Patients Rating Doctors: Let's Pay Popular People More!
Obligatory conflict-of-interest announcement: I am paid an hourly salary by a local government. My patients may fill out satisfaction surveys for other physicians in other settings, but they don't for me.
Part One of Three: My patient only had 20 minutes to wait for the van headed to detox. The people who had worked to get him into a detox program already numbered in the double digits. Sam (not his real name) was the classic public inebriate - he woke on sidewalks with the shakes, vomited blood on a regular basis, had lost most of his teeth, and was such a frequent victim of head trauma that depressions and scars ridged his balding skull.
Over the last week, our substance abuse counselor had daisy-chained together an impressive series of phone calls, blood tests, and clearance forms to line him up for one of our rarely-available detox beds.
Only 20 minutes to go.
But it was 20 minutes too long for him.
Sam wanted pills to help his shakes, and he wanted them now. When I told Sam the nurses would bring them as soon as they could and that I needed to examine him before the van arrived, his head turned away, and his arm-crossed rocking picked up speed.
With a sideways look at me, he pulled from his jacket pocket his trump card - a crumpled prescription. He showed me how, just that morning, an emergency room doctor had already given him a prescription for Librium (a long-acting withdrawal drug, with high street re-sale value).
He was telling me that he didn't need all this hassle.
Librium is, by any measure, a dangerous drug, with a narrow gap between helpful and lethal. If you shake out one or two extra pills to try to quell the violence of your withdrawal symptoms, or you take a dose, feel better, and then succumb to the lure of a readily available bottle, you can die. (Or, perhaps worse, go into a coma and endure prolonged, intensive, and expensive suffering.)
Librium is extremely dangerous to a serious inebriate and is a big cause of the markedly short lifespan of people like Sam. But Librium is also a really quick and easy way to get someone to leave your ER happily.
Despite Sam's shakes, coughing, and symptoms that indicated he might be vomiting blood again, he had spent less than an hour from check-in to discharge in his Librium-producing ER visit.
Sam saw me looking at his ER client satisfaction survey and discharge instructions, and he said, "I want my prescription back. I'm not waiting any more."
Disclaimer: Identifiable patients mentioned in this post were not served by R. Jan Gurley in her capacity as a physician at the San Francisco Department of Public Health, nor were they encountered through her position there. The views and opinions expressed by R. Jan Gurley are her own and do not necessarily reflect the official policies of the City and County of San Francisco; nor does mention of the San Francisco Department of Public Health imply its endorsement.
