When you're the patient, 'healthcare' takes on new meaning

Thank you for your article. My sister just came home from her third hospitalization since December 1st, 2009. During the first hospitalization, she became apneic and hypotensive due to possible sepsis and adrenal insuffiency. Instead of giving her a stat dose of her steroids, her team felt she needed an immediate CT scan to figure out the source, damn be her blood pressure of 84/47 or her respiratory rate of 40. This was at 11 am. Finally, by 4:30 pm, she received her first dose of steroids, but was still hypotensive, anuric, and confused. When asked why she was not in an intensive care unit setting, I was told, "We are the best hospital in the country; we don't do that here." By 10 pm, my sister was on Dopamine and wide open fluids. When I mentioned to the resident that in the past, my sister needed bicarb in her IV to respond,I was told, "We are the best hospital in the country; we don't find that necessary". At about 4 am, when my sister had received 6 bags of IV fluids run wide open and several hours of Dopamine with no response in her BP or urine output, the resident gave up and added bicarb to her IV. Within 15 minutes, her BP came up and her urine output picked up.

I will not go into the rest of the oddyssey. When I asked the head of the hospital to look into what haad happened, I was told by one of his assistants that the problem was a clerical one; the reason why she did not get her steroids was because she was transferred fter the order was written. Well, since I spent 40 hours in the hospital with my sister from 11am until 8pm the following night, I know that was a lie. It was unmotivated and all-knowing medicl personnel that almost killed my sister and not some clerical error. And in "my day", a resident or an attending would have gone directly to the pharmacy to get the steroids in such a case.

You are so right, the new bill will only increase the odds of EVERYONE getting crappy care in most hospitals, even the country's "Number one hospital for eleven years in a row."

I am impressed by your ability to make such composed arguments on such a personal subject.

And, what is most interesting to think about, is that it would be nearly impossible to 'force' a true look at the healthcare system onto an administrator or decision maker within the system without it being a tainted view. If co-workers and caregivers knew that the individual was going through an experimental stay as a pseudo-patient, then their reactions and care may be compromised.

Only when the physical and mental sides are connected with the 'health - care' can an individual truly grasp the system that they, or a family member, are a patient of.

So, how can administrators and/or other decision makers get a real-life perspective on 'health-care' without being an unfortunate recipient of an emotionally charging life experience?

Thanks for your ideas!
Director of PR
http://blog.amistaff.net
Amistaff Healthcare Technology

I don't quite understand what the point is. What are the solutions, we all know the problems. Is doing 'nothing', leaving those without financial resources outside the system, the solution so that those within the system can continue to get their mediocre care. Let's come up with solutions, not complaining about what the proposed changes will bring. We have to start somewhere.

I can tell you this much: Flailing about, spending money the system doesn't have is no place to start. Lowering the bar so everyone gets care is no place to start. In most cases, care is not mediocre. These examples are the exceptions, not the rule. This country still has the best health care in the world, bar none. Here's a solution: Stop flooding the system with beaurocrats, creating even MORE third-party payees, and create honest competition between health providers. This will naturally improve quality and control cost. The "we have to start somewhere" argument is tired and has no merit. Health savings accounts: Enough said.

I'm really sorry your sister had such a bad experience. I hope that she recovered from her ordeal. It is unfortunately common in our schizophrenic system. I am a doctor, and came up in the days of 120+hour weeks during internship. That was nuts, but what we have now is worse: no personal responsibility for the patient. Everyone is a shift worker, it's no one's fault the order didn't get "taken off". I was taught that when you gave an order that emergent you saw that it was done. Period. You didn't write it and walk away and wait for the order to go to Pharmacy, then come up with the next delivery, then get noticed by the ER nurse who already has other patients, then gets tubed up by the clerk when she has time to the ICU where they say "I thought "they" gave it in the ER!

It's actually why I went into Anesthesia, because I couldn't stand nagging the nurses (did you give it yet?, did you give it yet?) and I couldn't stand NOT to nag them (what if they didn't give it yet?) When I want to give a drug I draw it up and give it, although that is becoming more difficult even in the OR. We had to appeal to get the emergency drugs unlocked so that we had access. One of my partners actually ripped the door off the drug cabinet to get drugs for an emergency c section!

I had a friend in residency who had Addison's disease (needed steroids in stress or he became very ill). He was visiting his family at home and became ill. Even when he told them he was a doctor, he had Addison's, and needed steroids, the ER doctor did not believe him and did not treat him right away. It's enough to make you lose faith sometimes... But if a patient tells me they need certain things and it makes sense and fits the clinical picture, I try to listen- it has kept me out of trouble many times. Unfortunately, the fast-paced production that we are "encouraged" doesn't foster that kind of communication. The answer always seems to be technology and distance from the patient, like the virtual ICU- you can treat the monitors without ever having to touch the patient! I worry that no one will know how to do a physical exam when I am old enough to need medical care...
But it would be much cheaper if we actually trusted our physical exam more, not to mention more gratifying to the patient. It would also foster the kind of honesty to maybe keep care appropriate rather than comforting