One Significant Way to Lower Healthcare Costs: Listen to Patients (Especially, Women)
When patients’ complaints are not taken seriously or in a timely manner, it causes untold suffering. It’s also an inefficient use of hospital resources and healthcare dollars. We need to do better — doctors need to do better. Nurses can, should, and have stepped up for patients too ill to self-advocate. But we could save a lot of time and money if doctors were educated in medical school to “listen to the patient,” regardless of gender, color, sexual orientation, cultural background, or socioeconomic status.
Patients must come first. By sticking to this simple rule, patients and the hospitals that treat them will also save money.
Much has been written about gender-bias in healthcare — and based on my twenty-five years as a medical professional, I’m here to tell you it’s real. In all my years as a nurse, I have never had a doctor order a psych consult on a male patient being admitted with physical illness — only on male patients admitted for a suicide watch or a substance-abuse issue. But I can’t count the number of times a physician has ordered a psych consult on a female patient being admitted with physical illness. In lieu of investigating and ordering tests, if the source of the patient’s complaints was not immediately obvious, out would come the “ego-protection strategy” of ordering a psych consult. This occurrence was particularly common if the patient was over forty. (In my opinion, Sigmund Freud is responsible for untold damage done to women’s lives in the name of science.)
I’ve also had the psych label thrown at me. But because I’m a nurse, I ignored the vicious and irresponsible insult of Munchausen-by-proxy-syndrome and showed up in the ER with my sick child anyway — and a mere thirty minutes later, my five-year-old was having emergency surgery. At least that doctor, a pediatrician who should have known better, had the grace to apologize. (Most do not.) He’d simply suffered a temporary bout of ego-driven “let’s blame the mother” syndrome. Unfortunately, it’s more common than we’d like to think.
Fortunately, nurses have allies in the hospital setting: nursing supervisors, the hospital’s chain of command (nurses, make sure you know it by heart), and pharmacists. Sometimes, other allied professions can be allies, as well — but pharmacists were my go-to source for backup whenever I needed it. Did it help that our floor’s pharmacist was a male? Probably.
I became a nurse, in part, because my own mother was medically mistreated and misdiagnosed for two critical years because of gender bias — and possibly, age-related bias in healthcare, which is ridiculously common. My mother did not, in fact, suffer from “empty-nest syndrome” or “a vitamin-B12 deficiency.” She had advanced colon cancer, and it nearly killed her.
Similarly, my female patient with complaints of abdominal pain of unknown origin wasn’t suffering from psychosomatic illness following her messy divorce. Two years prior. While the GI consult on-call that night was watching a basketball game — her colon ruptured. I hustled and got her into emergency surgery that saved her life, but the delays that endangered her were 100% avoidable.
The new mother on our medical floor wasn’t suffering from a “failure-to-bond” with her first-born infant; nor was she in a semi-catatonic state following a difficult delivery. The psych and social work consults weren’t necessary — they were unproductive and intrusive. In fact, she suffered a severe, spinal-fluid leak following her epidural. It happens. One small blood-patch later, she was packing her bags to go home, smiling and cooing at the newborn cradled in her husband’s arms. Sadly, she’ll never get those first, forty-eight hours back — when her doctor didn’t believe her, or me.
The older woman who complained of excruciating, blinding, abdominal pain after every meal wasn’t attention-seeking, or drug-seeking, or lonely. She had a whopping big clot in her mesenteric artery.
All of these cases cost so much money, for the hospital, and for the patients in question. Diagnostics cost money, too, one might argue — but the simplest diagnostic costs very little:
Listen to what your patient is telling you. It’s nursing 101, and it should be doctoring 101, too.
Case in point: Following a laparoscopic appendectomy, a lovely, otherwise-healthy, female continued to complain of nausea — despite the nurses administering anti-nausea medication around-the-clock. The patient’s failure to progress delayed her discharge following ambulatory-surgery, which frustrated her surgeon tremendously.
“Do you think she just wants to be pampered?” he blustered. “I don’t understand why she doesn’t want to leave? It’s not normal!”
“No, I said,” in an even tone. “I think she’s nauseous. Have you considered a different anti-nausea medication?” I urged.
“Well, this usually works with everybody else. I just don’t understand why she’s being so difficult!” he said, again.
“Could it be because she feels like she has to throw up constantly? And that she can’t keep any food or fluids down?” I asked. “Could we ask the pharmacist to come and talk to her, and see if he could recommend a different medication?”
At his dubious look, I asked, “What could it hurt? Besides, we’re going to need her room for your post-ops coming back from surgery this afternoon …” I said, greasing the squeaky wheel.
Literally, an hour later, the patient was smiling, dressed, packing her suitcase, and calling a cab. Not every patient responds to every medication in the same way. This particular patient wrote my Director of Nursing a glowing letter about my nursing care. She thanked me for advocating for her, and she mentioned the professionalism with which the pharmacist and I had treated her. I doubt that she wrote a similar glowing recommendation to the Director of the Hospital about the way her surgeon treated her.
Now, you might think, if I’m such a know-it-all, why didn’t I go to medical school myself? But that’s a cop-out. We each have our roles, and my role as a nurse is to care for, and yes, advocate for, my patients. If I don’t do my job, things tend not to go so well, for my patients and for the healthcare system as a whole. And the same goes for every healthcare professional, no matter how many years of schooling it takes one to get there:
I’ve seen a physician poke his head out of a patient’s room and announce, “Excuse me, this man is choking.”
And, I’ve seen a Nursing Assistant push past him, leap onto the bed, and perform a fierce, abdominal thrust that saved the patient’s life.
Back to the money thing. The cost of my nauseous patient’s excessive hospital stay, in today’s dollars, would have been in the neighborhood of $2,700 per day — so, an overnight stay that turned into a three-day stay resulted in up-charges of $5,400. And it was completely unnecessary: If the doctor had listened to the patient, prescribed an alternate medication, or consulted with our knowledgeable and attentive pharmacist — she’d have gone home the morning after surgery, as expected.
But, compared to the patient who had to have a colectomy, a colostomy, and life-long medical care, $5,400 is a mere drop in the bucket. The vast majority of this unfortunate patient’s medical nightmare could have been avoided with more timely and appropriate treatment. Her physician never apologized, and I hope she sued him for negligence — because he deserved it. He was negligent.
Listen to your patients,
Do more careful and thorough diagnostics,
And touch your patients.
I’m not talking a spiritual laying on of hands, but a physical one would be good … During the six-month ordeal that preceded my mother’s colon cancer diagnosis, she had presented to doctors regularly with constant abdominal pain, an inability to pass solid stool, a forty-five-pound weight-loss — and, with two grapefruit-sized tumors nearly obstructing her colon. Yet, not one physician palpated her abdomen. And not one even thought of ordering diagnostic tests.
This failure of the most basic level of physical assessment is the most important reason I chose to become a nurse.
Conducting a physical exam and listening to what your patient has to tell you are the most basic elements of medical care. Yet it is shocking how often they are forgotten, or worse, ignored.
This gross failure of medicine costs untold suffering — but it also costs a lot of money. Excessive healthcare costs can bankrupt individuals and hospitals.
Let’s do better.