I injured my shoulder while on vacation in Jamaica. I was in severe pain and I went to the local hospital where an extensive clinical exam was completed by a nurse – there was no doctor available until the next morning. I was a 90 minute drive from Montego Bay (which was the nearest xray machine) and a 1 hour flight from Kingston (which was the only MRI machine). The nurse’s exam suggested partial tear of the transverse humeral ligament or (less likely) a dislocation. I decided to wear a sling and return to the United States for ongoing care.
When I returned to the US the shoulder pain began to dissipate but I started feel numbness in my right hand. Being a clinician who still practices, this was very frightening! I went to urgent care in the US and requested an MRI because I was convinced there was no bone damage. However, the doctor informed me that it was hospital protocol to have an xray first. After my xray (which was clear) I was informed that, in order to have an MRI, I needed to meet with my primary care physician. Although frustrated, I complied. After a repeat examination with the PCP I was scheduled for an MRI. Now this is where it gets interesting.
I arrived for my MRI at 1pm…….and was finally taken in at 3.30pm. An extremely frustrating wait and two fellow patients decided to leave because they got sick of waiting! Experts have considered why patients don’t comply with imaging orders and issues of convenience and child-care were common. Then I slipped into my hospital gown and entered the MRI room where I was told about the protocol for the MRI – my first. When my patient bed was inserted into the scanner I realized (for the first time) that I was claustrophobic! Ashamed, I asked the technician to immediately take me out because I didn’t think I could handle this! With some calming words, I was again inserted into the scanner. This time I lasted about 3 minutes before asking to be rescued again! The story is long but the technician was very patient and I got through my 35 minute scan. A review of the evidence shows that 11.7% of children could not comply with prescription for an MRI and there is no such research among adults. Research has also shown that lower levels of education, coming from further away, and being female were risk factors for no-showing to MRI’s. I represent none of these factors and I almost didn’t make it!
What I take home from this experience is that I am a patient in one of the best health systems in the country and the world….yet, it’s not pleasant. It’s just not nice to be a sick. Diagnostic tests are not fun, waiting is not fun, not knowing is not fun, being a patient is not fun. When I’m taking care of patients I will remember to be more thoughtful, more patient and more kind. While it’s just a regular working day for me, my patient could be having the worst day of their life! Unfortunately, we have a reactive insurance structure and health system in the US that focuses on disease management rather than primary prevention. Subsequently, we are often coping with problem focused visits and the stress of a sudden dip in health.
Oh by the way, after my urgent care visit, the PCP visit, the xray and the MRI….my diagnoses is partial tear of the transverse humeral ligament. The same thing the hospital nurse told me in Runaway Bay, Jamaica!