The Patient Relations Office
Toronto General Hospital
190 Elizabeth St, RFE IS-401
Toronto, ON M5G 2C4
RE: CARE RECEIVED ON FEBRUARY 28th, 2008 IN THE TWH EMERGENCY DEPARTMENT
Dear Patient Care Coordinator,
On Thursday, February 28th, 2008 during an argument, through no one's fault but my own, I punched a wall which was drywall covered concrete. This resulted in a "fracture" (clearly completely broken on the x-ray) of the 5th metacarpal ("boxer's fracture"). I left immediately for the Emergency Department.
Upon my arrival, my triage nurse assessed my hand and offered pain medication. This triage nurse was VERY helpful and told me that due to the nature of my injury and the fact it was "a slow night" that I would "get to see a doctor right away". At this point the swelling was still low enough to see the bone pushing on the skin. I declined medication on the advice that I was seeing a doctor shortly.
A few minutes later the registration nurse called me in. I was first given a hard time about the condition of my health card and she then started to act like she was looking down on me because of how I obtained my injury. She said, "it was your own fault" and, "that wasn't a good idea, was it?" in a sarcastic tone (after I had recovered from a shooting pain through my arm). After assessing me she sent me to wait in the waiting room.
After at least another hour I went back to the triage nurse because my hand was extremely swollen and I was in a considerable amount of pain. The triage nurse took one look at my hand, again, offered me pain medication (an offer which I accepted), then told me to have a seat so she could see how long it would be. Within two minutes of this happening, I was called for an x-ray. From the x-ray, I was sent to the waiting area again.
During this time, I still had not received any pain medication and I watched as the doctor's time (30 minutes) was taken up with a couple arguing over the walking cast the hospital was offering to them. There was also a gentleman cared for with what he said "MIGHT be a sliver of floor tile" in his foot while I sat waiting with an unset, swelling hand fracture. At no point was I offered an ice pack to combat the swelling nor any advice on elevation or compression.
When I was finally able to see a doctor I was first interviewed by a fourth year medical student who was FANTASTIC. He made the initial assessment and brought me back to the waiting area. Upon his informing Dr. Steven M. Friedman of his diagnosis, (boxer's Fx) the doctor responded in a sarcastic tone, "let me guess, he punched a wall". I, being 5 feet away from this responded with, "Yes, I did. But is the commentary really necessary?" At this point, the doctor tried to defend his comment, words were exchanged and I requested to leave our interaction to him diagnosing and treating me without additional side commentary such as "I see at least one of these a day".
In the examination room, the doctor continued to bring up this exchange insisting that he "had not meant to insult [me] by it". I asked him to "put yourself in my shoes and see how you would feel in this situation." He continued to skirt the answer but insisted he would not be as upset as I was. I again requested for him to diagnose and treat me. At the end of this diagnosis he offered me something for the pain. He at first offered Tylenol 3's, but with my family medical history I explained this was not an option. His alternative was to offer me Percocet or Oxycontin. As I did not feel comfortable taking either of these narcotics I declined his offer. What I could not help but look at as a bribe (from my understanding of emergency room prescribing procedures). Again, the medical student impressed me with his applied knowledge, asking me if I had ever considered that I may have an inability to metabolize codeine - very insightful.
I felt they (specifically the registration nurse and Dr. Friedman) had preconceived notions about the injury and the situation that had surrounded it, so much so that it influenced their level of care.
My half cast had been awkwardly made and poorly wrapped. It barely covered the broken finger and due to the amount of swelling was unable to be set. I wonder had I been seen sooner, if this could have been avoided. My total time with the doctor may have added to 15 minutes, most of which was spent arguing over his bedside manner. Even while I tried to get my documentation to leave, he continued to argue, "there are people much worse off than you, here".
I would like my file to be reviewed should my hand need to be rebroken in order to set it, or should any further surgical intervention be required in the future. I need to know if the delay in treatment led to this situation. I also would like to know if Dr. Friedman's prescribing of narcotics is a normal thing for this type of situation in the emergency department.
Sincerely,
Craig Rigden