Another point brought up was that this office should have personnel who appear pleasant and happy with their jobs and surroundings. Disgruntled staff may reflect poorly on the “boss” and, in a setting where tests are ordered and surgeries are scheduled, job dissatisfaction can lead to mistakes and unpleasantness. The patient is usually not ecstatic about going to see the doctor, and to have to put up with moody or cheerless staff is unacceptable. The staff should be polite, helpful, efficient, and knowledgeable. Though it sounds banal, YOU are the customer and should be treated well whether you are the CEO of a major corporation, an unemployed day worker, or a single mom with kids in tow.
The last point my office manager stated was that the office personnel should know their business. They should know about disability and health insurance and be able to answer questions to make you feel “okay” about your upcoming surgery arrangements or about problems you are having after a procedure. The office staff is the doctor's upfront representatives, and their failure to be polite on the phone or in person is unacceptable.
I have seen some doctors who routinely keep patients waiting several hours for appointments, and I don't understand why patients tolerate this. Of course there will be times when unscheduled surgeries or emergencies arise, and I always call my office to let the patients know. They can wait or reschedule, as the case may be. When I return to the office, I always personally apologize to any waiting patients and give a brief explanation for my tardiness. Common courtesy is often forgotten by busy physicians and is not excusable!
Now, I wanted to present this chapter for two reasons. First, to let you know what goes on in the doctor's office (what you see and don't see) and second, to give you my own ideas as to what should be the rule of thumb in taking care of the needs of patients.
Most surgeons' offices are located near a hospital complex so that, if any problems or emergencies arise with patients, the doctor will be immediately available and can call for assistance if needed. Different surgeons have different types of facilities in their own office, in some instances, complete operating suites or maybe just the ability to remove small lumps and bumps. This necessitates either disposable instruments or a sterilization unit. Many physicians find it easier to take their work to a nearby emergency room, outpatient surgical center, or hospital and not have to concern themselves with the problems of maintaining a sterile operating facility. Nevertheless, all surgeons have the equipment and instruments needed to remove sutures and skin staples, remove drains, and change dressings. Most also have needles and syringes to do local biopsies, give injections, and aspirate fluids or blood samples. They will have appropriate facilities for disposing of toxic waste materials, and the offices are checked by OSHA which is a governmental agency inspecting for cleanliness and safety provisions. In today's world of serious infections and AIDS, patients deserve to know that the office they are in is safe as well as comfortable.
I think it is important for any physician to have some type of reference library, either consisting of books, journals or computer access to information, for help in dealing with day to day problems and to keep up to date with advances. Many hospitals have excellent medical libraries with librarians available to do searches for physicians on any topics. Affiliation with regional medical centers or university centers and teaching hospitals will assure the interested physician a place for continuing medical education, as well as additional consultation.
Now, why do I mention these things? Merely because medicine is a never-ending educational experience and, if your physician is not on the “cutting edge” of the newest advances, he's soon relegated to the “glue factory” because you shouldn't and won't seek out his opinion and care. When you look for a surgeon, keep these factors in mind and don't be shy about asking questions about the office if you are interested. Proximity to a hospital and a source for continuing education is important.
The doctor's consultation room should be comfortable and private, and the patient should be able to sit and talk if he or she wishes. Understandably, in some high volume clinic situations this may not be possible, but at any time you should be able to say that you want to talk about the proposed test and procedure and have your questions answered to your satisfaction. You're not buying a car or a house; it's your body we're talking about!
We will talk more about the physician-patient interaction in Chapter 10.
Chapter 6
THE OPERATING ROOM
Somewhere between joy and doom,
Lies the operating room.
Many people daily work there,
And some nurses go berserk there.
And in this place of fact and fable,
Stands the operating table,
Where the surgeons work their wiles
With sharpened blades and sneaky smiles.
So if you've made the big decision,
(Watching shows on television)
To have your hernia fixed tomorrow
Go to the hospital without a sorrow.
But be sure to know that factor:
That your surgeon ain't an actor!
In my book, Comprehensive Breast Care, there is an excellent chapter by one of the operating room nurses called “The Masked Strangers,” in which she artfully describes the various people you will meet and the functions they provide. Suffice it to say that you will encounter a number of “masked strangers” in the surgical suite. From the attendant who will transport you to the surgical department dressed in his “scrub suit,” you will be introduced to the “holding room” nurse, who will answer any questions you may have. She will make sure your laboratory work, chest xray, and electrocardiogram are in order, and will assemble all the paperwork, including the history and physical examination, and make sure the consent is properly written and signed. We don't want to take off the wrong leg or fix the wrong cataract! You will also meet the anesthesiologist who will be giving you the anesthetic agent that you, your surgeon, and he, have decided upon. He usually starts your I.V. (intravenous lines) for giving fluids and medicines and will reassure you about any questions you may have, especially if you are going to sleep. We will talk more about the anesthesiologist in Chapter 21.
You will then meet another nurse, who will work with the holding area nurse and accompany you with the anesthesiologist to the operating suite (or room, if it's not fancy!), where you will meet a scrub nurse or technician. During the procedure, the scrub nurse, in sterile gown and gloves, will be handing the instruments to the surgeon; the other nurse, the circulating nurse, will be available to get any needed supplies in or outside the room while you are asleep. The nurse and the anesthesiologist will attach blood pressure and cardiac monitors to you before you are put to sleep, and once you are sleeping, may do other procedures to monitor your vital functions. These might include placing a tube in your stomach (an NG or nasogastric tube), your bladder (a Foley catheter), or a central venous or arterial line (placed in a vein or artery, respectively). Often these tubes are removed before you wake up, but usually your doctor will tell you if he plans on leaving any in place after you have awakened, so it won't be a total surprise.
After the surgery is completed, you will be brought to the recovery room, where a specialist nurse will take care of you for about an hour until you are stable enough to go back to your room. Again, I would recommend your reading Carol Metcalfe's chapter on the “Operating Room Nurse” for her comprehensive and often amusing insights.
But let us consider when and why we use a hospital-based operating room as opposed to office surgery, an outpatient surgical center, or the emergency room. The hospital may be the only fully equipped facility in your community or it may be the only one fully accredited for use by your insurance company. But, aside from these issues, the acuity and severity of the surgery will often determine where it should be done. Whereas small procedures, such as removing moles and simple biopsies, may be done in a well-equipped emergency room with a local