Long Waits Bring Out Big Guns at LSU Hospital
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Long waits bring out big guns at LSU Hospital By JUDY PACE and MARGARET MARTIN Times Enterprise Writers Major changes are under way at the walk-in clinic of Louisiana State University Hospital in an attempt to put a stop to the long delays which have often kept patients from needed medical care for hours on end. I • Problems at the clinic have gotten so serious that Dr. Ike Muslow, vice chan-i cellor in the medical school system, has! personally stepped in to work at the, clinic. The problems show up in waits of up to 18 hours or longer, with patients complaining bitterly that they are not receiving adequate and timely care. The situation has plagued the facility for decades and has been reported in numerous Times stories. However, al-though officials have repeatedly said they were giving the clinic top priority, only recently have visible changes sur-faced. Muslow and Robert Hall, assistant to the dean for hospital administration, predict drastic improvements in the clinic within weeks. Muslow is not only supervising work-ers in the clinic, but is himself seeing patients and said he will remain in the clinic until he is satisfied it is function-ing well. He has been working at the clinic full time for two weeks. "I really think it has been a problem area for a long time," Muslow said. "I undertook it as a challenge." In addition, other med school faculty members have begun working in the clinic alongside interns who are re-1 quired to work there as part of their training. Those faculty members in-clude Dr. Arthur T. Fort, acting head of the Family Practice Department; Dr. Joseph Little, head of pediatrics; and Dr. Mike Harper, family medicine staff member. Muslow said the medical center is also looking for a permanent coordi-nator for the clinic. He said, too, he would like to see an appointment sys-tem initiated at the clinic, but does not believe that will start any time soon. He said changes are being made to cut down the waiting time and increase the educational process in the clinic. The changes come on the heels of prolonged complaints from patients and much concern among medical cen-ter officials and former clinic staff members. The clinic, which sees walk-in pa-tients on a non-appointment basis, han-dled 71,226 office visits in 1980 and 68,492 in 1979. Those with a close knowledge of the clinic say that the sheer volume of patients, who often arrive in groups, makes it difficult to cut out a waiting period. However, Muslow and Hall said no patient should have to wait more than three hours. Times interviews last week with pa-tients in the walk-in clinic found many wJ" had been waiting for seven or eight jgaits often mean missing meals •eople are afraidjB^psijoj their place in line and sometimes re-quire people to stay into the night or even come back the next day to see a doctor. Some clinic observers feel that Muslow's presence provides the answer to many of the problems — that is, to have an experienced physician who can see patients faster and exert authority over younger doctors and other hospital* staff members. However, most also feel that any future clinic coordinator must be given the same authority if the system is to work. Muslow is undertaking a job that several other local doctors have given up on, after attempting to make changes in the clinic. Their problems reportedly often stemmed from a lack of authority over interns and residents, particularly extending into other clinics at the med center. Dr. Robert Bays, who formerly headed the clinic on a part-time basis, praised Muslow for taking over the clinic and said he believes it is almost the only way problems can be solved there. Bays stressed that the clinic head must be given authority to do the job effectively. Repeatedly, officials have said the clinic was a priority item and have said they were working to address the prob-lems. Those involved in the clinic have written detailed memos and reports suggesting changes over the years. However, few noticeable changes have surfaced. Patients interviewed while waiting in the clinic this week told The Times that the waits have gotten no better in recent years. The delays, according to doctors fa-miliar with the clinic, are often unnec-essary and reflect problems in the en-tire clinic system at the medical center. Doctors say the treatment of the most seriously ill patients has been tradi-tionally left to doctors with the least experience — interns who are required to staff the clinic as part of their training. Although they emphasize that the interns are medically qualified, they said interns simply do not have the experience of older doctors. As a result, they handle patients more slowly and a logjam builds up in the waiting room. Some doctors say, however, that to speed up the walk-in clinic process would require revamping the entire clinic system. That, they say, is because specialty clinics would not be able to handle the deluge if they received more patients from the walk-in clinic. People close to the clinic place much of the blame on residents — doctors training for their specialties — who do not want to be swamped with patients from the walk-in clinic. Some said residents have interns or-der unnecessary tests and put off seeing patients, leaving them for the next shift. Muslow said delays with residents have been somewhat of a problem in the past, but said that stopping such delays i&aaa^Uus role in the_clinic. Outpatients crowd waiting area Dr. Ike Muslow at work in Med Center's walk-in clinic . . .vice chancellor steps in over long waiting periods One of the changes which Muslow is making is that a doctor must see the patients who are assigned to him on his shift. That means that doctors will have to stay until all patients are seen and will not be able to leave the patients for another shift. In addition, all patients who come into the hospital between 10 p.m. and 7 a.m. will now be seen in the emergency room instead of the walk-in clinic. Asked about the problems, two resi-dents interviewed by The Times said they do not think that residents neglect their duties. Part of the problem, according to Dr. Keith Payne, chief resident for internal medicine, is that there are not enough interns and residents for the number of patients. He pointed out that residents are responsible for a large number of pa-tients on their specialties and patients in intensive care units, as well as walk-in patients. He also said that interns have "im-mediate access" to residents for help in diagnosing patients. According to Dr. Scotty Hermann, fourth year obstetrics-gynecology resi-dent, the tests which patients are sub-jected to are important not only for the training of interns, but to see that patients receive the best care. Payne and others interviewed stressed the importance of maintaining a balance of both training and service in the hospital. "It's more than just learning; it's taking care of patient needs," Hall said. Some two dozen patients interviewed by The Times last week were not fully satisfied with how their needs were being met, reporting that they had been waiting for five to seven hours to see a doctor. Those patients, many who had come from out-of-town, said they would wait until they could see the doctor and would come back if they had to. Such a wait often means missing meals because a patient loses his turn if his name is called while he is gone. At 3:30 p.m. Monday, for example, Louella Jackson said she had been wait-ing since about 8:45 a.m. and had still not seen a doctor. She said she didn't eat breakfast be-cause she thought it would interfere with a test of her blood sugar and she had not eaten lunch because she was afraid of losing her place in line. Dr. Keith Payne . . . defends residents "I went out and got a Coke," she said. "I had to drink something." "I realize there's a lot of patients but they can do better," Mrs. Jackson said. Linda Childs, waiting with a patient, agreed that the waits were long. "You can plan on six hours no matter what you come in for," she said. In a recent lengthy letter to The Times, a Shreveport woman said she and her 57-year-old sister spent 15 hours waiting for an examination of her sister's arthritic feet and knees. Upset at the time it took for her sister to be seen, Iris Hatcher wrote a letter at 3:15 a.m. to detail the pair's day at the clinic. "For fear of being called for an examination and not being present, my sister stayed in that room for 12 hours, while I alternately went out and brought back our lunch and dinner," wrote Mrs. Hatcher. She said her sister was not seen until 11:20 p.m. and was then told "the or-thopedic doctor had gone off duty a few minutes before and, therefore, a diagnosis could not be made." In a letter dated just one day later, annt.hpr patient, romplained of a 13-hopj Jobert Hall . . . is nprovements coming wait to see | doctor and further delays after seeing 1 he doctor. The patient said she finally la ft the hospital at 4:30 a.m. after arrivin \i at 9:44 a.m. the morning before. "I think it' was a shame and a disgrace' that a person had to sit that long for treatment aijid still didn't get anything done for theda," she wrote. Those associated with the clinic said that finding experienced doctors to help staff the clinic is difficult. Hall said tliat the hospital could use three more experienced doctors in the walk-in clinic and is looking for some to hire. \ Muslow said he wants to hire a family practice facuJ ty member to take over the clinic on a> full-time basis, but has no prospects. He said it is hard to find someone welt trained, who can teach at the same Urn*: he is treating patients. Meanwhile, Muslow will continue working in the clinic and is confident the changes h|e can make will be effec-tive even when he is not personally supervising tb.e clinic. If so, a sitmation which has plagued the medical center for years will finally be improved, j TM.ii then, ihe waiting will go on.
|Title||Long Waits Bring Out Big Guns at LSU Hospital|
Outpatient Clinic (Louisiana State University Medical Center, Shreveport)
Muslow, Ike A., 1926-
Hall, Robert C.
|Notes||Photos of Dr. Ike Muslow, Dr. Keith Payne, Robert Hall, and the Outpatient Clinic|
|Identifier||See reference URL on the navigation bar.|
|Source||Louisiana State University Health Sciences Center Shreveport Medical Library (http://lib.sh.lsuhsc.edu)|
|Coverage-Spatial||Shreveport (Caddo, La.)|
|Rights||Physical rights are retained by Louisiana State University Health Sciences Center Shreveport. Copyright is retained in accordance with U.S. copyright laws.|