I’ve held season tickets on the fifty-yard line of health care for a long time, watching in alternating awe and horror at how medical interventions are provided. In the gratitude/wonder department, eleven years ago this month our daughter received a new set of lungs from an enduring-giver of life, the organs transplanted by a team of medical magicians.
Nothing detracts from that.
But it doesn’t mean I haven’t seen some things along the way.
I’ve written a couple newspaper pieces
(and, um, a novel)
about all sorts of institutional problems in the health care system; things that have long calcified into shrugging resignation.
(‘Oh you spent an extra weekend in the hospital because no one was available to set up home health care on Friday? Uh huh.’)
In terms of discharge-delay, hiring enough caseworkers to make arrangements at night and on weekends so things don’t get backed up has got to be a wise investment of health care dollars. I’m no economist but what’s the financial downside of employing enough people to avoid unnecessarily extending crazy-expensive inpatient stays?
Same goes for running diagnostic tests around the clock. How many extra days are spent in-hospital because most of the techs go home at 4:30, turning the lights off on the way out? It’s not like the facility actually shuts down. Why not take advantage of the resources in place and hire a second shift (at least) in order to expedite things that could actually decrease the length of hospitalizations?
(It would be incredibly cynical to even entertain the notion that extending admissions for insurance or out of pocket reimbursement is the actual point.)
Nurses on the Go—
The visiting nurse trend is another issue affecting health care these days. While the salary gulf between regular staff nurses and the travel variety explains why so many are opting out of the former group to join the suitcase-carrying (or even locally based) ranks of the latter explains the appeal, there are unintended consequences.
Starting with the pay differential itself.
Rewarding visiting professionals more than their full-time counterparts doing the exact same job is just kinda, you know, dumb. Automatic resentment is built right into the waiting work environment for the temporary hires. Apparently, though, the wage disparity is great enough that there are lots of travelers willing to suck up the acrimony (while also forgoing things like benefits and seniority) for the hard cash.
But constantly being the new kid means having to learn the ropes at each unfamiliar institution. And if you’re a patient of somebody without institutional memory, you might suffer. Just think about the snowflake variations in point-of-service machines at unfamiliar grocery stores when you go to pay. (Swipe? Insert? Where’s the enter button?) and then imagine what’s at stake is not just the hostility lifting off the line snaking behind you, but the delivery of actual lifesaving medication.
(Which is what happened to my daughter whose diabetes requires a different calculation than most, so that literally
she wanted to eat something during her recent hospitalization, the nurses needed to hunt down a physician in order to get an override on the standard order for insulin.) A travel nurse admitted reluctance in doing this as it was early days on the new job and he didn’t want to rock the boat being a pest.
So my daughter missed meals.
An anesthesiologist I happen to be married to says having a well-oiled team is a critical component of providing good care.
Someone Needs A Nap—
Speaking of being a doctor’s wife, this has provided a longterm, panoramic view of other issues in the system. For instance, I’ve witnessed up close the exhaustion inflicted on young doctors as part of the “training.”
During his internship (many) years ago, my husband and I went to see Richard Pryor. The comedian was hysterically funny, the crowd absolutely raucous—laughing and stomping so loudly it sounded like Pimlico on race day—but my spouse, fresh off a thirty-six hour shift, had to be woken up after the last curtain call.
That’s not just a funny anecdote because here’s the thing: Only a few minutes before meeting me at the venue he was still making high stakes decisions that could have had long-lasting ramifications for his patients. He might not have been single handedly running a code (or maybe he was) but you know, even just making a simple mistake in the computation of a Tylenol dosage can cost someone their liver.
These days interns and residents are limited to a mere eighty-hour a week schedule. And no more than twenty-four hours straight in the hospital. Which is better than what my spouse was subjected to.
Would you hitch a ride from DC to North Carolina with a glassy-eyed truck driver if he’d just driven straight from Canada? How about strapping your kid in the passenger seat? Because that’s what it’s like in the hospital when you reach out to a young doctor at the tail-end of his or her shift. These people are tired. Why do we expect them to have some super-human capability to stare down normal human fatigue just because they’re decked out in loose, green scrubs? Of course the same is true for older physicians working those hours. But at least they’re experienced.
Backing up a bit, I should say that the truck driver analogy isn’t actually that good. The government limits the number of hours they can drive to eleven.
I’ve witnessed other issues that are seriously counter-productive to good care. Like the hierarchal set-up. Employees are expected to stay in their own lane. On their own level. Which sure seems short-sighted when they might have valuable insight.
For example, a patient transporter told me that if he’d been invited to the design table before the institution’s physical footprint sprawled further across city blocks, he would have made sure that the most commonly used destination sites were placed closer to the relevant wards. Wheeling patients from point A to point B through endless halls, skyways and tunnels for far-flung scheduled treatments and tests is stressful. Especially if you’re on the clock.
And if your cargo is fragile all bets are off.
Weakest Link, Hospital Edition-—
On what turned out to be the day before the (unscheduled) life-saving transplant, I was in the painfully slow elevator with an aide and my terribly ill daughter on the way back from some distant test when she began coughing up blood.
By the handful.
Panicking, the employee and I began punching buttons on either side of the wheelchair, desperate to get back up to the specialist. We did just in time. But sending a critically sick patient off with an untrained aide (and an even less trained parent) seems like you know, poor planning.
Suggestion Boxes Work—
if taken seriously. They should be sprinkled throughout hospitals in particular, and the health care system in general. Consumers (like me) have some good tips. Just sayin.
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