Wednesday, February 13, 2019

Ruminations: Sitting Alone in a Paper Sheet



I found myself all alone in a paper sheet yesterday.

Yep, no hospital gown, just a blue "paper" sheet in the exam room.

Longer story that may come out in the end but right now, while it’s fresh, I wanted to give some very specific feedback to health systems in general based on my experience.

A few days ago, I sent my gynecologist a note via my health portal. Something was amiss and I knew I should make an appointment. I didn’t want my 15 minutes of appointment fame to be filled with initial explanations and level two questions so I emailed the nitty gritty plus a few potentially relevant (or potentially extraneous) details to my doc. And, despite the fact he has full access to my medical record, I reminded him of my health history.

His response was rapid, his recommendation was for a biopsy.

My fears aside, I was glad that we had established everything we could via email, in advance of my appointment so the office/procedure time could be as effective and efficient as possible.

I checked in 19 minutes prior to my scheduled appointment time, filled out the requisite health history form (on paper) and was called back within 6 minutes.

The MA introduced herself, asked me about my day, and took my vitals after confirming my name and birthdate. She showed me back to an exam room (lucky number 16!) and asked me the reason for my visit. Part of me was glad she was verifying but part of me wished she would have just confirmed the reason for my visit based on what was in my record. I mentioned I hadn’t had time to give a urine sample and she verbally directed me to the restroom. I asked what the urine sample was for and she said, “pregnancy test.” I explained that I was definitely NOT pregnant and she said, “It’s just protocol before a biopsy.” 
I peed in the cup and considered the fact that it cost me $10 (lab fee) to prove that I was not pregnant and who knows what it cost the institution in materials.

Two minutes later, she had given me the instructions to undress from the waist down and given me a blue paper sheet to cover up with. On her way out, she mentioned that Dr. C was, “running a bit late, so it might be a few minutes.” The door closed behind her at 2:25pm.

I sat half naked in the absolutely soulless exam room for 21 minutes.

I was nervous. When I’m nervous I get cold. I looked around the office, but no blankets were readily available. I considered asking for a blanket, but I was wearing a blue paper sheet.

I remained nervous. When I’m nervous I have to pee. I considered going to the restroom about 30 feet away, but I was wearing a blue paper sheet.

I could hear discussion in the next room (yep… totally!) and the individual was being referred to oncology. My heart ached for her and my nerves ramped up one more level.

When Dr. C came in, he greeted me warmly and we chatted for a bit. He expressed his surprise at the concise set of symptoms and health history I had sent him the day before, and I mentioned that I wanted our visit to be as effective and efficient as possible.

Dr. C thoroughly explained the endometrial biopsy procedure to me, even though I’d had one before, and asked if I had any questions. He called the MA back in the room and all the “fun” stuff began.

The procedure is what the procedure is, but I was appreciative for his gentle demeanor and he took my lead by talking as a good distraction from my discomfort. Just before we began, the MA suggested I use the heating pack proactively during the procedure and helped situate me.

After the biopsy, I remained in the blue paper sheet while Dr. C explained what we were looking for, and what my options were, depending on what we found. He said, “Results will take a week. Well, I SAY a week, but we will likely have them sooner. I just want to set expectations appropriately.”

All of my questions were answered, and I left the office.

While there exists another blog post talking about the emotional and psychological aspects of everything involved in this visit and now waiting for results, I actually thought I’d use this experience to give a bit of a report card for my visit.




THE GOOD:
  • Rapid and detailed response to my initial email helped ensure the appointment was directed in the right way (biopsy as opposed to conversation that necessitated an additional appointment).
  • I was taken to an exam room within 5 minutes of my appointment time. Especially in cold and flu season, I appreciated being in my own space.
  • Disposition and demeanor of my gynecologist: eye contact, thorough explanation of procedure; thoughtful responses to my questions
  • MAs suggestion to proactively use the heating pack and her help with getting it situated made me feel cared for.


THE LESS GOOD:
  • 21 minutes of half-naked solitude
  • Financial and material waste of a pregnancy test
  • Ability to overhear parts of the conversation in the next exam room
  • Paper health history forms (especially since I've been seen there for the last eight years)


WAYS TO IMPROVE:
  • Warm blankets! For me, a warm blanket is a physical and emotional salve. 
  • Provide more specific “running late” information
  • Decorations (or just some wall colors!) in the exam room
  • Music in the exam room (for my wait and for the procedure)
  • A more thoughtful protocol around pregnancy testing
  • Health history update form sent electronically prior to my appointment




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