Ever wonder what your older patients are thinking after you send them home? EPM wanted to find out, so we visited a small town in Pennsylvania and asked 17 women in their 80s who were meeting for their weekly round of canasta. Here’s what they had to say.  

“I was in the trauma unit once, and they couldn’t get a room for me, so they put me in the casting room. What an experience.”
“You need a drink while you’re in there!”
“A little scotch wouldn’t hurt”
“The doc wanted to keep me (in the hospital) because he said I had a very big problem, but I said I wasn’t staying there. I’m going home. I didn’t want to stay. I’m just more comfortable in my own house and with my own doctors.”
“I was laying there in my pajamas and a woman came up asking for $50. I’m aware there’s gonna be a charge, but bill me. You’ll get it!”

“I asked them to call my doctor because he has all my records. Then they tell me they’re not allowed to call. I don’t understand why everything is so confidential!”
“My big gripe is the bed, if you can even call it that. You die on that thing! You’re laying there and you’re trying to turn and you’re sitting up. It’s murder!”
“...and if you turn, you might fall off!”
“A lot of older people, because of the abruptness or lack of communication, begin to think that this can’t be a doctor, he’s probably a student. He probably doesn’t know a whole lot and that’s why he’s not communicating well with me. I’d be willing to bet that a lot of older patients, when they visit the ER, think they’re being seen by a student.”

“I never had a problem with the doctors in the ER . . . but I always thought they were interns or students”

“These doctors should have a course in how to speak to the patients”
“Don’t use such big medical terms. Come down to earth and put it in simple language”

“I have what?”
“One thing that’s really important is to really let the patient know what’s happening next and what that means. If you’re going to send me up to get a CAT scan, you might need to take a minute to explain why or what the CAT scan is.”
“More cases than not, I’m willing to bet they’re understaffed. But all that people really want is for the doctor to know they are there. It might just mean popping in to check how they’re doing every now and then. Maybe they can’t even take the time to find out how you’re doing, but their presence makes a big difference.”
“The only problem with the ER is the wait. The only time you get in there fast is if you’re brought in by the ambulance.”
“Even with all the critiques, we still say ‘thank you’ to these physicians. We know that they have to be ready for anything.”
Of the many issues discussed throughout the afternoon, a few basic elements of emergency department care rose to the surface. Most prominent on everyone’s minds were the beds, which were felt to be terribly uncomfortable for elderly patients.

“If you have a bad back,” said one woman, “laying on that thing doesn’t help.” The feeling was unanimous.

A close second was the general consensus that physicians need to improve their bedside manner, working a bit harder to “do some educating” regarding what is happening, explaining the situation in laymen’s terms.

At the heart of every constructive critique, however, was a person who understood how overburdened the ED has become.

“Emergency physicians are a special breed,” said one woman. And once again, the feeling was unanimous.

Special thanks to Mary Ahern and the women from Bethlehem Village in Flourtown, PA.
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# Great IdeaWilliam Sullivan 2009-06-13 21:04
Really liked this idea and the responses.
You should keep up these types of impromptu interviews in other venues such as the supermarket or a barber shop. Maybe even mini video-clips for the web site?
It would do all ER docs some good to get an idea of real-life reviews of our services outside of the Press Ganey scores.
# The beds!Scott Wilber 2009-06-17 20:58
The comments about the beds are important. Older patients have a tough time in standard ED beds. For a cheap way to improve comfort and satisfaction in this population (and remember that they send in Press-Ganey surveys much more often than younger patients), consider providing inpatient-style "Geri-chairs" as an alternative to standard ED gurneys.

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