SOME YEARS AGO I attended a conference at the Queen Elizabeth Hospital (QEH), where a team of young doctors reported on a customer service survey they had designed and conducted among patients at the hospital.
While I can’t recall the intimate details, one of the points that stuck with me all these years was that there was a clear relationship between the age of the patient and the level of satisfaction. According to my memory, an older patient on a ward was likely to be more satisfied with the food than a younger one, while the bedside manner of medical staff was rated lower by younger patients and higher by older patients.
My reading of this is that as you get older, you learn to accept what life throws at you with less resistance and complaint, while younger patients have not yet learnt to say “que sera sera” when confronted with certain situations.
My own observation over the years, however, is that when it comes to the Accident & Emergency (A&E) Department of the QEH, there is almost universal agreement, regardless of age, that it is the last place any Bajan wants to go when he or she falls ill. Unfortunately, for most of us, there is no alternative.
So why does the A&E continue to have such a poor reputation after all the work done by exceptional physicians such as Dr Irvine Brancker and Dr Haresh Thani, and many younger medics since then, to transform it from the old “Casualty” to the “modern” A&E?
By my reckoning, there are some structural challenges, starting with the fact that it is too small. The waiting area is cramped and people waiting for treatment literally fall over each other.
I also believe that it is nothing short of inhumane to ask people who are in pain or discomfort to sit in metal chairs, when those in charge know that for some that wait can be upwards of 12 hours.
The bathrooms are also not adequate and the rate at which they are cleaned and refreshed does not reflect a department that handles so many ailing people.
The space inside the assessment and treatment area where medical staff operate is also grossly inadequate, and on busy nights staff and patients are literally crawling over each other. The very set-up of the department tends to leave patients agitated even before they have time to complain about or compliment the treatment they receive.
As I stated in a previous article, the long wait many patients suffer through is compounded by the amount of time doctors spend writing reports after treating each person. This necessary “evil” often leads to the criticism that doctors are doing nothing while sick and injured people are suffering.
So, do doctors really have to spend all this time reporting? Is it a legal requirement? Are there alternatives to writing? Why does it appear that doctors at Sandy Crest Medical Centre and FMH emergency room spend less time writing?
Additionally, a reader called and asked me to find out if doctors can’t use voice-to-text software that automatically converts spoken words into text.
I spoke to a veteran in emergency medicine, who has spent considerable time at the A&E as well as in private emergency rooms to get his take.
One critical point he made was that it was unfair to compare facilities like Sandy Crest with the A&E since the latter often handles far more complex cases. In fact, these private facilities refer matters they are not equipped to handle to the QEH. These cases then demand considerable time from the A&E doctors.
My medical source agreed that doctors often spend as much time compiling notes as they do administering care, but the nature of each case was the main determinant of the time allocated to this administrative chore. He explained that if the patient requires other specialty services such as X-rays, CT scans or blood tests, then instructions have to be written.
Additionally, he pointed out that in private facilities there is less competition for diagnostic services and equipment, so results are returned much faster.
When further treatment is required on a ward or other area of the hospital, or elsewhere, then notes have to be thorough so other medical personnel would have as much information as if they had seen the patient themselves.
“A surgeon who will have to operate on the person seen in the A&E will require intimate details of what occurred, medicines administered, et cetera. And often this is time-consuming because the report has to reflect the chronological order in which things occurred,” he added.
Doctors also have to be meticulous with their notes if the matter is likely to end up in court and they are to be called on the give evidence, he added.
“Doctors will often stop after treating each patient to document what occurred while it is fresh in their minds. You don’t want to run the risk of waiting until the end of a shift and then end up writing down the wrong thing.”
He explained that at Sandy Crest the process of compiling reports was made considerably easier by the introduction of electronic medical records. Doctors now type their reports, but the programme provides a number of shortcuts. This approach, he added, would definitely help at the A&E, but he warned it could cause even longer delays in the initial stages as doctors learn to use it.
My medical expert also admitted there could be value in the adoption of voice-to-text technology in the emergency room, but the hospital would probably have to provide a noise-free room for dictating notes to the computer in order to avoid garbled or inaccurate text.
Asked if during the current period of limited finances – when authorities might find it hard to employ more A&E doctors – it would make sense to hire secretarial staff at considerably less cost to assist doctors with clerical functions, the doctor said there might be some merit in giving it consideration.
“How well clerical people handle the nuances of delivering medical care might have to be addressed, but anything that can bring about improvements ought to be considered,” he added.
Before I end, I want to make one additional point. Most Barbadians, including medical personnel, would agree that patients spend too much time in A&E. There is also agreement that report writing takes a huge chunk of each doctor’s shift. However, I do not want anyone to conclude that I have determined that the problem at the A&E is caused by report writing. That would be an incorrect conclusion.
I have seen enough to recognise that there are many contributing factors and the solution has to be approached on multiple fronts. My major point in this article is that report writing seems to be a low-hanging fruit that, with a little creativity, hospital officials might pick, with potentially huge gains.
