JULY 2003 • Volume 27 No. 7

Emergency department expansion, renovation will enhance care

Leadership, teamwork pay off in successful trauma survey

Trauma program QI projects

Results of statewide hospital survey provide benchmarking data

New rules limiting residents' work hours will require increased efficiency

Lawyer and medical ethicist helps physicians, families navigate ethical dilemmas











A view from the other side of the bed


This past Memorial Day weekend was supposed to be my last fling at snow skiing before all the Lake Tahoe resorts closed up for the season. I wanted to experience spring skiing one last time for the year, with Lake Tahoe as the beautiful backdrop to what remained of the winter snowpack.

Unfortunately, a skiing accident ended my glorious day. After "catching a little air," I landed on my left leg in "Sierra cement," an expression that refers to thick, sticky, not-very-skiable snow. My skis got stuck and the force of my weight shattered my distal tibia and fibula. I also dislocated my left shoulder, probably when I braced myself as I landed.

I experienced the ski patrol sled ride to the base of the mountain, and my friend drove me to the local hospital where I was evaluated in the emergency department, X-rayed and stabilized before my drive home. The next morning, I was re-evaluated in Stanford's emergency department, admitted and treated for my various injuries. I had become a health-care consumer rather than a provider.

My experience at Stanford included an MRI of my shoulder and a trip to the operating room to repair my leg. I received the benefit of physical therapy, occupational therapy and excellent care from our nurses, aides, interns, residents and physicians. I can honestly and unequivocally state that SHC provides excellent care.

Since my discharge from the hospital, however, my experience as a health-care consumer has included some frustrations that have broadened my perspective on what our patients must deal with. I have experienced the absurdities of having to obtain medications that aren't covered by my prescription drug plan but are covered through my health plan. This meant that I couldn't just go to the pharmacy down the street and pick up my prescription, but rather the medicine had to be delivered through an infusion service. This would have caused delays in obtaining the medication, which would not have been acceptable under the schedule my doctor had specified so that the medicine could achieve its desired effect. I ultimately had to have some of the medicine picked up at my local pharmacy and paid for out of pocket (as my insurance wouldn't cover it) in order to take the medicine the way it was prescribed.

My next challenge was to obtain a wheelchair that would navigate some of the narrow doorways in my home. With my injuries I am currently non-weight-bearing and can't use crutches, so a wheelchair has become a temporary necessity. Finding a company that could rent me the right kind of wheelchair turned out to be more of a challenge than I had imagined. While I was ultimately successful in my quest, this came only after several days of phone calls and several deliveries of chairs that were too wide or were not for people of my height and weight.

While these two episodes provide only a glimpse of my frustrations, I know that our patients must face many more challenges than we realize in obtaining the care they need. With my recent experience, I have learned a few things that will help me empathize with my patients as they navigate our often-complex health-care system. For one, I believe that our scope of care as physicians must include improved planning for the patient's needs after discharge from our facility.

Despite the very advanced, high-tech medical care we provide, it is clear that more basic, human elements are just as important to our patients' health-care experience: good listening and communication, proper attention to detail, sensitivity to patients' needs, and sensible health-plan coverage policies. We as health-care providers should strive to bring these about wherever we can.

If you have questions or comments, please contact me at lshuer@stanford.edu