TCS Daily


Just What the Doctor Ordered?

By Glenn Harlan Reynolds - March 2, 2005 12:00 AM

In last week's column, I mentioned that I now have a bionic wife, courtesy of an implantable cardioverter/defibrillator device. She's now recovering nicely, but the experience has left me with a few thoughts on health-care delivery.

The technology seems pretty good. My wife's ICD is a technological marvel, and these devices are improving rapidly, something that seems likely to continue as Medicare's recent expansion of coverage for ICDs pumps more money into the system, supporting further research and development. The imaging technology that they used to implant the device, and assess the results later is pretty impressive. So is the wireless monitoring technology they use on the cardiac floor.

 

The people were also very nice. They were universally efficient, caring, and pleasant. (One nurse cheered my wife up by pointing to her (rather protuberant) belly and announcing that she had had a heart attack several years earlier but was now pregnant at the age of 46. Her bustling energy and good cheer were ample evidence that there's life after heart trouble.) As always, the physicians seemed more remote from most of the goings-on, but they seemed quite careful and competent.

 

It's other places where they fall down. Being in the hospital is an exhausting, draining experience even if you aren't sick. I spent a lot of time, and a couple of nights, there, and I felt like I had been run over by a truck. Imagine how I'd have felt if I had been, you know, a patient with something actually wrong with me.

 

Sleep interruptions are one problem. The floor below my wife's housed the sleep-disorder clinic, where they monitor people and try to help them overcome various problems, like sleep apnea, so that they can achieve an uninterrupted night's sleep. Ironically, it's probably the only place in the hospital where they let you sleep all night long if you want. My wife was interrupted, on average, about every 90 minutes or so all night long: To have blood drawn, to have vital signs checked, to have her temperature taken, to be given medications ("wake up, it's time for your sleeping pill" isn't just a hospital joke) and, most irritatingly, to be weighed.

 

Now, there are good reasons for a lot of this stuff. Medications have to be given at certain times, temperatures have to be monitored, and so on. Even the weight is important, especially for cardiac patients where fluid balance often matters a lot. (Though not in my wife's case, as her problems were different.)

 

But the end result of all of this stuff, especially when it's spread over the evening, is a huge amount of stress on somebody who's already under stress from illness. I don't think that anyone has done the experiment (as has in fact been done with regard to mental hospitals) of hospitalizing some healthy grad students for a couple of weeks and then measuring their condition on discharge, but I'm pretty sure I know what the result would be: Most of them would come out in far worse shape than they were when they entered, even if they managed to avoid other hospital hazards like nosocomial infections or malnutrition from lousy hospital food. And I rather doubt that anyone familiar with hospitals and hospitalization would disagree. That suggests to me that somebody ought to be thinking harder about ways of making the hospital environment more patient-friendly. It's impossible to make a hospital as stress-free as, say, a spa or a hotel, but it seems to me that with a bit of planning and organization it would be possible to do a lot better than we're doing now. (And several of the nurses with whom I discussed this problem agreed.) Like the traditional hospital gowns, an awful lot of things seem to be "flimsy, drab, and designed for the practitioners convenience rather than for the patients comfort." It's time for that to change.

 

Speaking of hotels and comfort, it might be a good idea for hospitals to pay more attention to visitors' needs, too. No matter how good the nursing staff is, they're understaffed almost everywhere. That means that hospitals rely, to greater or lesser degrees, on patients' families and friends for everything from minor services like refilling water glasses to fairly major things like monitoring treatments and medications to make sure there aren't errors. I always pay close attention to that sort of thing on behalf of my family members who are hospitalized, and have caught a couple of mistakes that might have led to serious problems.

 

You'd think that would be cheap malpractice insurance, and hospitals seem to notice in the abstract -- I saw posters telling people that if they couldn't have family or friends around they should hire someone to sit with them -- but not much is done to make the lot of long-term visitors easy; even the chair in my wife's room was excruciatingly uncomfortable. ("I'd rather be a patient than a visitor," one nurse told me). While there are some efforts along these lines, there's not enough.

 

I'd have liked a comfy chair, and high-speed Internet. (The latter would benefit patients, too -- my computer has a go-anywhere cellular card from Verizon, which the hospital told me was safe to use in the rooms, and my wife got considerable pleasure and relief from being able to check her email, keep her web-related stuff updated, etc. I think a lot of patients would benefit similarly, as hospitals aren't just uncomfortable, but crushingly dull. Yeah, I know: Comfy chairs and wireless Internet are my answers to a lot of problems. But hey, they're good answers!) But though Internet access would have been nice, I'd have settled for a comfy chair.

 

Call me crazy, but I suspect that if hospitals -- and health care generally -- ran more along market lines, there would be a lot more emphasis on making patients and visitors happy, and on organizing things more efficiently. As Andy Stedman notes, in writing about emergency rooms:

 

Restaurants and tire stores, like emergency rooms, never really know how much business to expect. However, it is unusual to have to wait hours for a meal or new tires, whereas in emergency rooms it seems to be the norm to wait hours for treatment. Theyre not full, either, theyre just woefully understaffed.

 

I wonder if this perspective will get much attention during discussions of health-care "reform?" Not unless those of us who think that way make some noise.

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1 Comment

Hospitals and health reform
I spent 30 years as a surgeon in practice and teaching a day a week. I retired after back surgery and spent a year at Dartmouth getting a graduate degree to indulge a special interest of mine: Quality improvement. When I finished, I found no one interested. The insurers were afraid higher quality would cost more. You'd think they would realize that Toyota already proved that wrong. Maybe the times are changing but I'll believe it when I see it.

Secondly, I think we need a universal health plan but the Canadian system is not one that would work here. The French system, which I analyzed in a series of blog posts here: (http://abriefhistory.org/?cat=184), might be the right approach. The French system is the best health care system in the world. It is diverse with private and government mixed and is almost universal in France.

We should look at it. Republicans are going to have to do something about this and should educate themselves.

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