Prologue.
Here are my 2 days in a hospital sitting at the bedside of somebody who is close to me.
A patient was brought to the nearby regional hospital in Freising (about 50 km from Munich) with a strong vertigo. Ironically it was the same hospital he visited 11 years ago when his first acute stroke happened.

At that time the reaction was fast: he arrived to the hospital within an hour being fully conscious, with no visible manifestations of neurological syndromes. It was Sunday evening. Bad luck: no neurologists in the clinic. The patient was left with no help for 10 hours in the emergency till neurologists returned from their weekend the next morning.

Unfortunately, the stroke did not want to wait. Coming with the mild dizziness and high blood pressure the patient was discharged from the hospital with the left side Paralysis. No wonder he has developed an aversion for Freising. But there were rumours that things had positively changed.

This hospital is now under the supervision of the famous  Rech der Isar  clinic with the outstanding reputation and highly qualified personnel. Even telemedicine is now available to compensate for the lack of Freising’s resources: one can presumably set up videoconferences with Rechts der Isar experts. I have signed a document confirming that I have no objections against such services.

As we arrived, the vertigo got stronger. I had to take a roll chair to get the patient to the reception. The lady at the desk was preoccupied with papers we had to fill in barely glancing at the patient sitting in front of her.

After 2.5 hours of waiting at the Emergency ward the patient was not at all better. I had to inquire the information desk if the nurse could come to fetch him up. The cool glance and the short snap:” we are doing our best with the resources we have” immediately reminded me about my place in this milieu.

Luckily in the next 15 minutes a nurse appeared. The doors of the emergency department closed behind them. Another exhausting hours of waiting full of uncertainty. But this is OK. We all understand that medical examinations take time.

I was staring at those sacred doors together with other relatives, friends and caregivers with the same burning question: what ‘s now? The question hanged in the air. Finally, my prayers were heard: through the half-opened doors I saw my patient stumbling but definitely targeting toward the exit. Ignoring strict orders: „do not enter” I have rushed to assist him. Being left for another 1.5 hours alone in the room with no info he was apparently planning an escape. This was not rational. But understandable: being in the hospital one feels vulnerable, nervous and completely neglected. Just a short friendly phrase, clarification of what is coming next would have made a great difference.

Day 1.
Day one was the anxious attempt to get the results of preliminary medical investigations. I arrived at about 12 pm, since according to my knowledge, all medical checks and hospital rounds should have been more or less completed by that time. The patient I was visiting looked extremely week. Vertigo continued. I hoped to get the results of the Computer Tomography, but had no idea whom to address. Nurses were rushing through the corridor, but there were no traces of physicians. Other patients in the room told me that there was no ward round that day, only a junior assistant popped in. It was absolutely not clear who was responsible for a given patient. The only way for relatives to get some info was a window of 45 minutes (between 15.15 and 16.00). And that is for all of us including patients.

At last I got him. Exactly between 15.30 and 16.00 a slender and brisk chief doctor was standing in the corridor chatting amiably with a group of ladies. The name of my patient apparently did not ring a bell. No wonder: he has not seen him so far. Slowly some associations between a patient and his records were revoking in his memories.

The patient was diagnosed with the left side cerebellum stroke. It was one of those “silent strokes” one does not notice right away. According to the Chief Doctor, it was “not fresh”, hence no urgent therapy was required. The doctor was honest: he could not explain the reason of the continuing vertigo. He was a cardiologist, not a neurologist. More examinations and the consultation with the neurologist have to be done in the course of the week to understand the problem. Fair enough. But the patient was already 1.5 days in the hospital. Was it not a sufficient time for a neurologist to visit him?
Day 2.
We were awaiting neurological examination. I managed to grab the assistant doctor who was careless enough to stroll through the corridor. He was young and still had some glimpses of sympathy in his eyes. Unfortunately, he also could not provide a reliable information being a cardiologist. The neurological department was on the same floor. But it seemed like on another side of the planet.

Time tickled. It was Friday 17 pm. At 17.30 the assistant entered the room announcing we can go home. I could not believe my ears. Seeing my bewildered expression, a young man shyly added: we have only one neurologist and he will be back on Monday.

Again, the same nightmare as 11 years ago: our health, the health of our beloved ones depends on a presence of a single physician. What about the potentials of telemedicine, the virtual consultancy with experts from the Rechts der Isar promised in the documents I have signed at the admission? Perhaps technology was there, but apparently used only for exclusive cases. Ours did not seem to be among them.

The received medical conclusion contained multiple descriptions of test results as well as copy and paste from the previous documents. The diagnose was: Neuritis vestibularis. So, where the problem lies? In the inner ear infection or a poor blood circulation leading to the cerebellum stroke? And what to do to prevent another one? There was nobody around to answer. The neurologist was already enjoying his weekend. The doctors’ letter contained some unknown names and the lonely signature of the poor assistant.

It was an outstanding example of a virtual care: several medical persons provided test results, somebody processed various documents. Based on this composition diagnosis and care pathway were recommended. Maybe there was a thorough thinking process behind, but it was hidden from us.

So, how about those sacred relationships between patients and doctors? Hand shaking, eye contacts that are considered to be so valuable for diagnostics and care that no technology can substitute? What about patient’s engagement in the decision process? All those questions seem to be just rhetorical.

Epilogue.
We are still struggling. Vertigo is going on. Our general practitioner recommended the same medication treatment this patient was taking for 10 years ago, although his health situation has apparently changed.

Recently I have read a thought provocative study on unwarranted regional variations in German Healthcare provided by  Bertelsmann Stiftung  which I do recommend everybody to check on. It appears that the quality of care we receive very much depends on geography we live in: availability of the right specialists in the area, their personal professional experiences and skills, last but not least availability of resources, such as medical equipment etc.

As a citizen and a patient, I would also add – bureaucratic culture still prevailing in some parts of medical environment. Culture that prioritizes documents over patients, impersonal protocols over individual care, formal procedures over curiosity to solve a problem.

While leaving the hospital I saw a slogan written on its walls: “you are here to become healthy again”. Were we part of the system’s occasional fault or its fundamental failure? Or maybe we were simply in the wrong time in the wrong place?