I did it backwards and said the good news first. Now, the bad news.
I have been reading about healthcare all day and it makes me want to cry. I love the life sciences, I love doctors and nurses and what they do, I think there have been amazing advances in healthcare and I don’t think any of the current problems are beyond fixing.
But damn. There are a lot of problems.
I’m sure more problems are developing, right now, AS I’M TYPING. For example, this past week Obama appointed Dr. Donald Berwick as administrator of the Centers for Medicare and Medicaid Services, and already Berwick is drawing heat. He is going to ration healthcare!
It pains me how emotional and partisan his appointment became and he hasn’t even done anything yet. For a more sane opinion on his appointment, click here.
Anyway, that is just a recent problem. There are also all those other long standing problems, the kind we like to let fester until something dramatic happens.
During my recent trip to the Brigham and Women’s Hospital, Brad Boehringer, 33, an Emergency Department (ED) nurse, started by giving me a tour of the department. As he talked, the festering problems started pouring out:
1. The way the computer banks are organized (in I-shaped rows with doctors’ workstations on the inside, nurses on the periphery, their screens facing the patient rooms) leaves nurses vulnerable–their backs are to the patients and it’s easy for people to read over their shoulders.
2. There aren’t enough rooms for psychiatric patients. Psychiatric care rooms are specially designed so the patients don’t have access to medical supplies or sharps containers, and the rooms are often occupied for days because there is nowhere else for them to go. Not enough in-patient psychiatric facilities.
As we started talking more about the rest of the hospital, he had other concerns as well.
3. The Emergency Department is flooded with people with pretty benign problems–a sore ankle, a bit of nausea. I asked him why those patients didn’t just go see their regular primary care physician. After giving me a high-five and telling me I would fit right in at the ED, Boehringer said it was because people had to wait for a few days or weeks to get in to see their primary care physician. By then their problems usually go away, evidence, he said, that those patients never needed to see a physician in the first place.
4. Many patients come in because they want drugs. Before I arrived, Boehringer had a patient who came to the ED because he wanted more Dilaudid (a trade name for hydromorphone). Apparently, the patient’s dog chewed up his original bottle, and though the dog did not break through the bottle or ingest any of the drug, the patient was worried the drug might be contaminated and thought it was best to dispose of it. Yeah, Boehringer didn’t buy that story either. Prescription drug abuse is on the rise, and EDs are seeing the effects. In the patient’s defense, apparently coming down from hydromorphone is a bitch.
Other honorable mentions:
- A loose take on “informed consent.” While Boehringer is careful to ask a patient which arm she would like her IV in, rather than simply telling her he was going to insert one, the Physician’s Assistant says flatly “we’re going to run some tests,” before sweeping out the curtained door. The patient might have been happier to discover she wasn’t pregnant had she known she was getting a pregnancy test in the first place.
- The lab. It may be accessed by a cool futuristic chute in the middle of the unsafe work stations (see above), but when the lab results come back showing the patient has a possible urinary tract infection, Boehringer has to call down and urge them to culture the sample and determine what infection she has. Apparently the lab only likes to do half its job.
Clearly, these are big problems that will require more than one blog post to discuss. That’s okay, this blog was getting too broad anyway. Why focus on all of healthcare’s problems when the Emergency Department alone has such a rich supply? So just sit back, and get ready to watch the horror of Emergency Department issues unfold before you.