ED doctor-turned-patient: All doctors must get to know patients

As a patient, physician is shocked by 'uneven' care

Writing in this month's issue of Health Affairs, ED physician Charlotte Yeh recounts how she found herself on the other side of her job after a debilitating car accident and explains how her experience has helped her better understand patients' needs.

A timeline of 'uneven' care

While walking down a street in Washington, D.C., in late 2011, Yeh was hit by a car. After an ambulance team arrived, she was stabilized, placed on a gurney, and taken to a nearby hospital. Once there, she was put on a morphine drip and questioned by a physician about her pain.

"I told the doctor that I had severe pain in my knee and backside and she ordered a CT scan of my abdomen and pelvis as well as a chest X-Ray. Wasn't she going to examine my knee and backside?" Yeh writes. She lay on a gurney in the ED hallway for the next 15 hours because no inpatient beds were available.

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"Around this time, the staff learned that I was an emergency physician and moved me out of the hallway into a private room, assuming this is what I would want... [but] I felt abandoned, clutching my nurse call button, a lifeline to the world," Yeh writes. Hours later, a team of physicians visited Yeh and told her "Nothing is broken; you can go home now," despite her "excruciating pain."

She told the team she was unsure the she could walk with her knee in so much pain, but they told her, "Nothing is broken, so you can walk." Eventually, the team sent for a physical therapist, who quickly ascertained that she could not stand or walk. The attending resident told Yeh, "There's no medical reason to admit you, but if you can't walk, we'll just have to."

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Over the next few hours, Yeh asked repeatedly that her knee and abdomen be examined. Finally, she got the attention of an orthopedic consultant who determined that she had a medial collateral ligament tear.

It took another day before she found a physician who would give her a neurological exam; that exam found that she had suffered contusion of the sciatic and the gluteal nerves.

"On my third day in the hospital, someone asked if the admitting trauma team had done a history and physical. It had not… By my fourth day in the hospital, I was both medically and functionally stable," Yeh writes. But after physical therapy and two years, Yeh still walks with a limp and a cane, unable to truly recapture her previous independence.

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"As a medical professional who became an accident victim and then a trauma patient, I was struck by the uneven nature of my care, which was marked by an overreliance on testing at the expense of my overall well-being… Instead of feeling like a connected patient at the center of care, I felt processed," Yeh writes.

She concludes, "The guiding principle of all caregivers should be to know the patient, hear the patient, and respond to what matters to the patient. It should make no difference where you practice; any provider can do this. Emergency departments can't hide behind the excuses of 'we're too busy' or 'it's too chaotic' to avoid meeting this standard" (Yeh, Health Affairs, June 2014; Yeh, Washington Post, 6/9).

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