Long Waits Bring Out Big Guns at LSU Hospital

              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.