REFLECTIONS
ARE WE STILL IN CHARGE?
Teresita Bacani-Oropilla, MD
A
physician gets a call from his octogenarian parents. They have been
waiting their turn to be seen in an
emergency room in their home state for the
past two hours and Dad could not tolerate
the penile pain he had come to be seen for
anymore. His prescribed oral meds were not
working. What should they do? Son intervenes, makes a phone call, talks to the E.R.
doctor and his dad is seen pronto.
A septuagenarian who fell and injured his shoulder, is at home
with physical therapy and home health follow up awaiting cardiac
clearance to determine if he can withstand a surgical procedure,
if need be. It had been a month, and his appointment was not yet
due. Urged to call, his date for clearance was moved a day earlier,
after which he was to go back to the orthopedist.
On the other hand, fortune favored an old lady when she called the
answering service for unusual lower gastrointestinal bleeding after
midnight (a favorite time for emergencies, it seems). Her primary
physician, who knows her vulnerabilities, happened to be on call.
Before the crack of dawn, the old woman is settled in a hospital bed
for diagnostic and treatment purposes.
It is a dilemma on how to get in touch with one’s physician, or
their surrogate, or any physician for that matter, in times of perceived
emergency. The doctors are there, maybe in the next room, next
to a phone, yet they are, to quote a cliché, “so near and yet so far.”
Lucky are patients who are knowledgeable, who have advocates,
who become loud, rowdy, or threaten litigation in their misery.
They do get attended to on demand. On the other hand, the meek,
the less assertive, the non-complainers sometimes get the short
end of the stick.
Even in non-emergencies, patients and their families can be in
12
LOUISVILLE MEDICINE
a state of suspense while awaiting their doctor’s answer to their
questions, as in, “Don’t touch that phone! We are waiting! Leave
the small car, we may need it.” A wife who is in poor straits when
her husband starts hallucinating on an anticholinergic medication,
a patient who sleeps half a day after his morning meds, another
who starts sweating before meals, and another who has fainting
spells. What to do? A phone call likely gets an answering machine
that tells them to go to the E.R. or gives a spiel on the advantages
of exercise. One is fortunate if one is not referred apologetically to
another machine, but instead reaches a human who finally gets the
message to your doctor.
Layers of in-betweens have been placed before the willing, waiting,
maybe overworked physicians and their anxious ill patients. Late
miscommunications, postponements, or outright non-communications can have dire consequences. These are the proverbial cracks
where patients stumble or fall, sometimes taking their unsuspecting
physicians with them.
May we therefore, the physicians, the knowledgeable ones whose
trust people have put into our hands, although deep in a mire of
restrictions, not become serial caretakers of a series of conveyor
belts. These belts shuttle patients from one to another, leaving them
lonely objects bobbing in the deep, unknowing, without direction
or end point. May we find a way to be consistently available when
crises arise.
Are we still in charge? If not, what can be done to reestablish
easier access of our patients to us? We did it before, reliable pillars
of strength and comfort. We can do it again. Let it not be said that
between layers of helpers, bureaucracy, mandated procedures, and
purported financial incentives we are now distanced from them,
and frustrated. Heaven forbid that we no longer care.
Dr. Oropilla is a retired psychiatrist.