20 September 2007

Secret Shopper

One of the nice things about medicine is that it is still a respected profession in the average community, and as I have become more involved in the medical staff of our local hospital, an inevitable corollary is that I have begun to get involved in local community activities: charitable foundations, local politics and the like. It's a time burden, but personally rewarding, so I don't mind, and if nothing else I get to meet lots of interesting people.

One day, not long ago, I walked into a board of directors meeting for one such activity. As I entered the crowded room, about ten minutes early for the meeting, a loud voice cut across the murmur of small talk and chitchat that precedes any such convocation:

"Hey, I know that guy! He took care of my heart!"

I really don't generally look forward to these interactions: meeting former patients in a social setting. There's usually (always) a complaint about how long they had to wait, or the smelly drunk in the gurney next to them, or the "real" diagnosis given to them by their follow-up doc. I looked over my shoulder, hoping somehow that I had been followed into the room by a cardiologist, but there was nobody. I turned back, resigned, to face my fate. A cheerful, ruddy-faced fellow was forcing his way through the crowd, followed by a small phalanx of hangers-on and goons. The entire assemblage had stopped chatting and was turning to see what the excitement was about.

Moments later, he was pumping my hand up and down and breathlessly gushing, "I don't know if you remember, but you saved my life about six weeks ago." He mimed a defibrillator going "zap." I had no recollection, of course, but I said "Yes, yes, I recall, but I am sorry because I can't remember your name...." If nothing else, that usually buys me some time to think. He introduced himself as [name of prominent regional politician redacted]. Still nothing, but I've a terrible memory for names and am good at faking it. "Oh yeah, I remember now. So how're you doing?"

"Oh great!" He began speaking to the crowd of people around us, "This guy fixed me up real good. I haven't had a problem since. You wouldn't believe the stuff they do there in the ER!" He began recounting the details of his visit to the assemblage, with a somewhat over-dramatized version of my own heroic role in the events. And I did begin to recall his case, with that prompting.

It was, from my point of view a totally satisfying case, though hardly heroic. A simple cardiac arrhythmia, symptomatic enough to require urgent treatment, and most effectively treated by DC Cardioversion (zap). His complaint and vital signs had gotten him a bed and me at the bedside promptly, despite presenting on a busy holiday. I remembered him as a pleasant professional middle-aged guy, frightened, with a very anxious wife at the bedside. We established a good trust, terminated the arrhythmia with some electricity, and he went home happy. I never made the association between his name and the powerful local politician with the same name. He had been in bed 3-2, which is in a double room, and was in the ED about three hours. Bizarrely enough, during that time frame, we had no fewer than three acute ST-Elevation MIs come in, and all three were briefly in room 3-1 before being whisked off to the cath lab.

So this fellow gets his own heart shocked and happens to get to overhear my "You're having a heart attack" speech to three temporary roommates. No wonder he thought we were so great.

I shook my head -- what dumb luck, that a guy in this position of influence should have had that one-in-a-million ER experience. And I had no clue who he was at the time! It makes me think of long ago, when I used to work in a large retail chain as a sales associate, we would get these "Secret Shoppers," or "spies" as we bitterly called them, who would come in posing as regular customers but actually rating the performance of the employees. He had been sort of a medical version of a secret shopper.

I guess I passed.

No comments: