Patient Provider Education

Hanging on the wall, in most hospitals, is a Patient’s Rights notice. There’s some sort of acronym (I forget what it spells). The gist of the thing is that the patient is encouraged to ask questions of the health providers, educate themselves to both diagnoses and treatments, become active in the management of their illness, etc.

Some Bambulance Folk have been doing this since Day 1, in their small way, and DTs is of that ilk. We sharing types will take a blood pressure, heart rate, look at their rhythms, all that jazz. While we don’t necessarily volunteer the information – some patients find it boring, or just don’t want to know – we will if asked cheerfully tell them what we’ve found. Hey, it’s their blood pressure after all, we simply measured it.

Some folk do ask, but one can tell they’re too anxious. “What was my blood pressure? Was it good? Is it high?”

“What, did I frown or something?” asks DTs with a laugh. “Sorry! Well, it was 120 over 80, which is very, very good. Now that I foolishly worried you, though…”

It is in that vein of Educating Patients that I had a somewhat bizarre encounter.

Our patient was a middle-aged man with a non-tumorous growth near the brain. Our transport was taking him to the neuro center for the operation to remove it.

“They said it’s over here, somewhere” said the patient, pointing at his head. “They said it’s not cancerous.” The patient seemed calm, unafraid, but something in the voice indicated he was frustrated with his own lack of knowledge about what was going on three centimeters from his index finger.

Somewhere?

“They, uh, didn’t show you the CT or MRI?” asks DTs in all innocence.

“No,” said the patient.

Hmmm. Decisions, decisions. I had a big packet of CT and MRI films which was going with the patient. On the one hand, there might be a very good reason why they didn’t want to show them to the patient. On the other hand, this wasn’t like a BP – I did not produce these films. Gripping hand, however, they are pics of this guy’s skull, and the hospital has these neat little posters on the wall practically begging patients to show an interest in their treatments. Okay then.

“You know,” says DTs, “They sent the films. If you want, we can take a look at them, but I have to tell you, I am in no way, shape or form a radiologist. I can’t tell if anything’s normal or abnormal and I probably can’t answer any questions. But it’s your head, you know, if you want to take a peek.”

“Sure!” says the patient.

Folks, I am seriously rethinking this “share information” thing, and I’ll tell you why.

DTs randomly selected a sheet from a folder of forty or more films. Each film had about twenty shots of the guy’s head on it. Starting at the top, left to right, we’re looking at the thing. Yep, it is pretty cryptic.

“See,” said DTs. “I mean, you can see the brain and all, and here obviously is the skull, but dark patches? Light patches? I can’t tell you anything. It is interesting, though, yes?”

“Yes,” said the patient. “‘Specially that nail.”

Nail?

About the second to last frame on that sheet showed a 10-penny nail, suitable for building decks, smack dab in the middle of this guy’s head. Point-up, meaning it was driven in somewhere below the jaw.

Wow.

“Uh, they didn’t say you had a nail in there, did they?”

“No!” says the patient.

“Not re-enacting scenes from Lethal Weapon 2 at home, I take it?”

“Not recently,” the patient laughed.

“Well, hell,” says DTs, unprofessionally. “That ain’t right. But it is non-cancerous, if you want to be nit-picky.”

Quite understandably, more sheets are reviewed. None other shows a nail. Now, radiologists do sometimes use markers, kind of like “See here?” arrows, on the films, but this is definitely a nail, folks. Pointy end, three inches long, flat surface for hammering. Only on the one frame. If it was an arrow, it was the dumbest arrow design I have ever heard of. Why not put a ring of bullet-shaped objects around what you wanted to highlight, too? Or use a steel dagger to point out broken bones? And, if it was an arrow, why wasn’t it outside the skull pointing in, rather than in the center of the brain?

“You know what I think?” says DTs. “I think this is some kind of gotcha, one radiologist to another. Kind of an in-joke or something.”

“That’s what I think, too,” said the patient.

“Cuz, I mean, if you had a nail in your head, I should think they’d mention it.”

“Yeah, you’d think so.”

“And you’d probably remember getting it – somehow – in there,” DTs continues.

“Unless having a nail in your head would make you forget the event,” the patient pointed out.

“Pretty damned good aim for a nail, though,” said DTs. “Why don’t we let’s put this all back and enjoy the ride. I’ll take your blood pressure…”

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