The Benefit of the Doubt



Today a dear friend of mine told me a horror story about her recent trip to a hospital ER. She has kidney stones, with rare bouts of excruciating pain when they decide to break off from their renal resting place and scrape their way down her ureters.

My friend is a stoic person who also doesn’t like to cause trouble for others – so when she was awoken at 4am with that same familiar pain, she decided not to call an ambulance but rather drive herself to the ER. She also chose not to call her doctor out of consideration for his sleep needs.

She managed to make it to the triage desk at her local hospital and was relieved to see that the ER was quite empty. There were no ambulances in the docks, no one in the waiting area, and no sign of any trauma or resuscitations in the trauma bay. She approached the desk trembling in pain and put her health insurance card, driver’s license, and hospital card on the desk and let the clerk know that she was in incredible pain.

The clerk responded,

“Lady, I saw you walk yourself in here. There’s no way you’re in that much pain. Sit down and fill out this paper work!”

My friend replied in a soft voice,

“Please, can you help me fill out these forms? I can barely see straight and can’t concentrate well. I have a kidney stone and it’s excruciating.”

Tears fell softly from her face as the clerk rolled his eyes at her.

“Yeah, I’m sure you do. And I bet you’re allergic to everything but Demerol.”

My friend started becoming frightened, realizing that she was being pegged as a “drug seeker” and would be punished with a long wait time for pain medication. “Please let me just speak to the triage nurse.”

“Sure, sweetheart,” hissed the clerk. “I’ll get him when you’ve finished your paperwork.”

And so my friend sobbed as she tried to fill in her address, phone number, insurance information, etc. on the paper form at a hospital where she had been treated for over 7 years for ovarian cancer. All of that information was in their EMR, but the registration process would not be waived.

The triage nurse slowly emerged, still chewing a bite of his steak dinner. “What have we got?” He said to the clerk looking out into a waiting room populated only by my sobbing friend.

The clerk replied to him under his breath. The nurse rolled his eyes and sighed heavily. “Alright lady, let’s get you back to an examining room. Follow me.”

My friend followed him back to the patient rooms, doubled over in pain and was put on a stretcher with a thin curtain dangling limply from the ceiling.

She couldn’t control her tears. She couldn’t get comfortable and she moaned softly as she took short breaths to explain her past history. She handed him her business card, explaining who she was and that she was not faking her pain. The nurse made no eye contact, jotted down some notes in a binder, and prepared to leave the room.

“Listen, your crying is disturbing the other patients,” he said, yanking the curtain across the front of the room to block her visually, as if the curtain would make her disappear.

Hours passed. My friend had no recourse but to writhe on the stretcher and cry out occasionally when the pain was too intense too bear. She asked for them to order a CT scan so they could see the stones. The nurse ordered it, a physician never came to examine her.

Four hours later my friend was greeted by a physician. “You have kidney stones. One is in your right ureter, and there are others sitting in your left kidney. Do you need some Dilauded?”

“Yes please!” said my friend, hoping that some relief was in sight.

“Alright, the nurse will be here shortly.” Said the doctor, glancing at her chart without completing a physical exam.

The shift changed and a new nurse came in to place an IV. She was gruff and complained that my friends veins were too small. “I’ve never seen anyone with a kidney stone need this much pain medicine” she snapped with a suspicious tone.

Five hours after her arrival at a virtually empty ER my friend received pain medicine for her kidney stone. She is a cancer survivor and national spokesperson for patient advocacy. In her time of need, though, she had no advocate to help her. No, she received nothing for her years of service, for her selfless devotion to helping others, for her tenderness to patients dying of a disease with no cure.

That night, my friend did not even receive the benefit of the doubt.

Val Jones, M.D., is the President and CEO of Better Health, LLC. Most recently she was the Senior Medical Director of Revolution Health, a consumer health portal with over 120 million page views per month in its network. Prior to her work with Revolution Health, Dr. Jones served as the founding editor of Clinical Nutrition & Obesity, a peer-reviewed e-section of the online Medscape medical journal. She currently blogs at Get Better Health, where this post first appeared.

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  2. I do not think this patient was “stupid” at all! Your response was stupid!
    I recently went to our local hospital emergency room because I woke up with so much pain in my neck, down my shoulders, arms and into my hands. I thought I was having a stroke!
    When I arrived at the ER, the registration clerk was wonderful and refused to take any insurance info before I was triaged. She called into the ER, told them my problem and a Paramedic came out to look at me. He looked me up and down and said “You’re not having a stroke”. Then he told the registration clerk to put me in room 7.
    No one took my vitals, asked about medical history or anything for over 20 minutes! (The ER was basically empty). I could see the Paramedics sitting at their work station,
    (they are supposed to work as ER_Techs also.
    They were flipping through magazines and talking about what to have for dinner.
    The ER had one, nurse, who at the time was trying to coordinate two admissions to acute care. The nurse worked alone, without any assistance from any other staff.
    When the nurse finally got to me, she did my viatls, took history, etc. The ER doc came in, with a sigh of indifference, and said I sprained my neck. (I didn’t). In all fairness, he did order xray of my neck.
    He came me a script for Oxycodone and a muscle relaxer.
    The hospital patient satisfaction scores are at a all time low and you know, even the employees tell their family and friends to go to another ER id they think they have a serious problem.
    The indifference that is allowed in emergency services is cruel. Just think about the aged patients that have no one to speak up for them, how they have to tolerate
    indifference and sometimes neglect!
    Oh, and by the way, I followed up with my primary care physician and there is and was a lot going on in my body that was not a muscle strain!

  3. Dr Rothman,
    You speak only for yourself and certainly not for me or the many thousands of folks receiving care at VA Medical centers. You Sir are an outrage and a classic representative within the the US Health System that have made it what it is today. A single payer system is the path to equitable care for every citizen but of course if you are like so many of those who want to profit on the backs of the poor and suffering then you would not agree. We have had enough of the old school trickle down care. The US can and probably will produce the work force necessary to replace that which complains and does not work but profits.

  4. I need to point out that we are only hearing one side of this visit. Also it is being told to us by her sympathetic friend. I find it hard to believe that both the triage nurse and the registration tech would address this female patient who is in distress as “lady”. I have worked with many different types of people, from all walks of life and I have yet to hear anyone call a patient “man or lady”.
    The comments made by the tech regarding how much pain and her possible allergies also seem inflated. People who are in pain are especially sensitive to everything around them. I do believe that the employees of this particular ER sound very cold and uncaring but when I read these types of complaints against emergency staff, I feel that the real issues get buried under paragraphs of some exaggerated drama.
    This patient should write her letter of complaint but I suggest that she focus on the actual problem. A patient has a right to be seen prior to any medical forms being filled out, in this case the triage nurse should of seen her first and forms filled out later. The next issue is her wait without anyone updating her on what was next.
    Also X-rays are not indicated for stones, they do not always show up. A non contrast CT is the preferred test. All hospitals should have a CT tech in house, the wait for the test appears to be that this isn’t usually a nurse ordered test. You would never order a CT and expose a patient to needless radiation if the urine is negative.
    As an ER nurse the appropriate thing to do for this patient is start an IV and give fluids, send a urine and try to make her comfortable until seen by MD. Also this patient should of been triaged at a higher level due to her pain and how she would of looked on presentation.
    A simple urine test which is quick to do would of pointed the care in the right direction.
    I want to end by saying that I believe this patients interpretation of her situation but my concern is the writer who has taken this subjective history from her friend and presented publicly in such a manner. I’m also concerned about all of the people who are responding in an outraged manner after reading one side of a story and who are judging, jurying and executing without all the appropriate information.
    I hope this patient feels better and I want her to know that most of us care and try our hardest. I hope I didn’t offend anyone here as I usually refrain from participating, but I feel it’s so important that we start to use constructive communication.

  5. She should have gone online to this site: http://www.freemd.com
    Instead of sitting in pain for four hours she would have known in a matter of minutes that she had kidney stones and taken more effective action. Instead, she was at the mercy of the system….

  6. Please name the hospital–your friend’s horrible treatment should be exposed to as wide of an audience as possible and that hospital should be forced to take accountability for what it did to her.
    I had a similar experience when I ended up at the emergency department at Florida Hospital Celebration in Orlando for an about-to-rupture ovarian cyst.

  7. You’ve published a very scary story without providing the details necessary for people to protect themselves. By not naming the hospital, how can your readers avoid the place?

  8. I absolutely agree with bev M.D. – your friend should certainly expose this hospital’s faults through as many venues as possible. She may even want to complain about the facility publicly – through a newspaper or web forum. Although it will probably not help her directly, it may prevent the same situation from happening to another patient in the future. Maybe that’s idealistic thinking on my part, but it’s better to do “something” than “nothing.”

  9. Yes, of course, Dr. Rothman. Clearly, anyone who seeks help in an emergency room at 4:00 in the morning is stupid. No one else was at fault. That an admissions clerk is performing triage, that a nurse doesn’t follow a protocol, let alone perform his own observations, that a doc spends a nanosecond to sign the order and doesn’t bother with anything more, that the nurse then grouses about the dosage, these are all indicators of a perfectly functioning American style “free market” – one is free to die because no one gives a fig, and you, dear consumer, are considered a criminal parasite until proven otherwise.
    I have resisted the urge to call you what you are because I like to be polite, and ad hominem attacks are SO 2007. I’m sure that makes me stupid in your eyes. Certainly, if you see nothing wrong here except that the patient noticed what was going wrong, you defacto defend everyone else’s poor, poor efforts. That’s my picking-bone.
    So I politely beg that you kindly return to your alter of “free market” capitalism. It requires attention and a freshening of the genuine imitation gold leaf. Ben Bernanke has been paging you.

  10. Dr. Rothman wrote: “imagine how much worse it would be if it was Nationalized.”
    Better get a clearer picture Dr. Rothman except the ideological one.
    From Ontario Canada (Nationalized): http://www.cbc.ca/health/story/2007/01/25/er-waits.html
    Of which contains this; “Webster said the good news is that people with urgent medical problems weren’t waiting long to be seen.”
    U.S Study: http://health.usnews.com/usnews/health/healthday/080115/er-wait-times-getting-longer.htm
    “The study also found that blacks, Hispanics and women had to wait longer for care.”

  11. why the secrecy? What hospital? What nurse and doctor?
    If you don’t name them it didn’t happen?
    If they are so horrible why are you protecting them?
    How do you expect things to change?

  12. I’m sure you have already advised your friend to make the maximum stink possible, including calling/letter to the CEO, complaint to the state health board, etc. “Care” like this should not go unexposed – even though we all know the drill about drug addicts claiming renal stones.

  13. I have worked in ERs and wonder how come a basic KUB was not ordered by the ER MD to see kidney stones instead of waiting several hours for a CT? Years and years ago an IVP would be ordered stat and we would do that at any hour of the night. Technology is supposed to be making things better, not worse. Most big ERs would have an US or CT tech available and she would have been taken care of quicker.
    The real pain in all of this is she will be recieving an incredibly inflated bill which will bill her the same for a nod and ten second look as a ten minute exam. On top of that, she will also have seperate bills by the ER MD and the radiologist. The bill will be inflated so that even though she has insurance, they will have her on the hook for either a deductible and/or the uncovered portion after insurance pays their agreed to costs.
    It is sad to say that she could have made out better being a bum just dumped on the steps as that ER sure looks like it has experience in that department.
    Veins can be a problem, but that is the IV tech’s problem, not the pt’s problem. If you have a problem, get another set of eyes or fingers to help find a good vein. How can they even ask her to be quiet when this is an ER with people there because of injury?
    I have been at very nice hospitals with nothing like this and find that it all comes from the top down where the good staff leave when they are treated like dirt and you get the second tier level employees who were bounced from another facility because of the same attitudes. It may not be all of their fault as many a good intentioned employee becomes jaded and runover by a mismanaged chaotic mess where you just give up since it never changes.
    Please keep us informed of the after billing party as that will also cause her pain. Hopefully, she will find a better place to do the post kidney stone removal in an outpatient setting.

  14. Your friend is Clearly a very good person but she is also very stupid! She should have just called an ambulance. She wouldn’t be bothering any one by calling an ambulance.
    Apparently our health care system is horrible, imagine how much worse it would be if it was Nationalized. I saw it every time I used to go to the VA, it has has close to 10 employees per patient and gives out the worse care imaginable.

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