A Golden Lesson In Patient Care

By Ken Congdon

By Ken Congdon, Editor In Chief, ken.congdon@jamesonpublishing.com
Follow Me On Twitter @KenOnHIT

My wife loves The Golden Girls. That’s right, the 1980s sitcom starring Bea Arthur, Betty White, Rue McClanahan, and Estelle Getty. She used to watch it all the time as a little girl with her mom and sister, and now it’s nostalgic for her to view reruns of the program on The Hallmark Channel and TV Land. Considering I was a teenage boy back when the show was popular, I never really watched The Golden Girls. Needless to say, a program about a bunch of elderly women living together in Miami didn’t really appeal to me back then. Honestly, I can’t say this plotline appeals to me now. However, since my wife enjoys the program, I (by default) have caught a few episodes throughout our marriage. I must admit, I like the show. The cast was a terrific ensemble of comedians and the writing was extremely clever, especially for its time.

One episode in particular caught my attention when I saw it for the first time last week. It was a two-part episode titled “Sick and Tired.” In this episode, Dorothy (Bea Arthur) is suffering from a flu-like illness that renders her weak and confused. She’s so exhausted she can’t even speak at times, and the sickness won’t go away. Dorothy sees several doctors throughout the episode — none of which can find anything physically wrong with her. They dismiss her symptoms and tell her what she’s experiencing is just a normal part of getting older, or that the illness is “just in her head.” Frustrated by the lack of a diagnosis and the way she’s been treated by physicians, Dorothy is reduced to tears. She actually begins to believe she is crazy.

Finally, Dorothy is referred to a physician that successfully diagnoses her condition as chronic fatigue syndrome. While the physician admits nobody is sure what causes the disease and there is no real cure, Dorothy is simply relieved to know that she is not alone — she does have an affliction that affects several others. Moreover, she is appreciative of having a physician that actually listened to her complaints, objectively considered all possible causes, and didn’t label her as a mental case.

Later in the episode, Dorothy bumps into one of the doctors (Dr. Budd) that dismissed her and confronts him. Here’s a clip of that interaction:

My favorite line is when she says: “I don’t know where you doctors lose your humanity, but you lose it … You better start listening to your patients. They need to be heard. They need caring. They need compassion. They need attending to. You know, someday Dr. Budd, you’re going to be at the other end of that table. As mad as I am, and as mad as I always will be, I still wish you a better doctor than you were to me.”

It’s amazing to me how a television show that first aired back in 1989 (that’s 24 years ago folks) is still so relevant today. As far as the healthcare industry has come from a technology and treatment standpoint in the past two-and-a-half decades, we haven’t made much progress when it comes to how physicians interact with their patients. Many are still woefully poor performers when it comes to listening, communicating, and compassion.

I had an experience very similar to Dorothy’s a few short years ago. I suffered from what seemed to be a terrible Urinary Tract Infection that just wouldn’t go away. I was tested for UTIs, a variety of STDs, and prostatitis. I even had a scope jammed up my urethra. None of this was fun, and all the tests came back negative. For years the pain persisted, and I saw doctor after doctor that ran the same tests and told me nothing was wrong. They said it must be in my head. I got to the point where I gave up. I was resigned to the fact that I was going to have to live with this unexplained pain for the rest of my life.

Like Rose (Betty White) did for Dorothy in The Golden Girls, my wife convinced me to keep seeking a diagnosis. She urged me to travel outside of Erie, PA and see a specialist at Cleveland Clinic. My appointment with this urologist was a revelation. She reviewed all of my previous tests (instead of reordering a series of new ones), listened carefully to my symptoms, asked a ton of questions for more clarity, and gave me a diagnosis — pelvic floor dysfunction.

It was a diagnosis I didn’t believe at first because she said the pain could be relieved over time with some physical therapy and regular pelvic floor exercises. No prescription drugs or surgeries would be necessary. I can’t tell you how ecstatic I was when this treatment plan actually worked! The other doctors I visited the years prior never even considered pelvic floor dysfunction because it is relatively rare in males in my age group. Moreover, it wasn’t a condition that would show up on a lab test, X-ray, MRI, or ultrasound.

So what does any of this have to do with health IT? Not much — just a simple point really. I’ve spoken with numerous C-level executives, IT professionals, and clinicians from healthcare facilities across the country about EHRs throughout my tenure at Health IT Outcomes. The biggest criticism of the technology always seems to be that it interrupts physician workflows and negatively affects physician and patient interactions. Of course, nobody wants this, and the EHRs that are most transparent in this regard are typically the most highly regarded by clinicians.

My point is this — while most EHRs do change physician workflows and communication techniques, maybe these habits are in dire need of changing. For example, it’s clear from The Golden Girls portrayal and my own personal experiences, that many doctors aren’t always the astute and compassionate caregivers they think they are. An attentive, sympathetic doctor can be a godsend, and there are many of them. However, a condescending, uncompassionate doctor can make a painful, frightening, and frustrating situation even worse. Unfortunately, I’ve encountered more of the latter than the former in my lifetime.

Perhaps it’s time for many clinicians to re-evaluate their physician/patient dynamic. EHRs can provide an opportunity for healthcare providers to do just that. An EHR can’t force a doctor to listen to or care about his or her patients, but it can ensure certain questions are asked and diagnoses are considered. Perhaps the technology can serve to encourage doctors to engage more with their patients and revitalize the level of enthusiasm they have for their profession. Sadly, however, EHRs don’t appear to be having this affect. Instead, they only seem to making already disgruntled physicians even more cynical.