Sunday, September 10, 2006

Responsibility

I called the mother to get permission to transfer her baby to a hospital with pediatric cardiac surgeons. At first she didn't want to give permission over the phone, preferring to wait until she came to the hospital. She said she was at the car wash and would then come right to the hospital. I pressed her though, preferring to get permission now and be certain of it rather than waiting for her to come in, and mother consented. I was glad I obtained phone consent because it was five hours before mother came to the hospital.

How does coming "right to the hospital" turn into arriving five hours later? I don't know, but such behavior is not uncommon for our patient population. People will say they're coming in to talk to us and then not show up. No shows are also common at our hospital's clinics. Last week I wrote about my conversation with a woman carrying a baby with Trisomy 18. She was one hour late for our appointment, and when we finally met she neither apologized for nor even mentioned her tardiness.

When I started dealing with patients in medical school, I was surprised at how irresponsible their behavior was. Non-compliance with treatment recommendations and missed appointments were common. Coming from a pretty straight Midwestern family - one where you showed up when you said you would, and one where you would take your medicine if your doctor told you to - I certainly hadn't expected that. Now I practically plan on people missing their appointments.

What's the reason for such behavior? I don't know. I suppose if you don't have reliable transportion, a common problem for my patients, it could be difficult to get where you're supposed to be on time. But I think it's more than that. I think life is looser for some in my patient population. Responsibilities just aren't that important.

Which may be why generation after generation remain poor and uneducated, with lousy or no jobs.

17 Comments:

Blogger Judy said...

Our docs trusted a mom to come to the hospital to sign a consent to transport a kid with necrotizing enterocolitis who had already perforated his intestine.

Mom said she'd be "right there" and the transport team beat her. Then hung around for half an hour. Then another 20 minutes. Finally our hospital attorney informed the docs that under state law, they only needed 2 physician signatures in an emergent situation. This was.

4 hours after the baby left, the parents arrived. They threatened to sue. Hospital attorney countered by informing them that they'd already been charged with negligence. Child protective services would be contacting them shortly. There was no lawsuit. CPS stayed involved. Kid survived, fortunately.

Oh, and I forgot an orthodontist appointment last week. Just forgot. Card was posted on the calendar. Office had called the day before. No excuses.

9:16 PM  
Blogger Ex Utero said...

I wonder sometimes if it's a passive aggressive behavior. If it's because we round at a certain time of day and if their not there, then they have to make and appointment to meet with us or "get lucky" and have us walk by the bedside after they've been waiting all day. Some parents are never there, but others spend countless hours and yet only get a few precious minutes every so many days with an attending. I guess I don't take it personally if they miss an appointment. I do however, get all of my consents for surgery, transfusions, etc. right then and there over the phone. I also try and talk to parents when ever I see them at the bedside - if I can - even if it's just to say that I'm pleased with their child's weight gain over the last few days or something to that effect.

9:44 PM  
Blogger Clark Bartram said...

The level of responsibility of many parents is inversely related to the incidence of demanding to "discuss the plan" at 1AM with the on call resident(or hospitalist in my case) who knows nothing about the plan or the patient except for the info on the sign out sheet. This is of course invariably something along the lines of 34 weeker with history of GI issues and some spells when in reality it is a kid who just got off of ECMO and currently has NEC. Sorry, had to get that off my chest.

11:00 PM  
Blogger karrvakarela said...

A lot of the times it's just a lax attitude. I remember this young couple who came into the ER after their baby had rolled off the bed on to the stone floor. It was the second time it had happened, the grandmother accompanying them told us. They just looked around sheepishly.

About late appointments: with regular delays at the doctor's office some patients prefer to come in late rather than sitting around and waiting. Of course, some people have a habit of taking things lightly and a missed doctor's appointment is just one of many missed opportunities. It's a shame.
Funnily enough, I was thinking about this earlier today: would we be justified in refusing to see patients who are regularly late for appointments (and who present with no medical emergency)? I know they do it in Psychiatry.

11:15 PM  
Anonymous Anonymous said...

Although this sounds very racist, I am thinking of the concept of "BPT" or "CPT" -- Black People Time or Colored People Time. My husband is Black and I am not. His family is highly educated/successful, Huxtable-esque, but this phenomenon has been present in most encounters with them, large and small.

It used to infuriate me until he used the reference -- and I didn't take is quite so personally. I would generally say, "It starts at noon..." re: our baby shower, when it actually started at 1:00pm. And they would still be late. It is really infuriating, esp. with airplanes, etc. My MIL is an attorney and I honestly don't know how she can pull this crap.

She hosted a party and showed up 90 minutes late -- for her own party -- Fortunately, most of her friends are Black so they were mostly late, too -- I was horrified since I ended up setting everything up from the caterer -- and when she finally showed up she said, "I gave it to God and it all came together -- Praise, Jesus!!" I'm like, forget about Jesus, I got this party started, you jerk.

In any case, there you go. My kids are very punctual! Do what you say your going to do, be there, and be on time!

12:02 AM  
Anonymous Kelley said...

At the risk of appearing as though I'm placing myself on some "super mom" pedestal, I am not, but I'll say this... You don't pull that crap when it's your kids. Now, I've missed many an appointment, or been late, for myself, but due to my kids..... hmmmm.. Perhaps, and this is just a stab in the dark, they are too comfortable with their child being in the care of the hospital. They think, again, perhaps, "what safer place could he/she be?", so they assume it's no big deal?? Not very smart thinking but it's a possibility.

12:09 AM  
Anonymous Anonymous said...

Neonatal Doc - You mentioned a "generation after generation" mentality. I couldn't agree more. It's like good old Welfare. It's supposed to be a short-term form of assistance to someone who is suddenly laid off or such. It's not meant to be a means of income forever and ever amen. Yet, look at some of the patients with which you're dealing -- you've got great-great grandma (age 68) and great grandma (age 51) and grandma (age 35) and momma (age 17). They've all used Gov't assitance/funds as a their "living", often without ever having put anything back into this already over-stretched system. How can we expect them to be accountable for their own flesh and blood when they've never had to be accountable for anything else generation after generation after generation? They feel that they're entitled or owed, so why should it be any different for the babies they pop out time and time again? Somebody else will care for their sickly preemies, or their babies going through detox from crack or other street drugs. It's a very disturbing picture that's all too common.

Until our Government in the U.S. does something about this (and I mean BIG time), it will continue.

8:17 AM  
Blogger Kelly said...

I also know of a situation like Anonymous posted: the "grandmother" had raised 3 girls, who were now all on welfare, having their own children on welfare. They couldn't even afford their $4 gov't housing rent! Ridiculous.

But as soon as you said the mother was 5 hours late, my thought was: "Well, she probably figured she didn't need to be there anymore, so she could run her other errands." I've probably done that many times. If I'm on my way somewhere, and I am told en route that it can be done on the phone, then I will do what has to be done on the phone, and change my plans. Makes sense to me.

Yet, I'm sure in your world, that's probably not the case, huh?

9:25 AM  
Anonymous Anonymous said...

Since it's been mentioned already in these comments - I'd LOVE to see your comments on ECMO someday, Neonatal Doc. Parents reactions, etc. I'm coming up on the 1 year anniversary of my own child going on ECMO, and it's an emotional time and I'm curious as to how people handle it.

Love your blog.

1:37 PM  
Anonymous Anonymous said...

As a parent of a child with severe cardiac issues, and having spent weeks upon weeks in the ICU/hospital setting, I find it kind of funny that drs would be bitching about patients not showing up on time. We spend our whole "hospital" lives on hold , waiting for the doctor to "round" for the day..waiting in drs offices where the wait could easily be over an hour (with a fussy/ill child). We finally get our child to sleep at the hospital, and the residents decide 4:30-5:00 AM seems like a good time to flip on the light and probe and wake them up.

4:36 PM  
Blogger Awesome Mom said...

Yikes!!! I get incredibly anxious when there is even a hint I may be late for something. I can't imagine blowing off doctor's appointments or showing up late.

I have to agree with the previous poster however. There is nothing more frustrating than to show up on time for an appointment (which is 15 min before the actual assigned time) and then be made to wait three hours (this is a true stroy btw) to see the doctor and then barely get any interaction with him before he moves on to his next patient. I am respectful of a doctor's time and I expect them to be respectful of mine.

4:48 PM  
Blogger neonataldoc said...

Thanks, everyone. Anonymous 4:36, you've got a point. Some doctors do keep people waiting far too much. I try not to be one of them.

The welfare dependency thing is a huge issue; so is ECMO. Maybe I'll post about those someday.

As far as BPT, I'll stay away from that, although I once went to a wedding slated to start at 3 p.m. that didn't actually start until about 5 p.m. We were practically the only ones in the church at 3 p.m.

9:22 PM  
Anonymous Pen said...

Parents sometimes don't understand how serious the situation is, either. Perhaps it is wishful thinking - they don't want to believe that it's really an emergency, so they act like it's no big deal.

2:55 AM  
Blogger The Pajama Mama said...

I think the general population is irresponsible when it comes to these types of behaviors. I wouldn't take it personally. People tend to be equally disrespectful of other people's time.

8:53 AM  
Anonymous Sammy's mom said...

I feel your pain, Neonatal Doc, and I'm one of the NICU parents! I've been blessed to have had very good relationships with all of my son's physicians. They have always treated us as an integral part of the medical team, and that's exactly how I want it. Aside from my son, my husband nor I have a medical background, but we want to learn everything we can. When I hear other parents talk about how horribly they have been treated by physicians, I have to sometimes wonder why and what these parents are doing wrong.

I HATE being late for appointments, but I was also raised in a family who believed that you should wear nice clothing to an appointment with the doctor. Even though I may wear shorts, sweat pants, jeans, and t-shirts around the house while taking care of my son, I still feel the need to put myself together and pull on business casual clothing for an appointment with my son's doctors. It's just a show of respect for myself, for my child, and for the physician.

9:27 PM  
Blogger Betsy said...

I do recognize that there seems to be an overall lack of respect for other's time these days......and that there are parents out there that don't make sick children or their own care a priority.....

However, as I have had many experiences with my children (both preemie) in the hospital and my youngest one in the NICU with multiple problems, which did require a transfer to another hospital, I was able to see first hand a variety of parental relationships. While I did everything I could to be there throughout each day and night the entire time my children were in the hospital and would cancel anything including work that complicated my need to be there.....I understood that it was a luxury I had. There are some parents who are not comfortable with a hospital setting and I can speak most frankly on the NICU setting. It is very painful to see your beautiful child in pain and suffering, it is a very intimidating atmosphere and depending on the level of tenderness of the staff...some parents can't handle it. In addition to the financial burdens some families suffer. It is easy to critisize, when the shoe is on the other foot. Not to mention, life didn't stop for my 7 year old when my newborn was in the NICU. Her entire summer was spent (from the moment she got off the bus)in the hospital daily. She had appointments and camps and friends that were important to her. And in an effort to make life seem somewhat normal for her, my husband and I had to choose who would be where and "take shifts" - - it is not a normal situation for anyone and especially for those who do not have family handy, extra money, or the luxury of "time off" at a moment's notice, there can be a multitude of reasons why they are not in attendance or unable to be timely. Respect is definitely an in issue, but it also goes both ways. Communication is key, even when it is difficult to talk to a parent, sometimes it could be the push that they need. Perhaps, at times, it is as simple as them not understanding the seriousness of the situation.

That said, I do all I can to be on time for everything....when it comes to the health of my children I make it my first priority and PUSH with everything I have for their well being.

I think it is most important to remember that we are all human....what one feels may not be what another feels! Ask, Encourage, and support (that goes for both sides)!!!!!

10:58 AM  
Anonymous Anonymous said...

Just to mention:

I have NEVER had a doctor's appointment and had him/her show up on time. NEVER. It'S usually at least a 45 minute wait. It's understandable. But the point is, people get used to that and figure they might actually accomplish something instead of sitting in the waiting room twiddling their fingers.

I know that's not the point of your discussion, but patients tend to get kind of jaded aboutdoctors and punctuality.

1:00 PM  

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