Hospitals: Castles for Administrative Staff

Castleby Brad Nelson   7/11/14
I spent 3-1/2 hours last night in the emergency room of the local hospital. My mother did something stupid (tried to walk down a flight of stairs in the dark), fell, and cut her head. She’s fine. CAT scans, as they say, were negative, which is a good thing. She had a cut over her left eye that was repaired with stitches and one on the scalp that was repaired with staples. Why staples on this second cut? Because the scar wouldn’t show, so apparently staples save time, but do an inferior job cosmetically.

And if a hospital is so arranged so as to save time and to be efficient, this was the one and only instance of it.

The castle analogy is somewhat inexact, for a hospital is the easiest thing to get into. You just walk in the front door. There is no mote. But from there, the dragon you must slay is the endless and repetitive administrative staff.

No less than four people asked my mother the exact same questions: What medications are you taking? Did you feel woozy before you fell? Did you lose consciousness? What’s your name? Who is your doctor? And many other questions. Haven’t they heard of iPads and sharing information? Apparently not.

While sitting waiting, waiting, and waiting (which gave me lots of time to observe), I got the distinct impression that the purpose of a hospital is to roll mobile electronic carts from one end of the building to the other, for there seemed to be plenty of people employed to do just that. But as to actually helping the patients, that was a lower priority.

There was one other person in the emergency room when we arrived. I’d hardly say they were having a rush on injuries. Dealing with the hospital had aspects not only like a castle but like playing chess with a very slow and deliberate player. The hospital would make a move, and then we’d be set somewhere to wait about 45 minutes waiting for their next move. This happened several times. First was the entrance move where, with great deliberation, we were asked trivial information at the front desk (the gate, one could say) which would be asked again and again  during the course of the night.

We were then seated in the waiting area while the vast array of administrative staff (they sit behind a circular rampart of a counter) figured their next move. The next move was to be moved to a room where then absolutely nothing took place but the repetition of the questions: What medications are you taking? Did you feel woozy before you fell? Did you lose consciousness? What’s your name? Who is your doctor?

Meanwhile during all this time my mother is bleeding. Oh, it was a mild bleeding, one stemmed with a terrycloth towel that we had brought along. But no one offered a bit of help regarding the actual injury for over 2-1/2 hours. Granted, I understand the triage process. But other than the seemingly desperate need to roll electronic medical carts around the building or to sit behind the rampart desk area where a dozen medical staff all seemed to be doing something terribly uninteresting, I couldn’t see anyone else who needed help.

Good god, all I kept thinking is that if things are this inefficient now, wait until all of Obamacare kicks in. I would imagine that a private entrepreneur, with one third the staff, could have done the same job in one third the time.

To top if off, the walls were lined with stupid Orwellian-like administrative posters blabbing on in bureaucratese about some obscure goal or another. One of the posters was talking about the need to reduce the number of alarms going off. That seems a worthy goal, but what good does putting a 4′ x 5′ poster serve in this regard? Do hospital staff receive their training via posters? And aren’t the posters themselves just one more piece of noise that the posters say there is a need to reduce?

Good god, eat right, exercise, and do what the hell you can to stay out of these hospitals which seem to be little more than castles for administrative staff. Oh, to their credit, the staff were polite and cheerful. But they didn’t seem to be doing all that much.

Brad is editor and chief disorganizer of StubbornThings.
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Brad Nelson

About Brad Nelson

I like books, nature, politics, old movies, Ronald Reagan (you get sort of a three-fer with that one), and the founding ideals of this country. We are the Shining City on the Hill — or ought to be. However, our land has been poisoned by Utopian aspirations and feel-good bromides. Both have replaced wisdom and facts.
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28 Responses to Hospitals: Castles for Administrative Staff

  1. Timothy Lane says:

    In the Louisville hospitals Elizabeth and I have gone to, the ER consists of a series of individual rooms where you get sent quickly. Thus, you have no way of knowing how many people are in other ER rooms. On my visit I generally received good attention, though on one occasion Elizabeth used a pair of sanitary gloves when there wasn’t anything else available for me to urinate into (I was on strong diuretics, and they’d forgotten to leave a new urine jug after I filled the previous one).

    As for falling down the stairs, that’s happened to me twice. On one occasion, I slipped on a piece of paper on the stairs (I try to keep them free of such things, but this was in the morning and I didn’t notice it) and cracked a rib (which was odd since I slid down on my rump). We called a friend who was a chiropractor, who told us what to do, and thus didn’t bother with the hospital. The other time I was alone and tumbled down, head over heels — but fortunately went completely uninjured.

    • Brad Nelson Brad Nelson says:

      You can also make water balloons out of surgical gloves. But I guess they would make fine urinals as well. That’s being resourceful! 😀

      • Timothy Lane says:

        Believe me, we looked all through the room trying to find something we could use, and that’s all there was. I don’t remember who thought of using them.

        • Brad Nelson Brad Nelson says:

          It was a practical and innovative solution. I probably would have used the sink.

          • Timothy Lane says:

            That’s fine if you can get up high enough to use it, but at that time I was barely capable of entering the hospital on my own feet (severe pulmonary edema meant that I was virtually drowning in my own fluid — I let out 10 liters in 48 hours AFTER that first night of diuresis, and another 10+ in the next week).

        • Rosalys says:

          Didn’t you think to stick your head (or Elizabeth’s) out from behind the curtain and asking someone for a urinal?

          • Timothy Lane says:

            We probably didn’t have anyone handy; I don’t recall the details. But we had mentioned the need for one when they took the previous one.

          • Brad Nelson Brad Nelson says:

            Didn’t you think to stick your head (or Elizabeth’s) out from behind the curtain and asking someone for a urinal?

            I’ve read Timothy’s answer to this, and I’ll give you mine: They wear you down.

            I have no problem when at a restaurant or wherever to ask for something, even if it may be slightly out of the ordinary. But after 3-1/2 hours of watching people say “The doctor will be right with you” or “We’ll have someone take care of that” and then nothing happening for 20 minutes or more, you just give up. You get to the point where the only point is to endure the process.

            I lucked out somewhat because I had my Android tablet with me. I spent most of the time reading a book. There really wasn’t much of anything else to do but to watch my mother’s head and eye bleed or to read those stupid make-work administrative posters on the wall.

            • Timothy Lane says:

              We were discussing my situation with my sister (a retired nurse) and she said, “Get him to the emergency room immediately.” So I got dressed (I couldn’t fit my shoes on over my fluid-swollen feet, so Elizabeth helped me struggle to put on my slippers) and picked up a few books to read. Elizabeth brought me a few reinforcements the next day.

  2. Pokey Possum says:

    So true! To me, the glass enclosed room you get promoted to after the waiting room is like a holding cell. From there you are either sent away to the big house, or released (if you survive) after being thoroughly interrogated, and sometimes tortured. But they are very well trained in how to “handle” their guests in the nicests way.

    I’m so glad your mother was not more seriously injured!

    • Brad Nelson Brad Nelson says:

      No, my mother did not sustain any serious injuries, thank goodness. But my sense of the world being a sane place surely did!


    Brad – I would say what you experienced was the mixed economy in action – private hospitals are half-free and half-controlled by the government. The free half is the part that finally treated your mother. The government half was the bloated administrative staff dedicated to repetitive questioning and wheeling carts back and forth. And yes, Obamacare will only make all the frustrations you experienced that much worse.

    • Brad Nelson Brad Nelson says:

      The free half is the part that finally treated your mother. The government half was the bloated administrative staff dedicated to repetitive questioning and wheeling carts back and forth.

      Very well said, Nik. I do believe that’s it exactly.

  4. Rosalys says:

    My mother had a similar accident, with a cut on her scalp, about eight years ago. I her case she was living alone at an apartment complex and had to call me after to take her to the emergency room. Our experience was that we were moved behind the curtain very quickly with promises that someone would be right with us – and then we waited, and waited, and waited… Finally, about not quite an hour later someone did come in spent eons asking her questions over and over again, having her balance on one foot, etc., etc., etc.. I believe they were trying to figure out why she fell since she was alone when it happened. My mother’s story was that she misstepped, but there was some concern that she may have had a TIA.

    I think there are two reasons why they ask a lot of questions. One is to determine the the extent of the injury, especially with a thump on the head. The other – and there are times when one has to wonder if this is in fact the most important – to determine the likelihood of their receiving payment!

    But don’t relax because Obama care is already kicking in! Beware of Paliative Death! It’s the new euthanasia! My friend just this past week went through this nightmare concerning her husband who is very, very ill and couldn’t breath. What they were pushing – and they were really pushing it – in the ICU was that she “let him go.” They would give him morphine and it would be oh so peaceful. She fought like a wolverine and so he got a tracheotomy instead of a coffin!

    • ronlsb says:

      A minor point to add to your conclusions as to why the repetition of questions over and over. In most cases they are also trying to make sure there was no foul play involved. I actually think that is a good idea, though I am not in any way defending the whole process. My personal experiences with emergency rooms has been very much in line with Brad’s mother.

      • Brad Nelson Brad Nelson says:

        In most cases they are also trying to make sure there was no foul play involved.

        Oh, I got the distinct impression that I was a suspect. My mother wanted me in the room(s) with her during this entire 3-1/2 hour process so I heard every word. And I’m sure there are sons who push their mothers down a flight of stairs out of anger or the desire for an early inheritance. I just don’t happen to be one of them.

        And as rotten a son as I am by comparison to others I know, and as often as I lose patience (not with my mother so much as the female mind), I do mostly adhere to the Fifth Commandment, although when we reach the Fifth for purposes of our Ten Commandments symposium I may indeed have to plead the fifth. 😀

    • Timothy Lane says:

      That sounds a lot more like some of Elizabeth’s experiences, such as the time she went in with a severe nosebleed (a major occasional problem for her; I hardly have them myself, though there was one evening when I seemed to break an arteriole in the nose with very unpleasant results).

  5. Kung Fu Zu Kung Fu Zu says:

    As a comparison, I visited Emergency rooms twice the second time I lived in Singapore. Both times, I was treated quickly, efficiently and the costs were nominal.

    The first time was in the Singapore General Hospital which was, I believe at the time, the largest hospital in Singapore which had a population of about 4 million. It was government run, which means, unlike in the USA, things worked well.

    The second time was in Mount Elisabeth Hospital which was a privately run hospital. It was also well run.

    In both establishments, there were enough personnel to handle the number of patients. I entered the EM and the medical personnel determined whether or not I absolutely required immediate treatment or not. In one case, I could wait and was given a number and waited a few minutes for it to be called. I was then taken to a private room and treated, In the second case, I was in excruciating pain and was attended to immediately.

    In both cases I was in and out of the EM in less than an hour. Of course, Singapore does not have the Byzantine legal system we have, so that may have something to do with it.

    • Brad Nelson Brad Nelson says:

      An hour sounds about right, Mr. Kung, unless there are unusual circumstances such as an airliner just crashing down the street. Thanks for sharing your experiences. I suppose it is possible for something to be government-run and not be absolutely pathetic.

      • Kung Fu Zu Kung Fu Zu says:

        One must know that the government of Singapore runs the country pretty much as a business would be run.

        • Pokey Possum says:

          What’s the downside to running it that way? Is there one?

          • Timothy Lane says:

            Well, remember that Singapore is an authoritarian country. This probably enables them to be more businesslike than America or the European nations, but you can imagine the downside of that very easily. So many people forget that everything has a cost.

          • Kung Fu Zu Kung Fu Zu says:

            Running a government like a business would generally be fine.

            But to run a country like a business would be anything but democratic. It is exactly what our betters would like us to accept. The experts, technocrats and brights i.e those in power, would use their expertise to guide the rest of us. You know, because we aren’t too sharp.

            It must have occurred to you that a business is anything but democratic. Orders are given and if you wish to remain in the company you obey.

            Citizens are not employees. They are free to disagree with the business plan and not be punished because of this.

            • Timothy Lane says:

              I suspect the reason why an authoritarian country like Singapore can have an effective government is that the government employees don’t have the influence they do in democratic countries. Banning government unions might be sufficient. (As it happens, I’m reading Amity Shlaes’s biography of Coolidge, who came to public notice by standing up to a policemen’s strike in Boston. “There is no right to strike against the public safety by anybody, anywhere, any time.”)

              • Pokey Possum says:

                It was wishful thinking on my part that a government could be run like a business in regard to pleasing the customer in order to stay in business. Government “for the people”. But that would require that the customer be aware enough to know when they are being swindled, and then have enough backbone to demand the quality of goods and services for which they have paid.

            • Brad Nelson Brad Nelson says:

              It’s also possible that we Americans have become so corrupt, so self-serving, so egocentric and narcissistic that we’re just no longer capable of holding to a focused mission statement regarding a government program and serving people well, including doing what is necessary to trim the fat from the business. In America, especially when government is involved, these ventures just become a means of employment — employment justified by the new “caretaking” class that is developing. And they’re all such nice people, so their motives are beyond question.

              Maybe in Singapore the people have not been corrupted or turned narcissistic. Maybe the idea of working hard and serving the customer (whether inside or outside of government) is the ethic. And let’s face it, if we had the ethic to work hard and to serve the “customer” instead of seeing government as a cradle-to-grave surrogate mommy or daddy, government could work better.

              Adding to the problem is too much ass-covering. And there is little doubt that Federal regulations have choked the industry, as they have many other industries as the fuss-budgets try to wring all risk out of anything.

              Imagine how successful a business could be if it actually served the customers and wasn’t hamstrung by the government. Can’t you see a franchise operation such as “Cuts and Bruises ‘R’ Us” popping up? Their really was no need for a gigantic staff just to put in a few stitches for my mother. This could have been done in one-third the time (obviously Singapore can do it in even less time) and for much less cost, especially if “medical insurance” is not involved.

              We need to break the back not only of government but of the mindset that says that all risk must be removed. People are dying, and will continue to die in greater numbers, simply because the medical system is bogged down by bureaucracy and government. The difficult thing, as always (it requires having adults in the room) is seeing the harm that is less noticeable at the back end of things. The cost of government regulation, risk-averse fuss-budgets, and those who demand a life-long job no matter what are enormous. And when translated into actual lives (as it should be), we can unmask this stuff as being as harmful and counterproductive as it is.

              But when adults aren’t in the room, all you hear of is someone, somewhere, who had a botched surgery by some quack doctor, and so the entire system must be burdened with regulations, safeguards, bureaucracy, and vast sums of money all to prevent it again. And that makes these un-adults feel good and look good. But who asks the real question: How many people can’t get needed operations because you’ve now increased the costs? In order to try to wring the risk out regarding a one in a million event, you’ve doomed many people.

              We need adults in the room, not the narcissists and nitwits who have been bred by the Flower Power generations.

              • Timothy Lane says:

                At least as far as government is concerned, I’ve read the suggestion that in fact the US fares poorly because we still have the ideal of working in the private sector instead. It’s a reflection of the greater priority Americans put on freedom and opportunity, as opposed to security — which is unique to this world and the true definition of American exceptionalism (which is why liberals don’t believe in it).

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