Home | Posts RSS | Comments RSS | Login

Feb 18, 2008

Thanks, but No Way in Hell

Today was the second of two (thank god it's over) field trips with a small group I'm in for the class Patients, Physicians, and Society. Last semester we went to Morehead, a regional hospital about an hour and ten minutes from Lex. Today we popped down to Rockcastle County, an hour from here, to tour a small town hospital that happens to have a world-class Ventilation Dependent wing. It was all interesting and provided for some very interesting discussion. Mostly, however, I felt one resounding feeling.

Man, these small town people are WEIRD and don't have nearly enough to do.

We arrived just in time for lunch, which had been prepared by the hospital chef. It was really tasty, although the chef threw a little fit when I told him that I am vegetarian and that, apparently, my message communicating that had not reached him, and could he please not put a giant slab of dead animal in front of me. He found some cauliflower and I ate that instead, while everyone else at beef tips of roasted vegetables.

We were joined for lunch by the hospital CEO, the Chief of Staff, all of the Area Rotation coordinators, and a recently graduated physician who did undergrad, med school, and residency at UK. It was as if we were international dignitaries. Shaking hands, exchanging contact info, rubbing elbows and the like. I can usually do this pretty well, having had to beg for money for my entire performing career. However, doing it on four hours of sleep immediately following a three hour exam (that was brutal) was less natural and more exquisitely painful than I'd anticipated.

They just kind of do things differently out there in the country. Firstly, there was NO patient confidentiality. We were told all of the names, hometowns, diagnoses, and progress of nearly all 80 patients in the Vent-Depended wing. Including "one charming story of a stripper named ********** from ******* who was shot coming out of work one night because she wouldn't sleep with one of her customers. She's still a person, you know, so she deserves a life, too. But I say she's still a stripper at heart."

What? What does that even mean?

Or one patient we met who had extreme physical deformities and was unable to speak without the help of a computerized voice box. We asked what his diagnosis was. "Not sure, but I'll put together a list of all the patients and their diagnoses just so you guys can see what we do here."

Now, I'm no ethicist. But that, to me, is breaking confidentiality. We do not gain any knowledge or understanding with this information. Patrick argued that the rules about confidentiality are more lax because it's more like a nursing home or long term care facility than it is a hospital. There may be something to that, but that is still no excuse to email your patients' histories to completely uninvolved medical students.

At the end of the day, it was interesting to see this place and to learn about practicing in a rural community. But nothing those people could ever say, do, or show me would ever make me want to practice in the middle of nowhere. I love cities too much. (And Lex, I am NOT looking at you.)

4 Readers rock!:

The Scrivener said...

Huh. The lack of confidentiality might be because in a small town, mostly everyone knows everyone else anyway, so why keep up a pretense? Maybe?

Ok, fine, I'm just making excuses for that bizarre stripper story.

Alykat said...

Note to self....

Never, ever. Under ANY circumstances. ANY CIRCUMSTANCES. EVER. Go to a small town hospital. No way, no how, never, ever, EVER.

Always, always, always, always crawl to the nearest city population 1,000,000+ for all illnesses. Especially the embarassing ones.

I really feel like I have learned something from you today! :)

The Shrink said...

My oh my!

I don't have an issue with medical students knowing names or details of patients since they're obliged to behave as ethically as any qualified staff would. For busy staff to talk one way to a junior doctor or nurse and censor their dialogue when a medical student's there is not realistic, so I'm okay with us all being grown up enough to hear confidential details which we keep to ourselves.

You're spot on that the point is to convey relevant information rather than gossip, though.

There's something unwholesome about revelling in the peripheral details of a patient's history that's got no bearing on their clinical care. Sometimes it's valuable context and has clinical meaning so should be shared, sometimes it's simply biography and thus has no place being shared.

"She's still a person, you know, so she deserves a life, too. But I say she's still a stripper at heart."
But? So she deserves a life, but . . .
Is it conditional, then, not an absolute right?

Personally I'm fond of having access to cities and couldn't live too far from one. Professionally I couldn't work in a tiny rural community in the middle of nowhere but equally I've never been happy in huge urban teaching hospitals. I favour the smaller district general hospital (our local one has 600 beds).

I guess that's more of an issue when you qualify. Do you opt to be a small fish in a big pond, or go for a smaller hospital where you've more influence? Maybe I just like things my own way too much :-)

Xavier Emmanuelle said...

Thankfully the small town where I grew up is much better with confidentiality when it comes to medical care -- in every other possible area of your life everyone knows EVERYTHING about you, but thankfully the docs stay mum. It's still really awkward to run into your doctor in the grocery store/while out running/etc but at least not everyone knows your medical history.

I'm tempted by rural medicine because I grew up in a rural area and therefore I fully understand the shortage and the desperate need for competent medical professionals in those areas. However, I'd need to be close enough to a big city that I could go there a couple of times per week for dance classes, real vegetarian food, etc because I am SUCH a city person.