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September 19, 2001

A Patient Dissatisfied With Her Care

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor

JAMA. 2001;286(11):1311-1315. doi:10.1001/jama.286.11.1311

To the Editor: The Clinical Crossroads article about a patient dissatisfied with her care1 distinguishes technical quality from service (interpersonal) quality. I would like to comment on 2 of the patient's major complaints.

Ms G had a traumatic experience with the insertion of an intravenous catheter, which should have been anticipated by her history of "difficult veins." The "inexperienced, nervous" surgical house officer failed technically and humanistically. It is necessary to know when one's limitations have been exceeded, and the house officer's better judgment might have been to request assistance earlier in the process. The author correctly recommends "care protocols" and algorithms for situations in which egos, practicalities, and insensitivity to patients' suffering often impede compassionate clinical decision-making. The anesthesiologist was successful in placing the intravenous catheter, apparently without difficulty—a common scenario even after venous targets have been distorted or seemingly destroyed. Furthermore, the anesthesiologist in all likelihood was not supervising or responsible for the surgical house officer's unexplained involvement in establishing venous access.

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