Thursday, October 20. 2011
I spent the last four days observing the notorious US health care system in action. My wife underwent surgery, and I mostly hung out, observing. I had been reading more than my share of nightmare stories, but it all went about as well as it could. The case was complicated, but the surgeon and her team seemed to understand it and appreciate the intricacies. The surgery itself went quicker and smoother than anticipated, and the projected three day hospital stay was cared for with patient confidence. There were a few problems that cropped up -- too-frequent oxygen saturation warnings, nausea coming out of the anesthesia -- but they were recognized and sorted out. The nursing staff was far more attentive than I recalled from ten years ago when my parents had extended hospital stays, or my wife's previous surgery when she was booted out of the hospital with unseemly (and as it turned out unfortunate) haste. The room was private, and I was invited to stay as long as I wanted -- 24 hours a day. I even found the nurses asking if there was anything they could do to help me. I managed to be present pretty much every time a doctor came by, and every step was intelligibly explained. It helped that my wife was fully cognizant of the whole process, and always knew what she needed to work on when to make progress. In short, it was pretty close to ideal: the way a hospital should work. No doubt the bill was damn expensive, but I didn't get the sense of wasted effort or overtreatment.
It no doubt helped that the surgery was a well understood procedure, and that the treatment was very closely aligned with it. My wife had no significant illness going into the surgery. That is, for instance, a very different situation from the one where my father entered the hospital with MDS, being treated by a staff of cardiologists who had no idea what they were up against, who made one mistake after another before they finally dumped him off on a doctor who had a clue. Or I could dredge up other cases from my own limited personal experience. (E.g., when my father spent four days in surgical ICU due to a lung infection that defied their treatment until it was fully cultured and identified. Or when my father-in-law was prescribed a drug for an eye problem but given a drug that crashed his blood sugar level, which then resulted in several days of unpleasant tests investigating his presumed hypoglycemia.)
Still, it isn't hard to imagine lots of things that could have gone wrong here that didn't. For one thing, the hospital had instituted a software system that tracked drug doses and interactions -- probably the samd system the VA hospitals are famous for: it slowed the nurses down repeatedly scanning patient and drug barcodes, but it eliminates errors that elsewhere are astonishingly frequent (I recently read as much as one per patient per day). The ratio of nurses to patients was higher than I had ever seen outside of an ICU. We never had to wait more than 1-2 minutes after calling a nurse, and they were never in an excessive rush to go elsewhere. Occasionally I would step out into the hall and see one at a computer . . . looking at what appeared to be continuing ed materials.
I suspect that this was a rare case where business competitiveness served to improve the care level: well-insured patients could choose to come to this hospital vs. the other competitor, and for the types of surgeries this particular ward handled there was enough profit to be made to reinvest some in quality service. So to some extent you can chalk this experience up as a victory for the American system (although as my wife is on Medicare I don't give any credit to the private profit-seeking insurance companies). Still, this doesn't argue that health care reform is not necessary. Rather, this reminds us that a reformed system has to maintain this sort of quality level, and to extend it more evenly and equitably. And it reminds me that it can be done, for even if this particular case represents a shrewd business decision on how to run a wing as a profit center, one key reason it succeeded is that the people working there were free to serve without having to constantly recalibrate their actions in favor of padding the business' bottom line.
Personal note: we're back home today. My wife still has a ways to go to get back to normal, but that seems certain to happen in due course. And I need some sleep, but that too will happen.
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