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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