My Up Close Look at Health Care

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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.

photo by Rodrigo Basaure

5 comments

  • Curmudgeon: Glad you are home recovering. Just like you, my mother (84 years old) was in the hospital and came home yesterday. Just as you said, the people were great but medicines were seemingly not coordinated (old prescriptions, still in effect were, were not compatible with new) and tests were ordered and re-ordered. There are 21st century medical devices being used in 19th century fashion in most hospitals today, I suspect. And the cost, I don't even want to think about what this will cost. Sure, she has insurance, but we all pay one way or the other for the unnecessary tests, the duplicated tests. Oh, well, happy Thanksgiving!

  • Curmudgeon, your keen observation is spot on. There is way too much incompatibility and administrative overhead in healthcare today. And, the number of people who are harmed or killed by medical mistakes is completely unacceptable.

    There is a standardized medical records system called EMR, but its expensive and difficult to implement. So, many hospitals haven't. There is also a standard interface for medical equipment that works over ethernet, but often hospitals don't have the networked devices hooked up.

    So, I guess we still have a long way to go.

  • funnyaboutmoney

    You went in on a holiday during a flu epidemic? You were very lucky to get care at all.

    One Christmas, I went to an ER with a life-threatening condition that needed emergency surgery. After spending four hours in an ER so jam-packed there wasn't even a place to sit down (and the floor was too filthy to sit or lie down there) without even so much as a brief triage, I called a friend to take me home, figuring I'd rather die in my bed than shivering on a concrete bench outside the ER, in the company of a young woman who was miscarrying a pregnancy and also getting exactly zero medical care.

    Not until the next morning was I able to get someone to take me to a hospital in a more upscale section of the city, where after 19 hours of excruciating pain I was slapped into the operating room.

    I was lucky I didn't die, and I am thankful for the surgeons and the competent staff at the second hospital who did something other than tell me to take a seat. If it had happened 50 years ago and treatment had been delayed that long, I would have died…but on the other hand, 50 years ago people who went to the ER went there because they had real emergencies, not colds and flu, and a 19-hour wait would have been unthinkable.

  • funnyaboutmoney

    You went in on a holiday during a flu epidemic? You were very lucky to get care at all.

    One Christmas, I went to an ER with a life-threatening condition that needed emergency surgery. After spending four hours in an ER so jam-packed there wasn't even a place to sit down (and the floor was too filthy to sit or lie down there) without even so much as a brief triage, I called a friend to take me home, figuring I'd rather die in my bed than shivering on a concrete bench outside the ER, in the company of a young woman who was miscarrying a pregnancy and also getting exactly zero medical care.

    Not until the next morning was I able to get someone to take me to a hospital in a more upscale section of the city, where after 19 hours of excruciating pain I was slapped into the operating room.

    I was lucky I didn't die, and I am thankful for the surgeons and the competent staff at the second hospital who did something other than tell me to take a seat. If it had happened 50 years ago and treatment had been delayed that long, I would have died…but on the other hand, 50 years ago people who went to the ER went there because they had real emergencies, not colds and flu, and a 19-hour wait would have been unthinkable.

  • health_wellness_tips

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