The health care secret
The secret solution (at least partial solution) to the health care crisis is that it isn’t really that secret at all. It isn’t even rocket science. Not even medical science, really.
True, there isn’t one magic solution. Rather, there are hundreds of smaller solutions, not so magic but all pretty sensible. And while there are many solutions, I believe all can be derived from the same principle: Health care is about patients.
I know. Blew my mind too…
The biggest barrier to providing effective health today seems to me to be that decisions are more often made to accommodate administrative convenience or financial goals than to improve how the system cares for patients.
A couple of recent events have really made this clear for me.
First of all, there was a trip to the ER on a Saturday evening a few months ago. We had gone to ER, with much trepidation (because of notoriously long waits), because my wife had a very sore throat and was having a hard time swallowing. I don’t remember exactly when we arrived, but we didn’t leave until 4am, more than 8 hours later. This included a 6 hour wait in the waiting room, and a two hour wait in the examining room. Our human contact included my wife meeting initially with the triage nurse, being called in to the examining room 6 hours later, a stop in by a tech to take some blood and a nurse to order some tests (after we were in the examining room, of course). When the doctor finally showed up the conversation went something like this: “Well, it looks like you could have strep throat, but we would have to do (suchandsuch a test) to confirm. That would take a day to come back, but since I am not back here until next week, it is very possible the result could get lost in the system. It’s probably a 50-50 chance you have strep, so we could just start penicillin to treat it…”
Naturally, after waiting 8 hours and hearing that, she took the penicillin. The whole visit by the doctor possibly took 5 minutes, at the most.
The second incident occurred more recently, and is the culmination of a frustrating attempt to have someone seriously address some headache-like symptoms I have been having for quite a few months now. After some work, I was finally examined with some seriousness, and was referred to a neurologist. At the same time an MRI was scheduled. Unfortunately, when I received the appointment it was scheduled for a time when I will be out of town for Christmas. Thoughtfully, a number for the MRI scheduling desk was provided. I called.
When I called I was greeted by a voice prompt that went through some of the reasons you might call, and the action to be taken in each case. In all cases, the solution was some version of, “please leave your name and number and we will contact the referring physician who will then figure this whole thing out.” No, “press 0 and a human will lookat a calendar and find another appropriate date.” In fact, I wasn’t even given the option to press 0; the message just stopped.
Ok, now onto the fun part. Here are some simple solutions I came up with, well, without thinking too hard:
For the ER problem? Simple. When you present to triage, the person staffing the desk should be in a position, in most cases, to assess your situation, have a general idea of whether you are a complex case or not, order some basic tests (sore throat might get a blood test and throat swab or something) and decide whether you go into a group of patients that will require minimal attention from a phyisician (5 minuites and a prescription) or more attention or more complex tests (x-rays, scans etc). Then, ensure that the phyician, or perhaps a nurse practitioner, visits the “not too much attention” patients on a regular basis, so that the patients who don’t have to sit around all night don’t sit around all night.
Tada.
The next one is even easier: If I have to reschedule an appointment, I should be able to call and the person on the other end looks at an electronic calendar that aggregates whatever scheduling information they need, and books another appointment. The doctor will have provided whatever info is needed to judge the urgency of the scan, and any other judgement needed will be assumed to be part of the job of the person scheduling.
Both examples might require small increases in initial investment (more NPs for the ER or a more highly trained person scheduling) but the reduction waiting times would be huge, and would allow much more to be done with existing physical resources. Of course, ask a politician the value of having citizens who are more satisfied with the health care system and my guess is the answer would be universal: Priceless. The reality is that both solutions would likely result in lowered costs and improved patient care in the long term.
I don’t doubt there are numerous political and beaurocratic excuses why the system hasn’t dealt with such simple issues. My response would be that none of them are an adquate excuse. Until the system looks at redoing surgery on a patient to recover a surgical sponge as a patient safety crisis, rather than a financial one, we might as well stop talking about trying to “fix” health care. We’re just wasting our time.
