Send Los Médicos to Listening School Before It's Too Late

The Secret, Ysabel de la Rosa

An infuriating, heart-breaking bit of the recent Ebola news stories has nothing to do with WHO, CDC, or poor health care systems. The most heart-breaking part is a handful of doctors' unwillingness to listen and pay attention. Based on my own experience in the health care system and that of my family, this is, unfortunately, a norm in health care, a condition that no law or system has effectively addressed.

Thomas Eric Duncan has died. While people are stressed about being exposed to a virus, precious little is said about this loss of life and what it means to those who love him. Based on what I hear from news sources I trust, that he contracted the virus by helping someone whom he did not know was infected. His one simple generous act cost him his life. He deserves the dignity of being remembered as a man, not simply "the first case of Ebola in the US." His family deserves sympathy. 

Duncan told the ER staff he came to the US from Liberia. That one fact alone makes it unthinkable that they would send him home without further testing. The man did what he could and should have done.  Our health care professionals did not.

Yet Spain has outdone the US. Nurse Teresa Romero put herself in harm's way to treat a priest who returned to Spain with Ebola. After the priest died, she experienced symptoms that worried her. She went to doctors and hospitals, not once, not twice, but three times after she started running a fever, asking to be tested for the virus. No one listened until the fourth time she contacted them. Now, she fights to survive. Her husband is quarantined, and the suddenly efficient Spanish government decided not to put her beloved pet in quarantine, but to immediately euthanize the dog because he just might have the virus. It has not been proven that a dog can pass this to a human, but it might happen, so, "kill the dog" is protocol.

Of much more concern to me than panic over contagion is the pitiful state of listening in the health care systems in the Western world. I have lived in both health care systems, in the US, and in Spain. In fact, I have been a patient in the very hospital where Nurse Romero was told to go, where she languished in an ER, waiting for help. Even after reporting the worsening of her symptoms, even with the knowledge of her exposure, she was directed to go, not to the hospital prepared to treat infectious diseases, but to the hospital closest to her home, as though she were just another patient with the flu.  We hear repeatedly how advanced the US healthcare system is, and Priminister Rajoy was on air today touting the quality of Spain's healthcare system. But listening is not a system. It is an art and a science. It should change with every person who walks into a medical office, especially when critical information is presented:

1. Fever. 2. Just arrived from Liberia. 3. Stay in hospital. 4. TREAT FAST.
1. Fever. 2. Health care worker exposed to Ebola. 3. Go home. 4. Go to unprepared facility.
There should not have been one moment's doubt about what to do in either case. The difference in treatment was the difference in listening to the patient.

I cannot imagine the stress that Ms. Romero and her husband have suffered trying to get her own medical profession to listen to her. I can tell you, had she been a male doctor, and not a female nurse, someone would most likely have taken her seriously. That is still how it works way too often. What does a nurse know, after all? Just about everything, I say. I cannot count the times I have talked to a nurse about symptoms and received a more helpful response from them than a doctor. I cannot count the times I or someone in my family has risked suffering serious health consequences simply because, instead of listening to us, a doctor "decided" what was wrong, in spite of the symptoms we presented.

One instance stands out: I was scheduled for a procedure at UT Southwestern Medical Center to correct a rare heart defect. The surgical procedure is not done often, and my cardiologist warned me not to go into it casually. As it turns out, I had a strep infection the week of the surgery. I called the doctors, and they said they were willing to operate on me with an active strep infection. "It's up to you," they said. The only other person as stunned by this response as I was my cardiologist.

We will not make progress against the deadly Ebola virus (and a host of other problems) with Western health care's business-as-usual approach. In these recent Ebola cases, the BAU approach included these operating assumptions:  1.The doctor's assumption about the patient's condition is more important than the patient's input or symptoms. 2. Don't run a test unless you absolutely have to, because 3. It can't be Ebola, that doesn't happen here. 4. A nurse (male or female) does not know nearly as much as a doctor.

Assumptions do not make a practice, including the practice of medicine. Detective work is part of the diagnosis. Making up your mind without performing tests or paying attention to symptoms is the most basic and most common form of "malpractice."

My heart goes out to these families. All they needed was someone to listen to them so that our magnificent Western health care systems could help them and possibly save their lives. I am hoping and praying that Teresa Romero and her husband will survive this.

I am fortunate to have had some doctors in my life who don't fit this laissez-faire pattern, and I value them immensely. Still, as an industry at large, doctors need to learn to listen. Not one whit of their knowledge or clinical experience is worth a dime if they cannot or will not listen to the patients they are paid to serve.