With my recent experience being assessed (i.e. poked, touched, stabbed and squeezed) by Toronto nurses and doctors, I've developed a sound opinion as to the overall quality of service.Quality, not in the sense that the doctors are providing appropriate diagnoses, and that nurses know how to do things and smile when they greet you — since I actually had quite an excellent and competent surgeon involved as part of this experience — but rather the level of comfort you feel while swarming through the various departments, units and centres that collaboratively determine what's wrong with you (hopefully); and how they make you feel while you stay with them until they resolve the issue (hopefully).
The short form of this opinion is that the majority of the people you will deal with — the nurses and front-line triage staff — as knowledgeable as they may be, are so casual and nonchalant about their very important roles, treating you in a relatively courteous manner (they are in a people-service job after all), yet with a very coarse and an often subtly disrespectful way.
It's like visiting a medium-class chain restaurant. Not a global fast food chain with their customer service policies and documented hand washing notices, and not the high end Michelin-star establishment who's chef would rather brutally harm themselves than see a negative review in a newspaper, but that place you'd assume is reasonably safe to go to. You know what you'd expect to see, and how you'd expect to be spoken to, but none of it really matches up when you get there.
This all started when I went to a medical imaging clinic in Toronto for an ultrasound, and after the procedure was complete I asked the technician what the next piece of the puzzle is. So she scurries away to check with some people and comes back in: "they said to just go back across the street to the clinic."
So I go to the clinic: Here I am!
Now, you know those moments when someone tells you something in a way that anyone that's ever been given then run-around would think "there's absolutely no chance that will ever happen", but then there are those moments that you think, "but that was then, and now it is 2011, so they've surely got a tighter process by now", which encourages you to give that person just a sliver of trust and leniency, only for them to screw you once again?
I digress...
"You're back already?" the nurse asks with a puzzled expression. "We don't usually get the images until at least 3 hours after they've been taken. So I don't know why they would have told you to come here so soon."
And neither do I. So I march back across the street, intent to communicate my dissatisfaction in a highly uncensored manner.
Irritation 1: Perceived Privacy, and Absolute Insensitivity
The world is well aware of the various privacy acts in effect globally, and most organizations — including hospitals — must revise their documentation, data-access procedures, and staff training commensurate with these laws.
Unfortunately though, most of the interpreters of these laws are the front-line staff who — with the exception of those few shining stars who are intelligent, think for themselves and have some sense of empathy — do specifically what they are told and no more, or develop their own warped interpretation of the instructions.
"Oh, you're back!" one of the admin staff exclaim — in a rather stressed tone. "Sarah, the Venous Arm is back!"
So is that my name now? Would I have been called "the Gangrene Penis" had I been hit with a different issue? Because that would be far less embarrassing than just using my name, right? Since that doesn't violate my privacy in any way.
I completely understand these folks deal with thousands of patients a month, but I don't need to know how you speak to each other at work — in the same way that the head of your company doesn't need to know how you talk about them behind their back when they give you some seemingly meaningless task that is somehow presented to you with unprecedented urgency.
So patient-administration folks, when patients are within earshot, at least fake 'caring' for that brief moment, and give me the impression that you have some decency, and can call me by my last name at a minimum.
That same day I am urged to visit a hospital, and after much waiting and testing, then more waiting, then more testing, I have another coarse nurse come by that had been checking up on me throughout the day; the sort it seemed that's been doing this for 20+ years.
As she burst around the corner I assumed she was coming to get me, as I had been there for over an hour and she had come by a couple times before, so I began to stand up while looking at her. "No, not you. Where did he go...?" she belches, then abruptly turns around and heads in the opposite direction.
Nice. Not a big deal, but this is quite opposite the Japanese experience: my reference point to how most customer service should be conducted. Its only major fault mind you is that it is so super-friendly, that it seems very artificial, and typically has this aura of helpfulness while not actually serving any useful purpose — and being quite inefficient during the whole process.
Anyway, later in the day this same nurse comes back — for me this time, again — and asks me some questions before she has to stick me with a couple needles.
The Single Most Frustrating Issue when speaking with anyone in a corporate office, your friends, casual encounters and especially folks in the medical care industry, is when people speak to others using acronyms that they must absolutely know the listener has zero chance of having even vague familiarity with.
"Is this the first time you've had a DVT?"
"Ummm..."
At my request she finally tells me what that means: Deep Vein Thrombosis, or a blood clot for us humans.
How in the world would any normal person ever know it by that name?
This happens with friends, family and the corporate world too of course — and it will forever baffle me that people assume you will know things when you will most certainly not.
I've determined this is their way to verify that they are smarter than you, so they can feel more intelligent.
When they say something you don't understand, you'll likely ask them a follow-up question, and be graced with their magnificence when they respond.
Irritation 2: Bumps and Snags
All electronic medical equipment have cables coming and going from it to various parts of you, and other machines that give things to you or take things from you — and these things will either be electricity or liquid.
Because our bodies don't come standard with a USB port we require these experts to plunge sharp needles into us, and affix these needles with strong tape so that they doesn't come out during the course of your hospital stay.
Unfortunately it is often the most unqualified, uncoordinated and spatially unaware people that ever seem to manipulate these devices, along with any attached cables and hoses.
Sensitive cables will sway toward a hook, handle or otherwise — and you will instantly think, "Uh oh, that's going to catch". To prevent damage to yourself, you may try to pro-actively resolve the situation as they give you an incredibly unconvincing smile of reassurance: "oh hey don't worry about that, I've got it under control."
That's exactly what worries me though, because they absolutely do not.
In addition to these machines and cables, some nurses seem to manhandle you like a Thanksgiving turkey while they move your bed, or take needles in or out of you, or swing cables from one side of the bed to another, while the pivot point (that massive needle sticking out of your arm) sways with it.
I am in total disbelief of the number of times I've been steered into a wall, knocked something off a wall, or had many hoses and wires caught on various things that could have been absolutely preventable with just a minute of extra effort.
'Due Care and Attention' the English would call it.
That should be a mandatory job requirement.
I hope none of these people drive on public roads, since their lack of awareness is sure to follow them into the car.
Irritation 3: Hospital Beds
I realize there have been developments in patient care, as a quick stay in another hospital treated me to quite the luxurious auto-inflating and multi-adjustable hospital bed.
But for some of the older models — as with my recent stay — you can just tell that Intelligently Designed User Interface wasn't anywhere on the list of requirements in their development.
First, the buttons for raising the head and feet up or down are halfway down the bed. So exactly at my elbow. Not at any location where a human being could operate it, and yet these controls are facing inward (toward me).
So your options are to use your Elbow awkwardly; contort your immediate arm painfully to use you fingers; or reach over with your opposite arm — also painfully.
These beds also have mattresses and coverings that don't slide against the bed when it moves up and down, so they bind. When you are lying down and raise the head up, your head just sinks further into the memory-foam, while your spine and mid-section are compressed. Needless to say, for someone that's had surgery in the chest area it is enormously painful to shift your body around to relieve the compression.
So these beds do nothing then to give you a feeling of relief or luxury, but more allow you to lie on something that is more comfortable than a shelf.
Irritation 4: Sharing Information
The second most frustrating thing is that — especially in Toronto where on University Avenue there are five or six hospitals within very close range of one another — nobody seems to share information easily or quickly enough.
An x-ray I took across the street can't be accessed quickly enough, so we might as well take another here.
Do you have your CD of images from the ultrasound? Because you'd have to bring them yourself.
Do you know what they diagnosed you with?
Was it only clinical testing that they did, or did they take some blood and run tests?
Hasn't the secure internet been around for a while now, so we could have developed a method of doing so? And even if it is paper records, can we not have everything in one place or tagged for requests by other hospitals?
I realize that it's my body and I should ensure that I understand some level of detail as to what the issue is, and retain sufficient information for people to help me. But if it's medical terminology, diagnoses, specific tests that were run, etc., then why have we not yet found a way to relatively easily share this information?
When I've been referred to Place B by Place A, I'd expect Place A to deliver all the pertinent details to Place B so that they know all about me by the time I get there. The only purpose I should serve when arriving at Place B is to validate the claims and give them any supplementary information they require to further assess my case.
Irritation 5: Doctor Who?
Again this is especially frustrating in Toronto, since I went from Clinic A who referred me to Hospital B, who further referred me to Clinic C in Hospital C, who then booked me for a procedure in Hospital C, and a follow-up surgery in Hospital D.
Then a nurse asks, "Was this Doctor Who that you spoke with?", or "What did the Hematologist say?"
Now, from the five places I've been to in the past week, and spoke to anywhere from one to ten people at each place, how am I supposed to derive which of these are Doctor Who, what their position is, and what hospital they work in?
This, combined with doctors working under other doctors. So even though you actually met and spoke with Doctor A, any paperwork relating to that discussion has Doctor X's name on everything.
And when sitting in a hospital for half a day, nobody sits with you for hours. You sit by yourself, and once in a while you're given the honour of having an expert join you for five minutes to give you hopefully useful information that — assuming they don't delve into detailed terminology — you can actually retain and potentially relay to subsequent experts.
But, retain this:
- "Hi there I'm Dr. Yeo who works for Dr. Michael's in the Hematology lab at St. Michael's..."
- "Good morning, my name is Sarah and I work in the Peter Munk Cardiac Centre here at Toronto General..."
- "Hi I'm Dr. Jason Sellars who is a Fellow here at Toronto General and I'll be assisting Dr. Hanz-Michael and also Dr. Samson..."
- "Hi, sorry for the wait — my name is Dr. Pereira and I'll be your Anesthesiologist..."
There is zero chance that I will retain any of these names in any particular order or level of importance, never mind who is who, where they came from, and what their position is.
I just retain the immediate information related to my issue, ask follow-up questions, retain those answers, and move on.
So now, whenever I'm asked if it was Doctor Who I spoke with, I respond with a simple, "A doctor told me." — which typically delivers a mild bewildered look. Followed by some pen scribbles. And maybe a smirk from me.
The bottom line (or TDLR - Too Long Didn't Read):
The Canadian Healthcare system is adequate, and has acceptable waiting times for more elaborate procedures that are of a relatively high importance, but most of the people you will deal with are quite coarse, use words you will never understand, ask you about Doctors and specific medical tests you don't know anything about, shove you around like a delivery package, plunge IV needles into you as if they were practicing how to crochet, and put you on a bed that is uncomfortably squishy, with controls you cannot reach.
Though still nursing some of my post-operative wounds, I like the fact that I'm better now, but loathe the thought of waiting in another room for another expert to tell me that I'll have to wait in another room for another expert, just to gain consensus on what will be the final place for me to wait even more for more experts.
But all that said, I would rather go through it than sitting in the comfort of my homes and wondering if what we have is serious or not.
I just yearn for a more patient-focused style of care in our future, that takes the priority over just getting the job done.
