Our health care has morphed into a beast we haven’t been able to tame.
Its costs are the highest in the world and keep rising faster than inflation. Outcomes languish somewhere just north of third world countries. For instance, on my recent visit to Cuba I found that their perinatal mortality rate is actually better than ours.
Our patient satisfaction ranks at the bottom of the list of wealthy nations. Health-care errors are the third highest cause of death. Physicians are widely dissatisfied.
We love and are proud of our beast. Politicians brag it’s the best in the world. We’re fascinated by regional health systems’ burgeoning growth and gleaming buildings. We’ve seemingly adopted the attitude that costs are high, but acceptable and outcomes statistics are merely statistics.
Last week, over the course of two days I became seriously ill with sepsis from a chronically infected colon diverticulum that silently ate its way into the bladder, creating a fistula that mixed stool with urine.
The technical medical care I received was unassailable. The system for entering the hospital was followed. That’s the problem. Here’s a peek into my experience in the belly of the beast.
With my symptoms, my physician knew immediately what the problem was. He wanted to confirm the diagnosis with a C-T bladder scan and have me urgently hospitalized to receive intravenous antibiotics.
Nowadays, most in-hospital care is coordinated and/or provided by hospitalists, hospital-based physicians. My physician had two choices. He could admit me directly and consult a hospitalist for follow-up care or he could have me go through the emergency room (ER). Which would be best?
Knowing the system’s idiosyncrasies, he called the hospitalist, hoping to expedite matters. Also knowing how the system works, she told him if I were admitted directly the hospitalist would see me, as a new admit, when he got around to it. The best bet, she thought, might be tp go through the ER.
That’s where my daughter, Susan took me. Nobody, of course, knew about the earlier conversation between my physician and the hospitalist.
There are three non-trauma levels of ER service, controlled by separate physicians. I started at level one. After giving my story and having vital signs taken by a nurse, in due time I saw a busy triage physician. He ordered the same lab tests I had done at the same lab a few hours earlier. Before the results were back he agreed I needed to be hospitalized, but that wasn’t his decision to make.
So I was transferred to a level two suite where the same questions were asked and vital signs done. Hearing my story and noting that I now had a fever, the experienced nurse said he was sure I’d be hospitalized. But I’d have to see his busy attending physician. In due time, I saw her and gave the same story. She ordered a six-minute C-T scan.
Five hours after arriving at the hospital, she returned to tell me that the scan showed the expected fistula. She said she was sure I would be hospitalized, but it wasn’t her decision to make. That would be up to the hospitalist on duty.
My condition was deteriorating. My shakiness and unsteadiness worsened. Susan noted I was less coherent. I’d had nothing to eat since noon. She gave me a candy bar from her purse.
A blood test was ordered to test for early septic shock as I waited to see the hospitalist.
In due time, from working elsewhere in the hospital, he came to see me in the ER. We knew each other from my working there.
He agreed I needed to be hospitalized, admitted me and ordered intravenous antibiotics.
Seven hours after taking the “fastest route” to admission and treatment, I was transported from the ER to a room. I responded well to the antibiotics, was discharged home less than two days later, and will return for remedial surgery next month.
So what to glean from the shiny beauty’s innards?
Health care is a process badly in need of streamlining and engineering. As my condition deteriorated in the ER, all resources were wasted.
Nonprofit health care is essentially a cost-plus industry. The sky’s the limit. Competition between health systems is for market share, growth and prestige.
The beast will not be tamed until universal criteria are established and reported on outcomes and patient satisfaction, with proportionate payments made for services.
Then health system competition will be credible.