Reflecting on the healthcare system while waiting at the hospital for a loved one

Often when we talk about healthcare reform, it can be a rather abstract discussion -- you watch some tv show with ‘experts’ reflecting on some 20 page bill or hashing through the merits of a public insurance option. Last week, however, all the intellectual and abstract ideas were brought into something very personal for me and my family.

My wife had a Hysterectomy, and I spent three days at Swedish hospital in Seattle caring for her. With all the waiting time, it was hard not to reflect on the experience and think about it in the context of health reform. I’m happy to say that my wife is now recovering on schedule, and she’s given me permission to share the story and my insights.

Once she had decided surgery was her best option, we became even more avid information seekers; we shopped for the procedure with the best outcomes and then the surgeon with the most experience and best quality results for this procedure. The best available counsel we found was for a Robot-Assisted Hysterectomy because there was less risk, less pain and faster recovery times vs. the alternatives. We didn’t have to shop for ‘price’ (thanks to Microsoft’s benefit plan, but that is a different future post)…but even if that were the case, we probably would have chosen a more ‘expensive’ option if it meant less risk and more productive days -- getting back to normal life as quickly as possible.

We all know that surgery can be pretty scary. Throughout the experience, everyone from the doctor’s office to the staff at Swedish helped to make the experience a positive one, allaying any fears and making us feel comfortable and confident. We often forget that healthcare is truly a people business. In just three days – the number of different people we dealt with was amazing -- five docs, seven nurses plus the ancillary folks (lab techs, transport and other helpers). They all took time to connect with our emotions while doing their jobs.

Swedish is leveraging technology to improve their systems. You see it throughout the organization, starting in the lobby, with signs advertising the hospital’s new EMR system. During the course of our stay, when there was time I asked various staff members about their experience with the new EMR, and they were positive about the system because they had all the information in one place. While a common complaint was that the data entry took them more time, they felt overall it made them more productive and effective.

This highlights that we need to remember that technology is a means to an end. It is NOT the introduction of technology that will make a difference, but rather how leadership leverages the right technology to make a difference…in both quality results and economic outcomes.

I also saw a real focus on patient safety, starting with the pre-op processes. Each member of the care team carefully checked her arm band, her chart and asked several specific questions to be sure she was getting the right action. For us, the repetition became frustrating, but if this process were to improve patient safety, then it would be worth it. Despite the technology investments, the core safety process was in the human factors.

After the surgery was completed, she spent two days recovering in the hospital. This was a day longer than originally planned due to very low blood pressure and a declining hematocrit. While I used the guest Wi-Fi for work and email, it was even more critical for answering key questions about her condition, the trade-offs, the next steps – which helped me to get some context and understanding to a) engage more thoughtfully with the care team about questions/choices and b) assure my wife about what was going on during the long time periods when neither doctor or nurse was around. I think hospitals should consider leveraging their video and wireless infrastructure more effectively for patient specific education and connecting with their care teams. This is potentially a big opportunity for improved patient compliance and care team coordination.

Because the low blood pressure persisted, I called her primary care physician to get her baseline BP. If we had stored this information in HealthVault, I wouldn’t have had to make the call – I would have just been able to look it up. Furthermore, I would have preferred to have gotten her discharge information automatically transferred to HealthVault. We were given paper copies. This should be easier.

So, what’s the moral of this story?

· We can’t lose sight of innovation and there’s a risk that could happen if the government were to become the primary funder of health.

· Technology is a means to an end, but we have a long way to go to figure out how to use it smartly.

· We can’t lose sight of how important the personal aspect of healthcare is. The emotional support and human caring delivered by the care team was the critical component of our overall satisfaction.

This experience reinforced for me that a ‘healthy’ health ecosystem requires consumer choice -- it is a critical component to the effective functioning of markets and innovation. We made the decision to ‘save time/hassle’ vs. saving dollars as we do in other aspects of our lives. This really drove home for me that the debate about ‘rising health care costs’ doesn’t really account for improved patient outcomes in terms of fewer lost days of work/productive living. I am all for comparative effectiveness of various options and knowing what things cost, but it needs to include patient values -- like less pain and getting back to normal faster -- or it may lead to bad unintended consequences. I am more concerned than ever that increased government financing of health will ultimately lead to fewer consumer choices and will stifle future innovation with tangible economic benefits.

I haven’t received the multiple confusing bills and outrageous line items of detail from the hospital stay yet. Nonetheless, when it comes to getting a quality outcome from an advanced surgical procedure, I prefer the current U.S. health system with all its flaws to the alternative future of less consumer choice and innovation.

Comments

• Anonymous
  September 30, 2009
  The comment has been removed

• Anonymous
  September 30, 2009
  I offer all my best wishes to your wife for a full and prompt recovery. That said, your post is amazingly self centered as you just take out the financial aspect. It really makes me think of Marie Antoinette telling the hungry crowds to eat cake if they cannot pay for bread. The Seattle Times tells on monday (front page) the story of Susan Haul who has multiple cancers and medical bills already adding up to more then $100.000 she cannot afford. How come you can dismiss story after story of people bankrupted by the present system? What "consumer choice" is that? How more self-centered (blind) can you be? What about researching what would happen to a person needing an hysterectomy and not having your resources?

• Anonymous
  September 30, 2009
  The comment has been removed

• Anonymous
  October 08, 2009
  The comment has been removed

• Anonymous
  October 16, 2009
  Peter, I commiserate with your experience of feeling as if you were in a patient education vacuum during your wife's (thankfully successful) procedure and recovery. I too spent an anxiety filled extended period at a hospital with a family member undergoing surgery. Having educational resources there would've gone a long way to inform me and mitigate my anxieties about the condition, procedure and treatment plan. Toward that end I have something I'd like to share the following with you, you might find this helpful to provide for your HealthVault/Amalga clients who will likely be in the same shoes we were:http://www.wired.md/krames03/. Please let me know if you'd like to discuss further. Best regards, Anne

• Anonymous
  October 20, 2009
  Hello Peter, Happy to hear your wife is recovering well from her operation and thank you for providing this personal story of your experiences. In a similar vein, I have had to visit several doctors/hospitals over the last few months and in each case getting a copy of my records is time consuming and ultimately the records are provided in paper format.  When I asked if I could receive my records in a digital form factor (CCD or CCR) have been told that no, this is something that they (doctors, clinic and hospitals) do not provide, though did get the X-rays on a CD (DICOM).  Now I am left with a stack of paper and am loathed to re-enter this info into an online personal health account.  More pain than perceived value.  Did a short post on the issue suggesting that what consumers need is a "QuickStart Guide": http://chilmarkresearch.com/2009/10/20/wanted-quickstart-guide-for-personal-health-platform/ My chief concern is that if this is difficult for me, someone who works in this sector, imagine how difficult it is for the average consumer.  Little wonder that adoption and use of PHRs and Personal Health Platforms such as HealthVault is slow going.