Monday, January 22, 2018

What if it was your mother?

I have been reflecting this week about an incident that made it to the national news; a woman wearing a hospital gown was left by hospital personnel at a bus stop in our city. We don’t know all of the facts, but this has been reported not to be an isolated occurrence. Could this happen at GBMC?

Emergency departments are frequently under siege. I have been in healthcare for more than 30 years and through those years, I have seen how we frequently use the emergency department as the pathway of least resistance. Primary care office closed? Send the patient to the ED. Specialist unable or unwilling to deal with a problem in the moment? Send the patient to the ED. Hospital leaders not able to create a smooth system for admitting a stable patient to the hospital? Send the patient to the ED. No way to get an infusion done on the weekend? Send the patient to the ED. Mental health system is broken? Send the patient in crisis and his or her family to the ED. I have worked in the emergency department when it seemed that we were overwhelmed with many problems beyond our control. And of course when the emergency department is overcrowded, people wait and they get upset.

What if we assume for the sake of discussion that there is a patient for whom the emergency department has done its job of treating an acute problem? The staff believes it has done all it needs to do and the patient is not happy. The patient begins to act in a belligerent manner after being told that she is being discharged. Let’s also assume that the first reaction of the staff is to try and reason with the patient and calm her down. But what if the patient escalates her behavior and starts yelling and screaming and even threatening the staff? And what if this is the third angry patient of the evening who has gotten confrontational? Can you understand the urge of a physician, nurse, or security guard to have this patient leave the ED? Of course, you can.

And what if the patient in this not atypical situation was your mother? What should happen next? There is no perfect answer in this hypothetical situation, but of course, you want your mother treated with respect and kindness, even if she is out of control.

As the leader of the GBMC HealthCare System, it is my job to make sure that the ED staff members believe that we will not leave them on their own when they are confronted with problems beyond their ability to fix. They must also believe that people like me mean it when we say that everyone must be treated the way we want our own loved ones treated. But we can only hold people to this standard if we are ready to give them the help and support that they need to carry it out.

Could this happen at GBMC? It is my duty to assure that our incredibly hardworking physicians, nurses, advanced practitioners, other clinicians, and support staff teams have the equivalent of a safety button that they can push which will bring other leaders to help when they feel overwhelmed. I have shared this commentary with Dr. Jeff Sternlicht, medical director of our ED, and Monica Goetz, assistant nursing director, who oversee the emergency department, to have them assure our staff members that we will not leave them to deal with episodes like these on their own. What do you think?


  1. I do agreed that the ED is often used as a "dumping grounds" by the population and healthcare professionals alike. I have seen many families bring "mom" to the ED because she was acting "weird" on their way to their vacation and leave as soon as a nurse take "mom" in for evaluation. There are many reasons why one may end up in the ED. However the ED staff must protect themselves as well against confrontational and violent patients. How many acts of confrontation does one have to go through before saying "enough". We will never know what transpired from that situation with the woman at the bus stop in a gown. I wondered why she was alone, where was her family? How did she get to the hospital? did she wandered out or was she actually discharged from the hospital for she looked disoriented? I have a policy of Stop and think before posting for I might not be able to ever take it back. The public posts things and often we get only half of the story and the damage is done. I know for a fact that the policy and the Leadership here at GBMC is phenomenal and trustworthy. Our vision statement is actually practiced here throughout the campus and in our everyday interactions. I have yet to witness an unsafe discharge in the 3 years I have been here. I have no doubts that we are well equipped and have the support necessary for our ED staff and the rest of the hospital staff to handles such encounters and especially prevents them. The ED staff here at GBMC is phenomenal.

    Marcelle Kendrick
    Unit 45.
    Loves it here at GBMC.

  2. Thanks so much, Marcelle. You have helped to make my points more clear. We healthcare leaders need to make sure that we don’t let the ED be a “dumping ground.” You are correct that we have to make sure that our staff is safe and that we can defuse the situation if patients and families get confrontational and we always need to live by our vision phrase.


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