It Takes a Village in Health Care, Too
David W. Stepansky, M.D.**
A few weeks ago, while rounding on patients at Phoenixville Hospital, I began to experience a vague tightness in my upper chest as I walked from one nurses’ station to the next. The pain was fairly mild, but I also became a little sweaty with it. The symptoms did not cause me to stop and rest, but when I did sit down to write on a chart, the discomfort would subside, only to recur when I began walking again.
As a physician, I well knew what my symptoms might have represented, but being just as susceptible to denial as any other human, I chose to ignore things for a little while, not wanting to believe that I might be experiencing angina. I knew what would take place as soon as I said anything to anyone and only wanted to forget that it was happening. I actually went out to my car to drive to the office to start my outpatient hours, again experiencing that same mild but gnawing pressure in my chest. I sat in my car for a minute or two, just trying to think it all through, when I finally came to the realization that if I was indeed ignoring cardiac symptoms, than I was being very foolish.
Even then, I did not go directly to the emergency room. Instead, I wandered through the hospital until I found one of my cardiologist partners and told him my story. Of course, from that moment on, I ceased to be a doctor and somewhat begrudgingly became a patient. I knew from that moment that I would have to completely relinquish my regular identity and become wholly reliant not only on the judgment and skill, but also on the compassion of the many who then began to care for me.
What happened after that was at once extraordinary and commonplace. Following my evaluation in the emergency room, I was taken directly to the cath lab where a 95% occlusion of my circumflex artery was discovered and uneventfully stented. I recuperated in the post-op area, was transferred briefly to an inpatient room, and was ultimately discharged at 6:00 PM. In the aftermath of this whirlwind, surreal day, I found myself at home safe, healed, and marveling with my wife at how I had had my heart fixed from a tiny hole in my wrist. All that remained was for me to take it easy for a few days, contemplate how my life had changed, and reflect on this stark and jolting recognition of my own frailty.
The care that I received while a patient at the hospital was wonderful – efficient, accurate, and at the same time compassionate and reassuring. As an attending physician at Phoenixville Hospital for over 30 years, as well as the organization’s CMO and Patient Safety Officer, I have spent countless hours in countless meetings overseeing the hospital’s quality and safety. Yet experiencing the care provided from this new (and hopefully not oft repeated) vantage point was eye-opening in some unexpected ways.
In particular, I was repeatedly struck by the realization that exemplary health care is truly the sum total of the well-intended, expert actions of a multitude of people. With due gratitude to, and respect for, the talented physicians who cared for me, their actions would not have been possible without the support of a highly competent and reliable team that comprised both people and machines. I was repeatedly impressed and comforted by the confident attitudes of nearly everyone I encountered. Some of these people I knew well and some I had never seen before. The people who participated in my care, aside from my doctors, included ER nurses, x-ray technicians, laboratory technicians, cath lab personnel, post-op nurses, and telemetry nurses. But this barely scratches the surface when one considers that the technology brought to bear on me was developed and refined by scores of dedicated individuals whose ultimate purpose was to provide accurate and safe healing to individuals like me. In many ways, this was a humbling experience, as I must be thankful to a multitude of people, most of whom are actually behind the scenes and will never be known to me.
Many individuals who are involved in the front line of health care, including me, worry about the dehumanizing effect that high technology and specialization has had on patient care. Doctors and the systems in which they work are so often criticized for being aloof and insensitive to the emotional needs of patients. Health care has become highly business-oriented, often at the expense of the human needs of those for whom the system ostensibly came into being. Unfortunately, there is much truth to this concern.
However, the realization that I had during my brief hospital stay was that the human aspects of health care can be maintained even in the face of “dehumanizing” technology. Doctors do less “hand holding” than in the past, but this is at least in part because there is so much more they can do. Patients expect, and are entitled to, the high technology that modern medicine brings to them, but they are also entitled to the warmth and caring of the people who deploy that technology on their behalf. I can happily report that I received both when I was ill. It was, once again, an eye-opening experience.
The reality is that high-quality health care can only be the result of painstaking design. The care that I received could never happen were it not for the coordinated actions of hundreds of dedicated individuals. And so I would like to acknowledge the many people and machines that brought me back to good health. To my doctors, nurses, technicians and others who provided efficient and compassionate care; to the many people behind the scenes whom I will never know who also contributed to my well-being; and finally to Community Health Systems for providing the structure necessary for all of this to happen – my heartfelt thanks.
Copyright © 2013 by David W. Stepansky. All rights reserved.
**Internist David Stepansky is Chief Medical Officer and Patient Safety Officer at Phoenixville Hospital, Phoenixville, PA, and Chair of the Patient Safety Committee of Community Health Systems, Inc., Franklin, TN.