Central PA Medicine Summer2020 - 6

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President's Message

It Doesn't Have
to Be This Way
by
GWENDOLYN
POLES, DO

Heath B. Mackley, MD, MBA, FACRO
President, DCMS

In times of crisis, there is
a time to lead and a time
to follow. A time to speak,
and a time to listen. I am
ceding my usual "President's
Message" column, not because
I have nothing to say, but
because Dr. Poles' message,
as a Past President and
respected member of
our community, needs to
be heard.
- Heath Mackley, MD, MBA, FACRO

A

n African American female physician presented to the emergency department
(ED) with a severe acute painful sickle cell event unrelieved by oral medications
including opioids. She had not accessed the ED for care for approximately
10 years. Her pain was undertreated by the ED physician despite the pain
severity and informing him of her usual opioid dose. She chose to endure the pain until
evaluated by her hematologist with whom she had a long-standing relationship. She
was admitted by her hematologist and received appropriate dosing. Seven days later
she is discharged home. The next day she is found by her husband unconscious on the
bathroom floor. She is intubated in the field and transported to a level 1 Trauma Center
due to head trauma from the fall.
She spent 4 days in ICU on a ventilator, was treated for seizures due to the head
trauma, electrolyte abnormalities and placed on empiric antibiotics. On day 13, she
was cleared for transfer to in-patient rehabilitation.

During discharge planning, the case manager attempted to have the patient's husband
transport her in his car to the outside rehabilitation center of her choice rather than
arrange ambulance transport. The case manager assumed and overtly implied that the
patient could not afford the cash payment for ambulance transport. The patient and her
husband insisted upon ambulance transport given her severely deconditioned state as
she could not stand without full assistance. The patient paid by check as requested and
was transported via ambulance to in-patient rehabilitation. After out-patient physical,
occupational, speech, and neurocognitive therapy and independent rehabilitation she
returned to active practice. Upon receiving copies of her medical records to facilitate
continuity of care she was dismayed to read this statement in the discharge summary:
"Jane Doe is a __year old African American female, apparently a physician..."
This case summary is a concrete example of many biases experienced by patients
in the health care system. Assumptions were made. Biases may or may not be clear
to each reader depending upon life experiences, station in life, etc. - gender, racial,
socioeconomic and diagnosis (in this case Sickle Cell Disease) biases.

6

Summer 2020 Central PA Medicine
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Central PA Medicine Summer2020

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