Everyone who presents to our emergency departments are assessed without favor or prejudice.
The allocation of resources and the time they wait to be seen is based on an assessment of their clinical urgency.
It doesn’t matter if you arrive by helicopter or horse-drawn carriage. It doesn’t matter if you are a professor or a prostitute. It doesn’t matter if you were born in Sweden or Somalia. Everyone starts on the same spot.
Or almost everyone.
I can think of two exceptions to this process. Two groups of people who, at times, receive special treatment:
VIP’s:
The first is the VIP (very important person).
VIP’s include dignitaries such as heads of government, members of royal families, government ministers and heads of religious orders.
VIP protocols are also activated for senior public servants, support staff accompanying dignitaries, entertainers and media and sporting personalities.
Most public hospitals have some form of VIP policy. They are intended not to provide any special clinical care, but rather to consider the need for enhanced security, notification of hospital executive, and management of any media response to the VIP’s hospital attendance.
Even so, I can tell you from much personal experience that the presence of a senior politician or high profile media personality ( but especially a politician ) leads very quickly to medical executives and hospital management running about generating copious latherings of lubrication that quickly propels the VIP through the overcrowded emergency department and into a single room on the wards.
I can think of a number of episodes when politicians have been given beds on the ward ahead of much sicker patients who had been waiting well over 24hrs for bed access1.
Friends and Family:
Its a busy Friday night and the waiting times have blown out to many hours. You look up from the Triage desk to see your sister and her husband standing before you. He has a severe stomach ache, has been vomiting, and is in considerable discomfort. Even so, there are many other equally sick patients who have already been waiting over two hours to be seen.
What are you going to do? Place him in the queue to wait his turn ….and then have to deal with your sister?
What if it were a neighbor? What if it where your child?
What if it is a member of staff?
Being confronted with such a situation can place us in the midst of considerable moral turbulence. Professionally speaking, just because you know a patient does not increase their clinical urgency or afford them special privilege in the public system. But you do have to live with these people, and face their expectations. “I knew the nurse on duty really well…but she made me wait 3 hours to be seen!!!”
If we are honest, most of us would do our best to exert a little ‘professional influence‘ on our friends situation. More so, if they are family. It is difficult enough watching people you don’t know waiting far longer to be seen than they should, but when it’s someone you care about, it gets personal.
So here we have two instances when the floor of the emergency department is not exactly level.
And on reflection, I can remember puffing myself up and piously proclaiming that it was unethical and professionally uncouth to allocate extra resources to a patient just because they were a celebrity, or a politician. Whilst in the case of my own family or good friends ( my own VIP’s) I have been guilty of trying to exert some influence to do that very same thing.
Despite the hypocrisy of this, watching hospitals schmoozing to VIP’s whilst sicker patients languish in the health-care quicksand really bristles my buttocks.
- And to be fair, I also recall an incident when the wife of a former Prime Minister insisted she be given no preferential treatment and waited a considerable time in our crowded waiting room to be seen. Much to the stressinations of her security entourage [↩]
And let’s not forget, that if ED staff are going to be excruciatingly honest, they will also admit that if two ambulances pull up at the same time, each carrying a person with identical serious presenting complaints, and identical Triage-ing Categories, the younger patient will be seen first, particularly if the older patient is ‘elderly.’
I recently had the opportunity to meet the Medical Director of the ED from which my 71 year old Mother was allowed to walk out into the night with an undiagnosed sub-arachnoid haemorrhage.
I asked him how he would manage the not-so-very-hypothetical scenario I just presented, and he looked crestfallen, hung his head, and quielty stated “you know I can’t answer that.”
Our meeting was of course being minuted by a member of the hospital’s liaison team.
It was his body language which told me more than any member of the unsuspecting public might want to know.
Who are we – any of us who are health professionals – to determine who will receive prompt, safe and effective treatment if our beliefs about status, age, race, familiarity, fame or power influence us? What are we doing to our essential humanity if we buy into this?
When I was a young student nurse in the ED, I didn’t question this kind of stuff.
Now I’m 46-ish, and the grey hairs are abundant upon my head, and I’ve seen what covert ageism does to the prognoses and outcomes for previously fit and vital elderly folk who attend public hospitals, my hackles are up.
Glad you’re keeping it real Ian.
Margi Macdonald
Just so long as you apply some buttock bristling balm the next time I put in an appearance!
Nice post!
In a public hospital in a town which shall remain nameless, an ex Governor General was afforded absolutely zero special status and waited at least twelve hours for a ward bed in an overcrowded ED.
Priceless!!