This story is one from clerkship, one of my ER shifts. It a particularly busy shift. There were several codes, a few traumas and people generally having bad days everywhere.
As a result, the waiting time for less urgent cases was long - some eight hours. I met a patient who was triaged as “green” (not urgent) with a “foot problem”. He did not speak English. His friend spoke some English, but not much. I had a difficult time doing my normal history and physical. It was almost impossible to understand what his past medical history was, when he began to feel unwell or anything else we would normally ask a patient. The patient was perseverating about first his length of stay in the ER then his foot that was causing him problems with walking.
I was frustrated. So incredibly frustrated. I had to keep leaving to check in on my other patients and calm down enough that I could talk to him again. Eventually I realized that this guy was sick. I couldn’t tell if it was a neuro problem (?stroke, trauma, seizure) or a cardiac problem. Once I was able to figure this out - at least one or two hours after laying eyes on the patient - things went much quicker. He had an ECG, cardiac enzymes, blood work up, CT head, everything I could throw at him.
He was indeed unwell. He went for neurosurgery that night.
It’s a good ending - I saw him a month later and he was well, walking and doing his normal life.
This is a story about the system though.
The nurse who triaged my patient didn’t realise that this patient was as sick as he was and took the fact that the patient stated he had a foot problem at face value. They didn’t call a translator and probably wouldn’t have known the patient’s language or where to find a translator in the city.
The nurses who had this patient in their area didn’t check in on him. He was triaged green, he could wait. They had patients with active cardiac issues to tend to. They believed the green triage and had difficulty getting past the language barrier.
Without a proper translator I found the interview process for this patient difficult and annoying. I was focused on the annoyance rather than the illness of the patient. It wasn’t until I chose to go past the history to the physical that his illness became apparent.
Once his neurological deficits were apparent, the nurses were amazing in helping me get tests done quickly. Consults were called in, the patient was cared for.
10 hours after first presenting to the ED.
I was angry with myself and with the system that caused this patient to have such a terrible experience. I felt guilty for being so frustrated with the language barrier I had with this patient. I was scared that because of my ignorance my patient would have lasting deficits.
Rather than be angry with a triaging system that was doing what it could, I looked for practical solutions to the problem. With the immigration hub in town, we came up with a “health passport” for new Canadians. It contains basic info about the patient like their country of origin, mother tongue and how to get in touch with a translator. It would also contain their past medical history, medications and other important medical information that would help the ED physicians.
I left the community before I could see it put into place. I hope it’s being used with good benefit.
As a result, the waiting time for less urgent cases was long - some eight hours. I met a patient who was triaged as “green” (not urgent) with a “foot problem”. He did not speak English. His friend spoke some English, but not much. I had a difficult time doing my normal history and physical. It was almost impossible to understand what his past medical history was, when he began to feel unwell or anything else we would normally ask a patient. The patient was perseverating about first his length of stay in the ER then his foot that was causing him problems with walking.
I was frustrated. So incredibly frustrated. I had to keep leaving to check in on my other patients and calm down enough that I could talk to him again. Eventually I realized that this guy was sick. I couldn’t tell if it was a neuro problem (?stroke, trauma, seizure) or a cardiac problem. Once I was able to figure this out - at least one or two hours after laying eyes on the patient - things went much quicker. He had an ECG, cardiac enzymes, blood work up, CT head, everything I could throw at him.
He was indeed unwell. He went for neurosurgery that night.
It’s a good ending - I saw him a month later and he was well, walking and doing his normal life.
This is a story about the system though.
The nurse who triaged my patient didn’t realise that this patient was as sick as he was and took the fact that the patient stated he had a foot problem at face value. They didn’t call a translator and probably wouldn’t have known the patient’s language or where to find a translator in the city.
The nurses who had this patient in their area didn’t check in on him. He was triaged green, he could wait. They had patients with active cardiac issues to tend to. They believed the green triage and had difficulty getting past the language barrier.
Without a proper translator I found the interview process for this patient difficult and annoying. I was focused on the annoyance rather than the illness of the patient. It wasn’t until I chose to go past the history to the physical that his illness became apparent.
Once his neurological deficits were apparent, the nurses were amazing in helping me get tests done quickly. Consults were called in, the patient was cared for.
10 hours after first presenting to the ED.
I was angry with myself and with the system that caused this patient to have such a terrible experience. I felt guilty for being so frustrated with the language barrier I had with this patient. I was scared that because of my ignorance my patient would have lasting deficits.
Rather than be angry with a triaging system that was doing what it could, I looked for practical solutions to the problem. With the immigration hub in town, we came up with a “health passport” for new Canadians. It contains basic info about the patient like their country of origin, mother tongue and how to get in touch with a translator. It would also contain their past medical history, medications and other important medical information that would help the ED physicians.
I left the community before I could see it put into place. I hope it’s being used with good benefit.
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