The Waiting Room

Quick: check the listings for “The Waiting Room.” If it’s playing in your city, go. (Run if you live in Boston – the director will be interviewed by Alexandra Drane tonight).

The Waiting Room: 24 hours. 241 patients. One stretched ER.I went to a screening last night and agree with Ann Hornaday, a movie critic for The Washington Post, who gave it her highest rating: An E.R. portrait too true for TV.

A panel afterward featured:

  • Michelle Carter, M.D., Vice Chair and Clinical Director of Emergency Medicine at Howard University Hospital
  • Angelica Das, Associate Director of the Center for Social Media at American University
  • Robert Shesser, M.D., Professor and Chair of the Department of Emergency Medicine, George Washington University
  • Beth Feldpush, DrPH, Vice President of Advocacy and Policy at the National Association of Public Hospitals and Health Systems

What follows is a selection of questions and answers. Since this is from memory and I didn’t ask permission to quote, I can’t swear to their accuracy and I’m not going to name names  (but they’re obviously mostly from the two MDs on the panel).

1) Why did the hospital give such access? Do you think it reflected well on the hospital?

Highland’s CCynthia Johnson in The Waiting RoomEO is a provocative thought leader and Peter Nicks inspired confidence, despite being a first-time film-maker. Yes, the film makes the hospital look very good. It’s a very accurate portrayal of the “front of the house” vs. “back” (ie, waiting room vs. treatment
rooms). One panelist wants to hire Certified Nurse Assistant Cynthia Johnson (the audience agreed – she seemed to be everyone’s favorite character).

2) If we had a better primary care system in the US, would that alleviate the pressure on public hospitals’ ERs? 

Not necessarily. What is an emergency to the patient is not necessarily a medical emergency — they come when they can, when they have a question, etc. Sometimes they don’t come when they should have. There are many other pressures on the ER — for example, when all the beds are full in the hospital. (Note: I loved the ER docs’ answers and I’m not capturing them well. Basically they were saying that people have lives, they’re not medical experts, they don’t know when they need to come in, they make mistakes. The ER docs just try to meet them where they are. Beautiful.)

3) Would increased staffing in the ER help relieve waiting room backlog?

Not necessarily. ER use is actually quite predictable — weekends, especially when there’s a full moon, Mondays and the first day after holidays. Hospitals can accurately staff the ER. It’s more predictable than elective surgery. If the rest of the hospital is not managed well, the ER can’t triage patients out to the ICU, etc.

4) What about the scene when the young MD is being counseled by a senior nurse about how to tell a family that their son has died? Isn’t there a class or some instruction for this since it is probably a common occurrence?

No. There was no course, no book, no instruction. You accompany senior doctors and listen to how they inform families, then make up your own style and manner. Another panelist thought that scene was staged. (Note: this was definitely a moment when we all wished the director was there and I would be very interested in his answer.)

That’s all I recall and it’s just a taste of what the film inspired. Luckily, the film production team is continuing the conversation on Twitter, Facebook, Flickr, and with their storytelling project.

9 thoughts on “The Waiting Room

  1. Hi Susannah,
    I loved this powerful and emotional film and saw it here in San Francisco. Our organization was a donor because we recognized that this film has an important message that needs to be heard. We have several “safety net” hospitals here in the Bay Area and they face the same challenges of meeting the needs of a diverse population.
    Julia Hallisy

  2. Thanks, Julia!

    I wanted to provide a quick update: Alex Drane called me last night to say that she asked Peter Nicks directly about whether that scene was staged and he said no, it was not.

  3. Thanks to you I got to the showing at 4:20pm yesterday where Alex Drane moderated Q&A with Nicks and Hirsch. Wish I could have spent the whole evening engaging with them, BUT we will continue in the coming months via their plans to bring the conversation off the screen and into the community(s, nationwide).

    Notes before I head out today – I’ll harvest these later for a post of my own:

    - I totally agree with the WaPo reviewer, whose last words opened Alex’s moderation: “The Waiting Room bears poetic witness to an overlooked fact: America’s health care system may be broken, but its people are anything but.” Time after time I was amazed at the generosity and patience of the wonderful people working in these difficult circumstances.

    I’ve heard about field operations in places like Haiti, but it’s different when we see them doing their job on the fly. IMO that’s the power of a non-prescriptive documentary that doesn’t say a word, instead leaving the “say a word” to us.

    - All the patients shown had no insurance. I asked the producers “How much of this do we expect will change as reform rolls out and we supposedly have universal coverage?” They said they’re not experts on the bill so can’t say for sure, but others said there are holes in the “universal” thing. I hope we can follow up on this.

    - That led me to wonder about countries that do have truly universal coverage. A friend in Europe said, during a visit last summer, that they treat everyone including illegal immigrants, because (as in veterinary herd health) they don’t want the disease in the population. I know foreign healthcare systems vary; what would their ER workers and patients say, seeing this film?

    (Note, I didn’t ask what their governments’ health policy people and economists would say. There weren’t any of those in this film, and they can always be subject to thinking in abstractions like “transparency”; I wonder what front-line people see daily.)

    - How the heck does a hospital like this keep its doors open?? Where does the money come from??

    p.s. Susannah, please make yer links open in a new tab – I keep forgetting and erasing my comments-in-process! Dumb of me, but I’ve gotten spoiled by expecting everything do behave the way I expect.:-)

    • Thanks, Dave! So happy that you made it to that showing. And yes, let’s keep following the stories as they unfold.

      Sorry you had trouble — I hadn’t seen the Advanced Settings for controlling the link URL for an image, so the movie logo is now like all the other links, opening in a new window. You are the best source of honest, helpful feedback — thanks!

    • Hi Dave,

      I work at the National Association of Public Hospitals and Health Systems – and Highland Hospital (in the film) is our member. You know how they keep their doors open? Federal funding, namely Medicaid. It is truly amazing what the folks do that work in hospital emergency departments like Highland’s. And seeing the patients that go through their doors and the hurdles the staff bear to treat these patients … All the more reason to protect Medicaid.

      To your point about insurance expansion, it is certainly important and critical to cover millions, but yes there will still be a gap. Safety net hospitals will continue to provide billions of dollars in uncompensated care, especially since Medicaid expansion is now voluntary for states. [more info: http://bit.ly/WEb7Km ]

      Another interesting thing to remember – yes, many of the patients in the film were uninsured and using the emergency department for regular care. But these safety net hospitals also are often the only Level 1 trauma center in the region and often the only training hospital in the region. So Medicaid funding and expanded coverage in turn actually save lives for those already insured – either because these hospitals are where you might end up if you get into an accident or natural disaster strikes, or because these hospitals train the doctors and nurses that will treat you elsewhere.

      I hope these conversations continue online and in person! We are eager to share perspectives and lessons learned, and share the facts about Medicaid. We are even launching a campaign at http://www.protectmedicaid.org – I encourage you to take a look!

  4. I am so happy that this film is getting much deserved recognition. When I came across the online storytelling portion more than a year ago, I was shocked and excited that leadership at one of NAPH’s member hospitals in Oakland agreed to such access in its emergency department. But what an amazing journey to take — sharing with the world the complexity of working in and seeking care in an urban safety net emergency room.

    Curious about how and why this got started? Read about it from the CEO at Alameda County Medical Center (and Highland Hospital): http://www.naph.org/Main-Menu-Category/Newsroom/Safety-Net-Matters-Blog/A-Miracle-on-31st-Street.aspx

    Would love to hear more feedback!

    • Hey Maya! So great to hear from you — thanks for that link.

      There were so many aspects of safety-net care delivery that we just glimpsed on the screen, such as language barriers, transportation issues, billing and payment challenges, turfing troublesome cases, differential treatment based on perceived class (at least that’s what I thought was hinted at with the young white couple’s storyline). There was even a tragicomic Dr. Google moment when the man with bone spurs thought it was a kidney issue and drank 3 gallons of cranberry juice to no avail (!!).

      I found the panel afterward to be just a taste of the conversation I wanted to have with people about it. Hopefully NAPH and other orgs can help keep the learning going.

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