By Curmudgeon. Just to make sure none of my anxious relatives read this and think this is me, I’ll repeat – no, I didn’t write this. That having been said, Curmudgeon has a few important notes about health care in America that we’d all be better off thinking about now rather that later. My family is also struggling with this with some of our family members, as well – the good and the bad.
I was just discharged from the hospital. I went in through Emergency, with a life-threatening condition. I had my wits fully about me during most of the time (when not on painkillers), and tried to pay some attention to what was going on around me. The hospital was a mid-sized facility in a small city in New England, and is probably fairly typical in that regard.
I’ll start with a couple of neutral observations.
- Health care, and health care delivery, are highly complex and involved. The machines used for diagnosis and treatment are big, highly sensitive, and expensive to operate and maintain. Yet because my hospital had them on site, I was able to get a diagnosis within two hours, rather than days.
- The machines are not compatible. They produce paper as output, and are not wired together in any sort of process as we might understand in business. This result in a huge paper file that must be available to the caregivers, and must be read and comprehended.
The processes involved are enormously complex and individualized. No two persons’ care is identical, and while individual steps are well-known and practiced, the process as a whole is driven by the needs of the patient.
Now a couple of positive observations.
- I was attended to by a large number of dedicated and caring professionals. I can’t say enough about the people who attended and assisted me.
- In the hospital no one is asked how they are going to pay for a particular test, procedure, or treatment. This is a really good thing; patients are in a poor position to make economic tradeoffs with their health.
Next a couple of not-so-positive ones.
- At my estimate, approximately a third of the time of these dedicated professionals was spent checking and correcting errors, omissions, or inconsistencies caused by others, or by the system itself. Some of this is to be expected; the processes involve humans, after all. But not this much.
- As a patient, you deal with a confusing array of care providers on a daily basis. For example, I counted a dozen different types of nurses before giving up, and that doesn’t include specialty nurses. No doubt these distinctions are made to differentiate both function and skill set, but to the outsider it is pretty opaque.
The number of specializations concerns me, but perhaps is justifiable by the complexities involved. However, I’m much more concerned by the lack of a seamless and accurate flow of information between them. There is also not one “master truth” in the system, as many professionals hold many different understandings of what tests were conducted and what treatments administered. I had to go through a stress test, for example, because the admitting doctor’s offhand remark that I seemed to have a mild heart murmur lead others to believe I was experiencing chest pains, which I was not.
I would like to think that much of the confusion and misunderstanding can be eliminated. As a computer guy, my inclination is to think of a set of automated solutions, but that may not be the full answer. But there are inefficiencies in the system that can be corrected, letting the health care professionals do the jobs they need to.