Directed by Peter Nicks
Produced by Linda David, Peter Nicks, William B. Hirsch
Open'hood, ITVS, and Peer Review Films
Not Rated by the MPAA
November 2012 -- The new documentary The Waiting Room follows patients and staff in the overcrowded emergency room at Highland Hospital, which serves the poor and working class of Oakland, California. Working with footage shot over just 24 hours, director Peter Nicks (right) takes a good look at how the United States cares for its underinsured residents. The result is a quiet but compelling indictment of our dysfunctional health financing system. We see Highland's staff try, with skill and patience, to help emergency patients with ailments from gunshot wounds to chronic back pain, although what many of them really need is good primary care. The patients are resilient, but most have to wait a long time, and they are often frustrated, even agitated. Some just seem lost. The film gives physicians more attention than other care givers. And there are only a few glimpses of direct care nurses, even though emergency departments typically have as many nurses as physicians. Five of the eight health workers identified on the film's website are physicians. There is also one social worker, one nursing assistant, and one registered nurse. She is a charge nurse who appears in several scenes, always at her computer, expertly managing a long list of patients, determining who can be moved and when, who can be discharged and when. Sadly, the film never identifies her as a nurse, so viewers may not realize she is one. Yet some may well see the nursing assistant as a nurse. She manages patients in the waiting room itself, taking vital signs, collecting and dispensing information, and displaying diverse interpersonal skills. Of course, these are just guesses about how viewers will see the providers; some theaters showing the film call this charismatic nurse's aide a "feisty head receptionist." In any case, she and one of the resident physicians (Douglas White, right) form the moral core of the movie. For most viewers, the vision of nursing that emerges from this odd mix of likely misimpressions will probably be fairly good, but not great. The film's overall merit is clearer. As millions of people are still "waiting" for a more inclusive and effective health care system, everyone with a stake in that system--that is, everyone--should see this movie.
The Waiting Room opens on Friday, November 30, 2012 in Washington DC, Boston, and Sacramento, and in many other places in the coming weeks. See a full list of venues here.
The Waiting Room is part of a larger effort by the filmmakers and their associates to call attention to the actual experiences of the underinsured. The film is about 24 hours at Highland Hospital, but this is not the pulse-pounding of 24, or even ER. The movie has few trauma scenes, no celebrities, and no flashy stunts, unlike Michael Moore's 2007 Sicko, which also effectively highlighted defects in the nation's health financing system. Indeed, the new film has no third person narration at all, though occasionally a health worker (usually a physician) who is onscreen will narrate briefly over what we see. And in contrast to Moore's global approach, which showed how backwards U.S. health financing is compared to systems in other nations, The Waiting Room focuses entirely on one public hospital on one day, showing some presumably typical interactions between patients, family, and staff. Those who appear rarely seem to be addressing the filmmakers, and never the camera.
The real-life drama on display here can be sad and bleak, with an ensemble cast of troubled characters struggling against illness, but also against a sometimes mystifying bureaucracy and the social neglect that is both a key cause of the patients' conditions and a barrier to recovery. There are some comic moments, but people don't visit the emergency department when things are going great. The patients seem resigned, forlorn, frustrated, or lost, not quite sure where they are in the system, or why it seems unable to give them the care they need. One girl arrives with a bad strep infection; she virtually never speaks or shows any emotion. Her parents who have split up, care for her but seem barely able to acknowledge each other. An older man who has long worked as a carpet installer tries to get adequate care for his chronic back pain (right above). Another employed man arrives from another hospital that scheduled him for an operation for testicular cancer, only to cancel at the last moment because he was not a member of their network (right below). A patient who needs dialysis is bitter and abusive. And there are a few trauma victims, though their care is far from the familiar Hollywood vision of brilliant physicians working miracles with fancy machines. One angry man, who seems to have received treatment after being shot two days earlier, comes back complaining of numbness. He must wait while more emergent patients are seen. What many of these patients really seem to need, beyond an emergency department with adequate resources, is good primary care, or any primary care, which might have prevented or controlled some of the chronic conditions we see with less pain and at a fraction of the cost. All of the patients seem determined to go on, maybe because, to paraphrase one of them, the alternative is worse.
The movie clearly shows what the health workers face as they try to provide good care against difficult odds, but it is less interested in defining what roles the providers play relative to each other. At least the film does not exist mainly to glorify physicians, as Terence Wrong's wildly overpraised ABC documentaries like Boston Med and NY Med often seem to. The physicians who do appear here display none of the self-regard that infect many popular depictions and that too many media creators seem eager to endorse. And unlike Sicko, this film does not ignore nurses. Director Peter Nicks deserves credit for spending significant time with other health professionals. Still, physicians receive more attention than any other group. In real life, there are as many emergency nurses as physicians, and it's especially unfortunate that we see so few interactions between patients and direct care nurses here. The film returns again and again to the nursing assistant in the waiting room, but we see little of the triage nurse, who is making life and death decisions there. As good as the film is, it might have been better if it had spent more time with the nurses who provide much of the skilled care public emergency patients get and allowed the nurses to offer their perspectives about resource shortages, including nurse understaffing, as well as access to care and other issues.
The only significant registered nurse figure in the film is an apparent charge nurse. She is never identified for viewers, but the film's website says her name is Liz Lynch (right). She appears several times at her computer, seeming almost like an air traffic controller as she tracks where patients are, which beds are available, who can be moved, who can be discharged, all in consultation with the physicians. Lynch seems expert in patient management, though she is never seen away from this desk, so we never see her provide any direct care. And it's not clear if people will know she's a nurse at all, since she, like most of the others, is never directly identified. We do learn the identities of a few staff, including the social worker and at least one physician, when the camera catches their ID badges. Presumably the decision to omit onscreen identifiers is part of the film's verite approach, which reduces artificial barriers between viewers and the real drama before them. But that approach often does not serve nursing well because society understands the profession so poorly. Nurses cannot count on people picking up on subtle hints about their expertise or their central role in hospitals. And of course, even this film is highly structured. It is the result of countless decisions by the filmmakers, who did not just turn on a camera and later show viewers whatever resulted. Surely a great deal of material was shot, and the filmmakers decided who and what to show, what to omit, what angles to use, and so on. The film has music. Briefly clarifying a few job titles would not have broken any law of film naturalism.
By contrast to the nurse, the certified nursing assistant is one of the most important figures in The Waiting Room. The film's website says her name is Cynthia Y. Johnson (right), though viewers are not told that or that she is a nursing assistant. And because Johnson is so impressive, framing the story and arguably provided its wry soul, many viewers--even nurses--may conclude that she is a nurse. Johnson seems to act as a kind of triage assistant, taking vitals, calming patients, charming, cajoling, never talking down, and generally managing a waiting room overflowing with frustrated, suffering people. She maintains a constructive outlook, even when chastising one aggressive patient for swearing. She has the deft psychosocial skills we would hope to see in an experienced nurse. Of course, Johnson does not display much physiological expertise, because nursing assistants receive only a few weeks of training. But people are not used to seeing that from a nurse in the mainstream media anyway. It's easy to imagine some viewers saying, "Wasn't that one nurse in the waiting room awesome? She was my favorite person in the movie!" On the other hand, we're just guessing about how people might perceive these unidentified health workers. Nurses have been so scarce in mainstream media depictions of health care that many may not even know nurses work in the emergency waiting room. The theaters showing the film in DC and Boston actually describe Johnson in their online film summary as "the feisty head receptionist." So--does that improve the public's understanding of nursing?For nursing, The Waiting Room is a bit of a missed opportunity. But the film succeeds in creating a moving picture of what is wrong with the U.S. health care system, featuring some of the real people whose lives depend on whether we value civilization as much as slightly cheaper pizza.
Review by Harry Jacobs Summers
Nursing Editor: Sandy Summers, MSN, MPH, RN
Reviewed November 29, 2012
The views expressed herein do not necessarily reflect those of the Board Members or Advisory Panel of The Truth About Nursing.
See the film! Click for details for showings in Boston, DC, Sacramento, Portland Maine, Durham, Anchorage, Hartford, Lincoln, Denver, Chicago, Salt Lake City, Cleveland, Columbus
The Waiting Room - Kendall Square Cinema from Nov 30th through Dec 6th, 2012
1 Kendall Square, Cambridge, MA – (617) 499-1996
Daily show times: 1:45, 4:20, 6:45 & 9:20
Tickets on sale now: http://ow.ly/fAAwF
Friday, Nov 30, 2012 at 6:45 - SOLD OUT!
There will be a Q&A with director Pete Nicks & Producer Bill Hirsch
Moderated by Sara Archambault of the LEF Foundation
Saturday, Dec 1, 2012 at 6:45
There will be a Q&A with Director Pete Nicks & Producer Bill Hirsch,
Moderated by Paul Levy of "Not Running a Hospital"
The Waiting Room - E Street Theater from Nov 30th through Dec 6, 2012
555 11th Street NW – (202) 452-7672
With screenings daily through Dec 6th
12:00, 2:30, 5:00, 7:30 & 10:00
Tickets are on sale now: http://ow.ly/eLSpm
Friday, Nov 30, 2012 at 7:30
Special post- screening panel:
* Michelle Carter, M.D., Vice Chair & 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 & Chair of The Department of Emergency Medicine, George Washington University
* Moderated by Beth Feldpush, DrPH, Vice President, Advocacy and Policy at the National Association of Public Hospitals and Health Systems