In this heartbreaking CNN report, they tell the story of a child who, after a five-hour wait in an ER waiting room, developed Strep sepsis and nearly died. It's a terrible story, and a terrifying case both as a parent and as an ER doctor. To their credit, the authors treat the subject seriously, without too much sensationalism, and they provide a serious look at the status of the nation's ER overcrowding crisis and they shed some light on its causes. They obtain one of the greatest explanatory metaphors I have ever read on ER overcrowding:
Dr. Sandra Schneider, president of American College of Emergency Physicians, says the backups occur as emergency departments struggle to find beds for admitted patients."Think of the emergency room like a restaurant where people come in and go out," she says. "Now imagine a restaurant where the customers come in, but never leave. They come in for breakfast, they stay for lunch and they're there for dinner." When a patient is admitted to the hospital and needs to remain for additional procedures, they take up available inpatient beds leading to a domino effect, Schneider says.
Lovely metaphor, and immediately accessible to laypersons trying to understand the complex dynamics of ER patient flow.
So why do I hate this article?
First of all, in this case, it sounds like the "human interest" example they used was wrong, or at least illustrates a different point than the authors wanted to. The real cause of this child's outcome is not just the overcrowding of the ER, but the error of the triage nurse. A febrile child with petechia or purpura is a medical emergency, and this is clearly one of those cases where the triage nurse missed it. This child should have been rushed back, regardless of what else was going on. While the overcrowded ER was a contributing factor, the proximate factor here was a medical error. A secondary (and unknowable) issue, medically, is that if the child was sick enough to have purpura on presentation, she was already in DIC and probably would have gone on to have the same outcome of the amputations, etc, regardless of the wait time. Obviously, the delay was not helpful to her, so that's more of a quibble that will probably be left for the malpractice attorneys to debate.
But that brings me to the larger point. It's not just that they got the "human interest" case wrong -- it's that they had to have one at all to make the story "work" according to the journalistic conventions. Why does there have to be a dead child for readers to care about ER overcrowding? Is it not enough to walk through an ER waiting room and see dozens of people waiting in pain for hours on end? The guy with a broken fibula, appropriately triaged, who has to wait for three hours for an x-ray and pain relief? The dehydrated child who can't stop vomiting? The kidney stone? Is it OK that these non-emergent cases cannot be treated in a timely manner? Or walk through the halls of the ER and see the patients languishing on gurneys for hours and days. Is that not enough to communicate to a general audience that there is a crisis in the ER, and in the nation's hospitals?
This aggravates me because the incredibly touching and tragic human interest element of this story completely overshadows and distracts from the real problem. People will read this and come away sad for the patient and family, or maybe angry at the medical providers. But the systemic problem, the one which affects so many ERs across America, is demoted to the twenty-first paragraph, when it should be the headline. It should be in 100-point bold font across the front page of CNN every day. But a little girl suffered a terrible disease, and readers will be given that to chew over and dwell on, and the crisis that contributes to these outcomes gets short shrift.
That's why I hate medical journalism.