After decades of
writing about medicine, I finally found the (nearly)
perfect hospital.
It was a gloomy
Sunday afternoon last month. My little guy couldn’t
tell me what was wrong, but his breathing was
labored, he wouldn’t eat and he could barely walk.
I took him to
the emergency room, where the young doctor left no
doubt that he was dying. Congestive heart failure,
she said. Pneumonia, too. They took him straight to
the intensive care unit.
His
cardiologist, Dr. Nancy Laste, began giving him
oxygen, antibiotics and diuretics. Day after day, he
hung in, and so did she, though she was 9 months
pregnant.
That’s not what
impressed me. What did was the fact that virtually
every day for a week, Laste called me around 9 a.m.
and again at 5 p.m. Other staffers telephoned with
updates, too. I could also call anytime and have
someone read me the latest notes on the computer.
As you may have
guessed, my “little guy” was my 14-year old cat,
Dude, and the hospital was MSPCA-Angell in Boston,
which saved his life.
But the whole
experience has left me frustrated. If an animal
hospital can do so well at keeping family members in
the loop, why can’t people hospitals?
“That’s the $64
billion question – why can’t we do this for humans?”
said Gerald Kominski, associate director of the UCLA
Center for Health Policy Research. “A lot of people
have had this experience – the quality of service
they get in so many other sectors of the economy far
exceeds what we get in health care.” Among other
things, in hospitals, the patient often isn’t the
one paying for most of the care – that’s in the
hands of insurers.
Robert Blendon,
a professor of health policy and political analysis
at the Harvard School of Public Health and the
Kennedy School of Government, had a German shepherd
who was hospitalized in Philadelphia.
“The cardiology
resident called me every single day. Yet I’ve had
the personal experience with human relatives where I
could never get through to the physician or
resident.” Discharge instructions, he added, are
also often “better in well-trained veterinary
programs than in many discharges from [people’s]
hospitals.”
At the Institute
for Healthcare Improvement in Cambridge, a nonprofit
think tank, executive vice president Maureen
Bisognano uses a training video called “It’s a Dog’s
World” to make a similar point.
It shows a man
and his dog going for a walk and falling in a creek.
The dog gets whisked to an animal hospital, the man
to a people’s hospital. The dog is treated quickly
and caringly. The man encounters rudeness, long
waits, a bewildering array of caretakers and finally
makes it home. The phone rings. The wife answers,
thanks the doctor for calling and promises to give
him the right medications – in his dog food.
At Massachusetts
General Hospital, Karen Donelan, a senior scientist
in health policy has made a similar video.
If it’s such a
common observation among health policy analysts that
we do better with animals than with people, why
can’t we fix the people part?
Much of the
problem with human health care, the analysts say,
boils down to money, fear of lawsuits, the short
length of hospital stays, the sheer size and
complexity of modern hospitals, and, of course,
priorities.
Mass General,
for instance, sees 1.5 million outpatients a year
who speak 60 different languages; at any given
moment, MGH has more than 800 inpatients. Angell
sees 43,000 animals a year, of whom 60 are
inpatients on any given day.
On the other
hand, nursing ratios are not that different. At
Angell, there’s one nurse caring for every 8
patients. In human hospitals, the nationwide average
is one nurse caring for every 6, 8 or 10 patients,
depending on the severity of the case, according to
the American Nurses Association. Sometimes one or
two nurses care for a very sick patient.
To be sure, the
money flow is different. At Angell, pet owners pay -
and pay and pay - out of pocket, while most human
patients have some insurance. At Angell, the average
inpatient bill is $1,500 to $2,000. (Financial aid
is sometimes available.)
This freely
flowing money means doctors don’t have to spend
endless hours filling out forms. They don’t have to
“game the system” by trying to figure out under what
obscure insurance “code” to bill a specific
procedure. They don’t have to do unnecessary tests
to cover every potential legal liability.
“Veterinarians
don’t have nearly the administrative paperwork
burden that human doctors do, so they can focus on
what they believe is best for their patients,” said
Suzanne Delbanco, CEO of The Leapfrog Group, a
coalition of 175 corporations trying to improve the
quality of healthcare.
A people
hospital “has so many demands on it that this
customer-orientation ends up being a much lower
priority than trying to get the clinical side
right,” Kominski said.
But, with a
better attitude, couldn’t a people’s hospital set up
a system like Angell’s where a family member could
call in for updates? Clearly the patient would have
to give permission to satisfy federal privacy rules
and hospitals would have to verify a caller’s
identity and make sure its information was accurate.
But “there’s no
question we could do it technically,” said Dr.
Daniel Sands, an internist at Beth Israel Deaconess
Medical Center and information technology specialist
who helped pioneer the hospital’s PatientSite
system, a national model that allows patients access
to parts of their electronic records. Perhaps, he
suggested, there could be a secure website to keep
families abreast of their loved one’s condition.
“The problem,”
said Sands, “is how to get to the point where this
is routine care. Doctors are so overburdened with
work and that type of work – talking to families –
is something they don’t get reimbursed for.”
But it’s not
just about money, or legalities or time. When Dude
was at his sickest, Dr. Laste held off on blood
tests for a day because his condition was so fragile
she did not want to stress him further. In people
hospitals, patients are awakened at all hours for
blood tests or CT scans even though they, too, need
their rest.
Sure, Angell is
different. Where else would you find a penguin with
sinusitis? Or a snake having chemotherapy? In what
other ICU would you see the touching but hilarious
scene of humans closed inside big dog cages, feeding
and hugging their furry loved ones.
Still, I’d be
tempted to check in there myself. There is only
thing I wouldn’t like – all those barking dogs in
the ICU.
Judy Foreman’s
column appears every other week. Past columns are
available on
www.myhealthsense.com.
