88 Becoming a Patient
The system’s inefficiencies may hamper patients not only in being
admitted to the hospital, but also in getting evaluated once there. During
another hospitalization, when seriously ill, Walter got a bed, but was not
evaluated for hours. Finally, he was seen only after he phoned his phy-
sician, with whom he was on a first-name basis.
I called his office, and said, ‘‘Tom, I still haven’t been seen by any-
body, after two hours.’’ He called an attending, who came and
saw me. In the meantime, they had drawn my blood and took a
portable chest X-ray. But I had not seen a doctor. They had not
assessed or treated me. Six hours after my admission, the intern and
resident came. I said, ‘‘I have to tell you how upset I am with you.
I say this as a doctor to another doctor. You needed to have assessed
me.’’ The intern said, ‘‘Well, I ordered all the tests.’’ That was
their perception of what was needed to assess an acutely ill cancer
patient: ‘‘I was busy. A patient arrested in the X-ray suite.’’ There
was a series of ‘‘explanations,’’ all of which really just amounted
to bad medical care. But if I couldn’t get decent-quality medical
care, it says something about the difficulty lay patients have!
Increasingly, hospital bureaucracies seemed organized more for their
own benefit than for that of doctors, and last, for that of patients. Hence,
as both a patient and a provider, Walter felt frightened:
Hospitals and the health system respond to their own needs.
Doctors would be aghast at me saying this, but hospitals have been
shaped around the needs of the doctors, admin