This was the sage advice that my father gave me before he died. He died of a heart attack on a Sunday morning, in a hospital, waiting for the only “on call” Cardiologist available to get to the Emergency Room.
Through the years I wondered if a provider had arrived minutes earlier it would have mattered back in 1985, assuming it would not be as critical today (with all of our advanced training and technology). I came to find the answer for this question for 2015 depends on which day you have your emergency.
Being in the medical staffing industry I get to speak to hundreds of physicians nationwide. I have posed the question to providers many times and have received mixed reactions, regardless of location. One response seemed to bubble up to the surface often “Was the event on a weekend”? Wow …. What would that matter? Well based on morbidity statistics it seems to matter a lot, from coast to coast.
Working in Locum Tenens over the past 10 years I have come to believe that a lot (not all) of healthcare facilities will wait until a crisis in staffing occurs before implementing interim physician coverage. It seems that many administrators knee jerk “find a Doctor to Cover”. This is not a very proactive approach. That being said, I do appreciate the difficult financial position US healthcare facilities are in. National statistics bear out the challenging picture painted for their future. I am also aware of all of the conversations concerning the excessive compensation, and Bonuses paid out nationally to healthcare executives. I see headlines about the huge profits of insurance industry giants, and large multinational pharmaceutical companies. Their bottom lines in no way mirror the financial bottom line of the people, and organizations they provide products and services to. We hear from “experts,” industry spokespeople, analysts, politicians, and pundits of every flavor. The only people who have very little voice in the matter are the people at the center of all of this …. Patients.
My opinions and observations were expressed in an excellent article by Dr. Perri Klass for the NEJM (which I will shamelessly quote from, and I highly recommend you read). Her intimate knowledge addresses something that I work with every day … Physician Coverage on the Weekend. She looks at this problem from the patient’s point of view.
“From the physician’s perspective, weekends in the hospital are all about coverage.”
“We tend to take it for granted that hospital life slows on the weekend just as it does everywhere else”. But as Dr. Klass points out, “biology, life, and illness have nothing to do with the conventions of the calendar. When you’re sick and scared, Sunday is the same as Tuesday.”
“It seemed callous on the hospital’s part — expecting very sick patients and very worried family members to understand that the doctors’ convenience had to come first. They need the weekend off, so you’ll have to wait till Monday. Even in good hospitals, weekends have a decidedly makeshift feel, with a constant refrain of “I’m just cross-covering, we’re short-staffed, the person you need will be here Monday.” “Things thin out at night or on the weekend, but we all do our best, don’t we?” “Well, it doesn’t feel that way from the patient’s side. From over there, it feels like every time the weekend comes around, you relearn that the hospital is not actually about patients. It’s about doctors and nurses, physical therapists and nutritionists — people who are busily living their normal lives, when from the patient’s side, nothing is normal”. As Dr. Klass states “people are just as sick on Saturday as they are on Thursday; physical therapy, wound care, or pain management is not some frivolous extra. Why should people have to hear over and over again that it is the weekend, and that there was only one person here to do “whatever” for the whole hospital, or that someone was just cross-covering, didn’t want to make any changes to the plan, the attending would be in next week?”
Dr. Klass touches on this subject from a very personal vantage point, being a Doctor, and caring for her ailing mother. I worry that those businesses who, without fail, have words like Caring, Loving, Concerned, Superior, Advanced etc. highlighted on their web pages are really only speaking about M-F. I can’t help but wonder why in 2015, on the weekends, patients are facing the same issue that my dad did in 1985.