The Appearance Of Callousness

Have you ever seen the short film It’s a Dog’s World? (The “new” edition can be seen here).  This is a short film that makes the comparison of how a dog is treated with empathy, dignity and respect after an injury, while his master, also injured, does not get the same. The owner of the dog has to deal with among other things, people who don’t really seem to care about him.

I am very fortunate to be the CEO of the GBMC HealthCare system. I get so many wonderful letters about members of the GBMC family who do marvelous things for our patients. But I also get letters where we did not treat people the way we want our loved ones to be treated. When I read these letters, I most often believe that our people did care but they gave the impression that they didn’t.  I have come to call this the appearance of callousness. We often give the impression that we don’t care when we are overwhelmed or when we are busy trying to protect our teammates from being overwhelmed.

Here is an excerpt from a letter that I received this week:

“I am writing you about my recent inpatient stays at GBMC. I was admitted to GBMC for 4 days, went home for 2 days, but needed a readmission for another 3 days. My two stays couldn't have been more dissimilar. So I am writing about my observations, those who did a great job, and the few problems I found.

First, I think in general I got very good care. In the ED, I actually thought that the waiting was reasonable, they gave me a reasonable expectation of time delays etc. I found the ED nurses and techs very good- both in doing their job and giving the personal attention. One is struck by how busy they are and how they have to juggle many duties. Despite that, I didn't find it detracting from my care. Transport was fine, CT and sonogram people were pleasant, capable, and helpful.

I was admitted to an inpatient unit. My hospitalist was Dr. Renu Thomas, whom I found to be excellent. She was very thorough, had good insight into my care, was prompt about writing orders, and showed compassion and concern. Medically I thought she was excellent.  I was in a typical GBMC room- very small, but it was quiet.  I didn't really require a lot- mainly IV antibiotics etc. The nurses were all excellent, caring. One is struck by how busy they are, how they have to juggle many things. I liked that they wrote their names down each shift and left the direct number to the nurse. Once I used the call button, didn't get a response, but just waited since it wasn't that urgent. Later, I just called the nurse. Once a tech forgot something I asked for, and she was so apologetic. It really was fine. I had one aide who could have been a little quicker to help, but in general I found the staff great. The phlebotomists at 5:30 am were incredibly quick, quiet, and excellent at getting the blood work done. A night nurse, who clearly has many years of experience, was particularly helpful with her suggestions.

I was discharged home but the symptoms returned, so I came back for more intravenous medication. On my second visit my ED stay was again appropriate, not too long a wait, good staff. Then I was readmitted back to an inpatient unit. However I was put by the nurses’ station, in between a demented woman, and a hard of hearing man. And I was down from the ice machine- which is very noisy. So the room was very noisy and not ideal. This time I had a different doctor, whom I was not very impressed with. I found her manner not very caring. She made a mistake ordering me a medicine. When I mentioned it the next day- next time I saw her- she didn't even apologize. She just said that the computer wouldn't accept her code etc. When it was time to be discharged, she said I would have to wait at least 3 hours because she had sick patients she had to care for. I am sure that this was true but not what I needed or wanted to hear.

However my worst experience was from the unit coordinator. During my second stay, I developed a headache (my headaches often progress to severe migraines), and at 7:10 am hit the call button to ask for Tylenol. I was answered right away and told that it was change of shift so that it would be awhile for the medicine. At 8am when I still hadn't received the Tylenol, I called again. No answer. So I tried 2 more times over 5 minutes. No one even answered the button. So I got out of bed, and with my IV pole in tow, went out to the desk. As I approached, the unit coordinator said she told me the nurse would be coming. I said that no one answered the call button. She then, in front of many people at the desk, said that she had talked to me several times and told me that the nurse would be coming. At that point, I told her that she had only told me once at 7:10 and I wasn't sure that the bell had even worked the next time since no one even answered me. The nurse then came and gave me the Tylenol.

Later that day I spoke with the charge nurse, who was extremely polite, apologetic and helpful. She arranged for my room to be changed to one away from the nurses’ station. I did mention that I thought it was a problem that someone couldn't even get a Tylenol for an hour due to change of shift.

I will probably be returning again to GBMC as an inpatient because of my chronic medical problems. I am hopeful that I will have a better experience than my second stay. But in general the nurses are all excellent, caring, and very busy. You really get a sense of all they are taking care of with their patients. So many things go well at GBMC, but there is always room for improvement.

I am very grateful for the work of our people at GBMC, especially all of the nurses and technicians that this patient thanked and Dr. Renu Thomas.  But, as the patient said:  “There is always room for improvement”.  I called the patient and apologized for the appearance of callousness by that unit coordinator.  I told the patient that our unit coordinators do an excellent job but sometimes people slip and make it appear that they don’t care when they do, and sometimes they say the wrong thing when they are trying to prevent their nurse teammates from being overwhelmed. The patient accepted this and she told me that GBMC is still her preferred hospital. I thanked her for her trust in us.

I know that there was a discussion between that unit coordinator and her supervisor, to get her to reflect on her behavior and change it. I should also mention that our nurses are working to redesign our approach to answering the call light and they have embraced bedside handoffs and hourly rounding to reduce the frequency of patients needing to call them.

But in addition we all need to work to eliminate the appearance of callousness.  I look forward to your thoughts on this.