the functions of these units and what is expected of them. They are meant to be sites for healing, not further trauma.