Post-it Sunday 5/29/22-I see you

The post-it states ‘Healthcare has ceased to see the patient as a person. It has devolved into there is a problem I need to fix it.’

Eleven years ago there began a spate of simple cartoons on YouTube. They were from Xtranormal.

This is a website that you could build a cartoon around a script that you had written and it would be turned into a cartoon.

I have to confess I toyed with the idea of writing a script for the site.

But the cartoon Orthopedics vs Anesthesia is perfection.

And a prime example of the blinders that healthcare workers, including surgeons and nurses, sometimes develop.

In the skit, an orthopedic surgeon is telling an anesthesia provider about his patient in the ED. He begins the conversation by saying there is a fracture and he needs to fix it. When asked to tell anesthesia more, he surgeon repeats that there is a fracture and he needs to fix it.

The conversation goes downhill when anesthesia presses the surgeon to tell them more about the patient.

The surgeon doesn’t understand why he is being pressed for more information. As far as orthopedics is concerned there is a fracture and he needs to fix it.

There is some fourth wall breaking by the anesthesiologist when she looks at you, the audience, dumbfounded.

And the anesthesiologist drags more information from the surgeon. Piece by piece, when all they wanted to know is who the patient was.

The surgeon tells the anesthesiologist that the fracture is in the ED. And that the fracture belongs to a bone, the femur, and it is displaced, which means that is badly fractured.

The anesthesiologist is getting more frustrated, visibly so.

She comes out and asks who the patient is. And the surgeon tells her the patient is a 97 year old female. From a nursing home, with no comorbidities as she is otherwise well, and she is fasted. To him the fracture that belongs to this patient needs to be repaired.

After a pause, he continues that the patient is well, except for her temperature of 29 degrees Centigrade, which is roughly 84 degrees Fahrenheit, and a pH of 6.8. A normal blood pH is 7.35-7.45. Lower than that means that the patient is acidotic. And a pH of 6.8 is incompatible with life. So she is not otherwise well. And her temperature is way off as well, as a normal temperature in humans is 97-99. The anesthesiologist is dumbfounded.

But wait, the surgeon continues that the patient has a condition that he is unfamiliar. And he mispronounces asystole. This is when the heart ceases to beat, in other words death. The anesthesiologist’s mouth drops open. She can’t believe what she is hearing.

The surgeon rushes to console, telling her that he is very skilled with hammers and drills and didn’t tell her about the asystole to begin with as he doesn’t want her to refuse the anesthetize the patient. And fixing the fracture that he is fixated on won’t take too long because of how skilled he is.

The anesthesiologist tells him that CPR would be more useful to the patient. You know, to save her life. And he says that they have finished with that. Meaning the patient is dead. He tells anesthesia that there will be minimal blood loss. This enrages the anesthesiologist because of course there will be no blood loss because there is no cardiac output. He presses on telling her that he needs to fix the fracture and tells her she’s being obstructive in not letting him do the case. And if she breaks her hand by punching a brick wall, he will fix it.

This skit is meant to be funny. And it is. We all know surgeons like this.

This orthopedic surgeon is hyper-focused, only looking at a very small piece of the picture that is the patient as presented. Yes, there is a fracture. And that fracture would need to be fixed at some point. But there is more to the patient and to her entire healthcare picture than the fracture. Which is the point of the skit.

The anesthesiologist is looking at the entire picture and seeing that this is not a surgery that can be done at this time. The patient no longer has need for the surgery. You can feel her frustration at the surgeon as she declines his request for a case.

As healthcare providers we need to be less focused on the piece of the patient puzzle that we can fix, and more aware of the patient puzzle as a whole.

This post-it was written during a class I took about awareness of the whole patient, not just what can be fixed in the immediate future. And I made a note to reference the YouTube video.

And if you haven’t seen the skit, it is on YouTube. Just search for Orthopedics vs Anesthesia.