About a year ago a young, Spanish speaking mother came into the ER with her two children. The older child was about 5 and the younger (who was my patient) was two. The two year old girl had an ear infection. When I started looking at her chart I discovered she had been there the day before and prescribed an inexpensive antibiotic and ear drops for pain. As I examined the little girl I spoke with the mother using a translator and found out she didn’t get the medicine that was prescribed the day before. This was not a diagnostic dilemma. The patient has an obvious issue treated with a medication that typically works…. If you take it. The chart from the day before had discharge instructions in Spanish so in my mind the visit was complete. Diagnosis=otitis media. Treatment= same as what we told you yesterday. Frustrating that they came back to the ER but no surprise she wasn’t better. I went about my shift and discharged them summarily and didn’t give it another thought. These things happen about three times a shift in the ER.
On my way home after my ten hours in the pit I stopped at a stoplight two miles from the hospital. I saw a homeless man on one corner with a cardboard sign asking for money. On another corner however was a well dressed, young Hispanic woman with a sign that said “baby sick.. need money for medicine”. I realized she looked familiar and was suddenly struck by the truth this was the mother of the patient I dismissed early in the day. I pulled my car over and walked up to her and in my broken Spanish apologized to her. I gave her $20 for her antibiotic and ear drops and begged her to go home where I was sure the five year old was trying to care for the two year old who was crying with ear pain.
I don’t tell this story because I did a good thing by giving someone money. In fact, I’m ashamed to remember it. I failed this lady and her child and endangered them all because I dismissed them out of hand as non compliant. The truth is that patients come to us for our advice. Typically at significant cost in time or money. If they choose not to follow our advice I think the least we can do is ask “why?”. Sometimes it is a lack of understanding due to poor communication. Sometimes they don’t like the advice or recommendations. Sometimes though, they want to be compliant and will take steps to do so that would humble you. However, they could still fail and it is wrong to blame the patient for not getting better.
