Tuesday, February 21, 2017

The Good, the Bad, and the Ugly in Health Care

I hate being a patient.

I have to admit that, although I write about health care, I am typically what can be described as a care-avoider.  My exposure to the health care system has mostly been through my professional life or through the experiences of friends and family.  The last few days, though, I unexpectedly had an up-close-and-personal experience as a hospital inpatient.

I want to share some thoughts from that experience.

Now, granted, any perceptions I gained are those of one person, in one hospital, in one medium-sized mid-western city.  Nonetheless, I offer what I consider the Good, the Bad, and the Ugly of the experience.

The Good:  The People

The various people involved in my care, from the most highly trained physician to the person who delivered meals, were great.

I loved my nurses; they fit all those great stereotypes people have about the profession.  Attentive, caring, cheerful, knowledgeable, hard-working -- the list goes on and on (full disclosure: I'm married to a nurse, so none of this came as a surprise).

I liked my doctors a lot.  Each of them spent literally hours with me -- answering my (many!) questions, discussing what they thought was going on with me, describing the various tests or procedures, developing care plans to fit me.  They were super-smart and a pleasure to talk with.

The aides, the lab techs, the imaging tech, the transportation specialists -- all of them doing jobs that I wouldn't be able to do -- were each friendly and helpful, taking pride in what they did and how it helped my care.

Whatever you might say about our health care system, you cannot say that it is not filled with people who don't care about the patients in it.

The Bad: The Processes

On the other hand, on the lists of criticisms about our health care system, many of its rules and processes truly do deserve a place.  They're like part of an arcane game no one really understands.
I'll offer three examples:

  • Check-in: I was literally on a table in a procedure lab -- still wondering how the hell I'd ended up there and not quite sure what was about to happen to me -- when I was asked to electronically sign several forms (Privacy Policy, Consent to Treat, Consent to Bill) that I could neither see nor was able to question.  No court of law could call that informed consent, but that's what the process required before I could actually receive care.
  • NPO:  At one point it was thought that, on the following day, I might have a procedure, so I had to be NPO (no food or water allowed) for at least 4 hours -- but starting at midnight.  I pointed out that it was highly unlikely that they'd be doing anything at 4 am, and even mid-morning was unlikely since nothing was yet scheduled, but that was not persuasive.  As it turned out, I'd gone something like 16 hours NPO when they finally listened to my concerns: by putting me on a saline solution IV.  I think they understood the physical problem but not the human one.  (It ended up I didn't have the procedure anyway.)
  • Discharge:  On my final day, the doctor told me around 1 pm that I was being discharged.  Around 3 pm his nurse practitioner told me she'd personally written the discharge orders.  Around 5:30 pm my nurse gave me all my discharge papers, but told me I had to wait for Transport to escort me out in a wheelchair (even though I was perfectly capable of walking).  Finally, around 6:30 pm my wife simply commandeered a wheelchair and we made a break for it.    
The rules and processes are all undoubtedly in place for good reasons, but we need to un-handcuff all those great people when rules and processes get in the way of better patient care.  

The Ugly: The Technology

Oh, health care technology.  It is equally capable of delighting as it is of frustrating.  It is truly remarkable that the doctor could go up my arm to perform a procedure in my chest, just as the detail an MRI provides is simply astonishing.  

On the other hand, those gowns...

Let's start with the perennial whipping boy, EHRs.  All of the staff used them, seemed to accept them, and even (grudgingly) acknowledged their value.  But no one liked them.  Even the youngest users, to whom technology is a given in their personal lives, were frustrated by the interface.  And, on many occasions, EHRs did not mean that people did not still often have to drag in other electronic equipment or even paper in order for them to do their job.

EHRs could be better, should be better -- and better get better.

MRIs are a wonderful technology, but as I was laying in that claustrophobic tube getting imaged, I kept thinking: what the heck are all those clanging noises?  We can make stealth submarines, but we can't make an MRI that is quiet, so that anxious patients don't have more to worry about?

I was on various forms of monitoring devices, the smallest of which was the size of a 1980's cell phone and still required countless wires attached to numerous leads.  I kept looking at the set-up and wondering, hmm, have these people heard of Bluetooth?  Do they know about wearables?

My favorite example of ugly technology, though, came when I had to fill out a form (which looked like it dated from the 1970's), so that it could be faxed to the appropriate department.  That's right, faxed.  To a department in same institution, in the same building.  I couldn't fill it out online?  A paper form couldn't be scanned and sent securely to the other department?  

I'd love to be the boss of the guy who has to request a new fax machine, just so I could look at him with my best "you've got to -be-kidding-me?" expression. 

No health care system is perfect.  Every system has its own version of the Good, the Bad, and the Ugly.  No one wants to have health problems, and no one wants to need to be in health care settings.  When we do, and when we have to be, though -- well, our system can do better.  Let's give all those great people working in health care a better chance to help us.

If any of the above strikes home for you, perhaps you'll Like/Recommend, tweet, or otherwise share with your circle.

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