On Waiting and Waiting (and Waiting)

My frequent visits to radiology were, surprisingly, probably the single worst part about my early days (the first six or eight weeks, March 3rd to April 23rd). I knew that Cindy and Anne would take care of me, that Dr. Collins would solve the mystery of my fevers, that most everybody in the hospital had my best interests in mind.

The kind of support network I had between my nurses and physicians made anything manageable. Of course I worried about things while I was in their care. But I never worried that they weren't always acting in my best interests. It's one thing to be concerned about the future because, well, frankly, not much had gone according to plan thus far, but it's another thing to question the quality of your care.

That's why radiology was the worst part of the early days for me: we were forced to do exactly that kind of questioning.

They were busy. They were busy with other patients, and backlogs and whatever, and I know nobody likes to wait, okay, and crowded waiting rooms are annoying for everybody, and everybody thinks they're special and deserve special treatment to get them moved to the front of the line, but seriously. Come on. I seriously had no f***ing immune system. Was it too much to ask that when they called me down for my appointments that I didn't have to wait 30 or 40 minutes to get my x-rays taken?

It pissed Dad off, too. He's usually pretty mellow. Pretty low-key. We're both like that, both willing to let minor annoyances slide. But neither of us liked this waiting room BS. It wasn't "minor" at all.

He wrote a letter to the hospital Administrator on April 3rd:

My son, Robert K. Brown, was admitted to the University of Washington Hospital on March 3, 1990 and is currently an in-patient in the Oncology Department, 6SE, receiving treatment for acute myelogenous leukemia. I have nothing but praise for the Oncology Staff; they have been helpful, supportive, and informative. I am deeply concerned, however, by the performance of the Radiology Department, and am writing to describe what appears to me to be a system that needlessly endangers patients.

As a result of chemotherapy, my son's auto-immune system is suppressed and will stay that way for some time. Consequently he is extremely vulnerable to infection, and Oncology has gone to considerable lengths to isolate him, and to educate him and the family in the precautions necessary to avoid infection. Unfortunately, the monitoring procedure also requires that we have chest x-rays taken 2-3 times a week, in the Radiology Department.

The routine seems to be for the Radiology Department to call the Oncology Department to tell them when to send a patient down. However, the paperwork required for processing the patient is not initiated until after the patient has checked in at the desk in Radiology. Yesterday I escorted my son down to Radiology. Ten minutes after we checked in at the desk, I inquired about the delay and was told that he "wasn't in the computer yet" and that it would be a few more minutes. The total wait was 20 minutes, with only a paper mask for protection, in a public corridor with people passing my all the time; the other choice for waiting was a public waiting room filled with out-patients. The 20 minute wait is apparently on the minimum side for weekdays -- the wait can be an hour or more, particularly if the patient requires a hospital escort.

The Oncology Staff has requested several times that the Radiology Department call when they are actually ready to process the patient -- after all, the trip only takes a few minutes. My experience yesterday was apparently a sample of their "being ready." I realize that the Radiology Department might be busy; I find it inexcusable, however, that patients who are in very fragile health and susceptible to any and every stray virus are required to risk infection because the radiology department cannot manage what should be a relatively simple scheduling process.

My son has been in your hospital for one month, during which time he has undergone two bone marrow aspirations, had a catheter installed, and been on chemotherapy for two weeks. While he knows he will have to put up with more of the above, what he really hates and dreads is the prospect of going down to Radiology for a painless chest x-ray, where he knows he will sit and wait for an infection to come by.

Because of his illness, my son will be a frequent in-patient at your hospital. I certainly hope for his sake, and that of other patients with suppressed immune systems, that you will be able to correct this problem quickly.

Two weeks later, exacty, Dad received a quick and appropriate response from the hospital. His original letter was forwarded to the Administrative Manager of the Radiology Department. To their credit, they implemented a few important changes.

Dear Mr. Brown:

Your letter of April 3rd was forwarded to my office for attention. Due to your observations, the Department of Radiology is taking corrective action.

Effective immediately, all patients known to have suppressed immune systems will have their radiology examinations expedited, rather than waiting in the queue with other, potentially infectious individuals.

As you noted, our Radiology Department is exceptionally busy. We do strive to see everyone as quickly as possible. However, sometimes we experience glitches with equipment, paperwork, or sheer patient volumes that bog the operation down. In addition to moving patients, such as your son, to the front of the queue, we will make every effort with the Oncology Department to have paperwork processed in advance thereby effectively scheduling these examinations and minimizing or even eliminating wait times in these cases.

I would like to sincerely thank you for calling this matter to our attention, as it sometimes takes an objective eye to see a problem and help get it solved. If you have any questions or suggestions regarding the Radiology Department, please feel free to contact me -- as I welcome your feedback as a means for improving quality of care.