Spending time with patients

I've alluded to this before, already, that I'm against the constant rush of medicine from patient to patient. Today was another example. We had a patient who's been abused as a child resulting in traumatic brain injury on top of pre-existing cerebral palsy who's actually been doing quite well, married and working a regular job and ambulates around the house but uses a wheel chair outside her home. She came in for an acute exacerbation of her back and leg pain - pain which was previously well controlled by her pain management specialist - likely caused by some minor trauma worsened by her anxiety/frustration/stress. It was rather clear that the majority of her problem lay in coping with the new pain and the accompanying mental anguish. Her moods were rather labile as we later found out - during our interview she was extremely pleasant, sometimes tearful, but always polite. When we returned to check up on her she suddenly exploded in a fit of anger that rapidly became tears of frustration complaining that her pain was not being adequately treated. I felt truly sorry for her, and when the resident left to find a nurse she demanded that I stay by her side. I did feel a bond with her as I had interviewed her first, and could see that what she needed more than any medicine was simply someone to listen to her. She continued to cry and remained anguished despite my attempts to calm her down, and finally the resident called me over and I left her hurriedly. As we walked away from her, I thanked the resident for pulling me away but now I regret my action. I had clearly abandoned her in her moment of need. I used the excuse that my resident told me to follow her as an explanation for why I abandoned her, but that was a very weak excuse. She wanted to call her husband, probably someone who would listen to her and comfort her, but unfortunately my cell phone didn't have reception in the hallway. That was one of the major issues, I felt - her lyingi n the hallway. This is someone who's struggled against so many adversities that she cannot simply lie still. She wanted a TV, a book, anything to occupy her mind. I understood - I would be in similar straights if left to lie in a bed for hours on end without anything to do. We were waiting for a room to open up on the regular floor, and there she would get much more nursing attention than lying in the ER hallway where the nurses are outnumbered by the patients in a riduculous ratio.

So what did I do? Nothing. Absolutely nothing. I fled with the tail between my legs when the resident called, and then pretended that it was a relief to leave her. It was, truly, a relief in the same manner as not having to perform some courageous act simply by the command of another. Yet at the same time there was a feeling of shame, embarassment, if not inadequacy, in running away. I wanted to return to her and tell her good bye at the very least - not dissappear suddenly without any explanation. I feared that she would feel even more abandoned and become more aggressive/frustrated which serves only to alienate her nurses more and sets her up for a long, painful, and lonely night.

Yet I was a coward - I simply followed the resident back upstairs and tried to put her out of my mind. I hope she finally was able to speak with her husband, and hopefully got the pain medication that we asked the nurse to provide. It's so bad that I'm worried about seeing her again on Monday if she's not discharged. There's really no reason for her to stay, but if she ended up in the hospital on Monday, I'm not sure I can face her honestly after abandonning her like that.

Unfortunately, much of medicine stresses the efficiency and thus my talking with her, trying to comfort her, is actually frowned upon. I feel embarassed if I were to voice my opinion that I should return and see if I can somehow calm her down some more before leaving. I knew we had lots of other things to do, many more patients to see, but is that an excuse for ignoring a patient's concerns? Where do we draw the line between efficiency and sub-optimal care? Can we truly afford an one-on-one environment? This is where I think house visits (back in those days) had the advantage. Why can't we spend that same amount of time, dedication, per patient? With all the new technology, why can't we dedicate more face time with patients? Is it all in the name of capitalism that medicine strives for efficiency?!