“NO” leads to a cheaper, faster and safer patient option

24 Feb “NO” leads to a cheaper, faster and safer patient option

By Randi Oster

We were taking our eighth trip to the emergency room with my son Gary, who has Crohn’s disease, rushing from one hospital to the next. In Norwalk, the doctors inserted an NG tube up his nose, through his esophagus and down to his stomach to stop the vomiting that was wracking his body, then they sent him to Hartford, where he’d had surgery a couple of weeks earlier.

After an hour-and-a-half ambulance ride, Gary wanted to yank the thick plastic tube out of his nose. He kept repeating “Get it out!” sounding like a heavy-metal artist with a heavy beat. “Get it out! Get it out! Get it out!”

Gary screamed his song at the first nurse he saw in Hartford. She said, “Let me find out from a doctor if it has to stay in,” and then quickly departed.

After an eternity, she returned. “The doctor wants to take an X-ray of the tube to make sure it is positioned correctly in his stomach,” she said. “They need to confirm Norwalk’s procedure.”

She had to be kidding. Another X-ray? I was afraid of the amount of radiation Gary was getting from all the CT-scans and X-rays he’d received with each visit. No one but me seemed to be keeping track. The cost of these procedures is two-fold: There is the dollar cost. (X-rays range from $50 to $400, depending on the facility, the doctor, and the location of the desired picture. And CT-scans can range from about $350 in a clinic to more than $9,000 in a hospital, according to a Consumer Reports study in 2012). And there is another cost: increased radiation exposure to my son. An X-ray of the abdomen contains 10 times as much radiation as a chest X-ray, and a CT-scan of that same area (which he’d undergone during a recent hospital stay) can be 1000 times as strong, according to the American Cancer Society.

There was no way I wanted my child to be so over-radiated that he’d end up with cancer in 30 years. I turned to the nurse and shouted, “No!”

The nurse repeated, “The doctor wants to confirm that the NG tube is positioned correctly.”

I found it difficult to believe that the only way to confirm that the tube was in correctly was with an X-ray.

“That’s what the doctor wants,” she said.

“There will be no X-ray. Find another way,” I insisted.

“So, may I state this correctly? You are refusing medical treatment for your son,” the nurse said.

I saw the clarity of her question and recognized her guilt-producing tactic. Either I’d change my mind or, if I did not, the hospital would document my response and protect itself legally. “No X-ray,” I said.

She left. Gary screamed that he didn’t care about an X-ray. When the nurse returned, she said that since I was refusing treatment, they would admit Gary with the tube in place.

When we got upstairs, a new nurse who looked like she graduated yesterday, entered our room. “I understand they are concerned about whether the NG tube is placed properly,” she said, “and that you said ‘no X-ray.’”

Not again.

She continued, “I learned in nursing school that the PH of the stomach is in the 1-3 range. I bet I can get some PH papers and take some of the stuff out from the tube and then I can test it.”

I couldn’t believe there was a solution as simple as this. “Really?” I said.

“Sure! Let me get the papers.” She raced out of the room.

In less than two minutes, the nurse returned, dipping something into the bag that collected stuff from the tube. She put some cloudy, gel-like liquid in a cup, then dipped a PH strip in there.

She brought the color guide to Gary. If it turned in the reddish area, she said, we’d know that the PH level meant the stuff was from his stomach. It took seconds for the strip to turn scarlet. Couldn’t they have done this in the ER? It sure was cheaper than an X-ray. And safer. And faster.

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 Randi Redmond was a winner in the 2013 Costs of Care Essay Contest and healthcare leader empowering patients at www.RandiRedmondOster.com

6 Comments
  • Brandi Ryan-Cabot
    Posted at 14:09h, 24 February

    Bravo for savvy nurses!

  • Ann Cluck
    Posted at 14:09h, 24 February

    Good for her!!! Saving the patient and the ins. company money should be the number one prerogative, after the best solutions for saving a life. Sadly, that is not the usual procedure.

  • David, MD
    Posted at 14:10h, 24 February

    As an ER doctor of 14 years, I feel your pain. There are WAY too many entities between doctor/provider and patient that causing conflicts in care. I would tell you that in your particular case, it’s the malpractice attorneys. I can think of a hundred ways every day that I could save the system and the patient money, but trial lawyers have set the “standard of care” as “perfection.” Perfection — is VERY expensive. What that nurse did — honestly, makes perfect sense — but it’s not perfect. And it’s not validated by literature, blah blah — so on the off chance it was somewhere else, you don’t have a leg to stand on so doctors are forced into practicing defensive medicine…. rather than medicine that actually makes sense.

    The flip side is that patients who don’t have significant financial stake in the decision making, I have noticed, do the opposite – they treat healthcare like an all-you-can-eat buffet — the response to my recommendation that this is an unnecessary test is “well I want it.” And hospitals now have gone Press-Ganey crazy that >the>Patients<< are people that I work with as their doctor together as a facilitator to better health — if I'm successful as a doctor, you'll need me less and less. See the paradigm problem???

    I can say that practicing medicine has never been less fun — I would venture to say that many hospital-based providers feel held hostage to government (and often silly) requirements, malpractice attorneys and "customer satisfaction"

  • Dan K.
    Posted at 14:11h, 24 February

    What you did took a lot of guts to do faced with your son’s agony on the one side and the doctor’s, nurses’, and hospitals’ side on the other.

    How do we know when to push back at the healthcare providers? What questions can you ask or demand to have answered?

    I personally believe that we, the actual consumers, need some training in how to engage our doctors, nurses, etc., so we can get better healthcare.

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    Posted at 14:12h, 25 February

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  • RD
    Posted at 14:12h, 26 February

    Problem is, still can’t be sure it’s in the stomach. If it’s right near the stomach in the esophagus, with a little reflux the pH test would show the same result. God forbid a complication occur from using a tube incorrectly assumed to be in the right place, the lawyers would have a field day. I’ll be the first to agree that we waste money and over image people but the law doesn’t protect us from creative deviations for what they, often short sightedly so, deem to be standard of care.