Friday, August 19, 2005


A couple days ago I read an excellent article in the New York Times about how the health care system is often degrading to patients.

Here's an excerpt

The Importance of Names

After spending almost a year in an oncology ward being treated for leukemia, where she said she was spoiled by the nurses, Shawna Needham, 31, of Thomasville, N.C., had what she called a nightmare experience in a rehab unit.

"The nursing staff was inconsiderate and lazy; it would take them 15 to 30 minutes to answer, just to get help going to the bathroom," Ms. Needham said in an interview.

But she was afraid to complain to the hospital. "If I did that, that's the big time," she said, "and if they got into trouble and found out I complained, well, I didn't want anyone coming at night to slit my throat, put it that way."

Besides, she said, "I really had no idea who my nurses were; I knew none of their names."

Names matter enormously, patients say.

In Dr. Goffman's account of life in a mental institution in the 1950's, he describes the admission process as a stripping away of possessions, "perhaps the most significant of which is not physical at all, one's full name."

In modern medicine, patients more commonly become exasperated because they do not know the names of the doctors or other medical staff. At many clinics and hospitals, staff members come and go without introductions, patients say. Name tags are in lettering too small to read easily; the names embroidered in script on doctors' coats can get lost in folds.

In hundreds of focus groups conducted by Planetree, a nonprofit group based in Connecticut that helps hospitals become more responsive to patients needs, one of the most common complaints that patients had was that they could not tell who was on the care team or who was doing what, said Susan Frampton, president of Planetree.

"What we encourage hospital staff to do is introduce themselves, always, and patients should demand it," Dr. Frampton said.

James Edwards of Kinston, N.C., devised an especially effective technique. After being blinded and suffering severe injuries in a chemical plant explosion, Mr. Edwards spent about six months in a burn unit, where he got to know the medical staff by the sound of their voices.

Mr. Edwards was pleased with his care over all, but he became upset when hospital staff members entered his room without speaking to him.

After one doctor slipped into the room unannounced and tried to give him an injection, Mr. Edwards decided that he had had enough, said his father, James (Red) Edwards Sr., in an interview. His son posted a sign on the outside of his door. It read:


1) Please announce yourself when you come into my room (let me know your name and why you are here).

2) Please let me know what you're going to do and how it will feel before you touch me for any reason.

Thanks - Jim and Red"

The hospital where he was treated, at the University of North Carolina in Chapel Hill, has included Mr. Edwards's sign in a training video for its staff.

You can read the full article at this link:

In the Hospital, a Degrading Shift From Person to Patient


I thought to myself on reading it, you know I often do a bad job introducing myself to patients. I more often tell them my name, then ask for theirs, and sometimes I neglect to do either. I resolved to try to change.

After my second patient today -- a man who fell and hurt his ribs, I found myself just getting to the hospital and having to ask him for his name. I did everything else, assess, vital, 02, IV, monitor, except I hadn't yet asked him his name.

I need to improve this.


Did four calls today -- a police standby (They were serving a warrant with the SWAT team), the man with the ribs, a lady with dementia and MRSA in her sputum, who tripped and ripped out her foley catheter, and a diabetic.


The diabetic, an elderly woman who lived alone, was out cold, blood sugar less than 20. I gave her an amp of D50, woke her up a little bit, introduced myself to her, then asked her again a few minutes later if she knew who I was. She didn't, so I gave her a little more D50, then introduced myself again. She knew this time, but only briefly, as we were finally getting her to agree to go to the hospital (An insulin dependent diabetic this was her first time having a sugar so low), she started acting confused again, so I rechecked her sugar and it had dropped again, so I gave her another half an amp, then asked who I was, and she had no idea, so I reintroduced myself, and this time it stuck. I don't know if introducing myself four times makes up for my neglect in the past, but I am going to keep working on it. And yes, I called her by her name repeatedly. I'm going to be working on that, too.