Saturday, June 09, 2012

The Journey We Take Alone -- Part 21

 By Alexander "Sandy" Prisant

The Health Care Follies: 2012
I want to talk to you about hospital insanity. It has nothing to do with the psych ward.
Recently I had to stay overnight at a local hospital. With all the things going on in my body, this is no longer a big deal. Scary stuff may be happening, but nowadays it feels more or less like going for a haircut. 

This latest visit was only 36 hours long, but it reacquainted me with The 10 Rules of Hospital Havoc. They go a long way toward explaining why, while we keep telling ourselves we have the world’s best healthcare, the one objective judge of these things--the World Health Organization--says we in fact rank 37th in quality amongst modern industrialized nations.  That is a seven with a three in front. Since there are only about 20 or 25 civilized western nations, this is a little scary. It certainly scares me.

Almost as soon as you get to the hospital you begin to see why, as the rules of hospital havoc are rolled out before you:

1.            You are not a patient, you are a profit center. In terms of operations, investors and profits, there is very little difference between Hospital Corporation of America and United States Steel. Or for that matter, Jack’s 21 Lane Boardwalk Bowl-o-rama.

2.            Computerization does not enhance patient care; it reduces it.   Nurses now stop by your bedside far less than 20 years ago. Know why? They are now trapped in a glorified hi-tech typing pool, transcribing doctors’ notes and orders—right down to what happened to that aspirin that fell on the floor.   Nurses fall into two categories---the ones who are computer literate and spend 80% of their time inputting everything. And the other 20% who snuck by the computer orientation course and now spend 100% of their time botching the transcriptions and frantically recopying everything by longhand on scrap pads they hide in their white frocks.  After all that and taking endless vital signs, time remaining to attend to actual patient needs is somewhere between nil and zero.

3.            HIPAA is a Communist plot.  The Federal Health Information Portability Act is like something out of Orwell’s 1984.  In theory it is meant to keep your most intimate medical details confidential. In practice it allows them to be broadcast to your dry cleaner, your local school crossing guard—almost anyone in fact, except you. (Note: Before Congressional gridlock, HIPAA seemed a sterling piece of bi-partisan legislation. So let’s be careful what we wish for now.)

4.            The four hour rule. There is no decision of any magnitude that can be taken in hospital in under four hours—including a glass of water. One exception is cardiac arrest. Hospitals are only helpful for people who have completely stopped breathing.

5.            The diet scam. If two days’ eating mattered that much, why did you need to come to the hospital in the first place? The staff turns diets into the Holy Grail —but it’s usually heresy.  When I checked in it was imperative that I receive a high protein diet to prepare for a treatment. Instead I was put on a low low protein diet. It took 7 staff over 8 hours, to correct this—delaying treatment by 10 hours.

6.            The “Who, Me?” rule.  Hospitals have hundreds of staff whom only know the first rule of the Hippocratic Oath is “Do no Harm” The second rule should be ”why bother showing up?”.  All staff can only do one thing well--not make a decision. Everyone has been bludgeoned into mind control that will not allow any common sense thought.  Pills are given at three set times of the day. None of these include meal time. If you absolutely must take a medication with your food the only possible answer is to sneak it in from home. No hospital pharmacy will give it. No nurse will help.

7.            The Charge Nurse Shuffle. Each floor has a charge nurse. Modern anthropologists have yet to determine what this person actually does. Her main role seems to be introducing herself in the 30 minutes before you depart. She will then effusively offer to do anything she can. During the final half-hour  I had three small requests. She could not help with two and wanted me to call some other staff for the third.

8.            The Paper Chase.  People used to leave hospital in the morning, now you’re lucky to beat the evening rush hour.  Apparently three doctors, the hall monitor and the cafeteria lady have to sign off before anyone can leave. A prison parole does not require this many signatures.  You are then handed an absolutely useless set of print outs that exclude everything the hospital has learned about your condition.  Mine stated across the top “High Risk Patient”.  It then promptly dropped that subject and went into boilerplate: a number to quit smoking (I don’t smoke), the local Cancer Society (I don’t have cancer) and adozen more help groups that had nothing to do with me.  A great flourish was made as my nurse and I signed off on these standard wholly irrelevant pages. I felt like I was being awarded something torn from the Yellow Pages.

9.            Indoor ambulance chasing is kosher.  Beware of strange doctors bearing “gifts”. A cardiologist I’d never met sidled;up to my bed and talked to me for 14 minutes. He then said: I’m going to help you.”  But it sounded more like “Trust me; I’m a lawyer.” An hour later, a zombie nurse trained only to follow any stray doctor order,had placed me on restrictions in preparation for my heart procedure? My what?!? My heart may just last long enough for transplant.  It is not a suitable organ for a round of pin the tail on the aorta.  By bypassing the medical team that has cautiously shepherded me through the past 10 years, this hotshot cardiologist saw a profit opportunity and tried to take it.  When I sounded the alarm he was already marshaling staff and had an operating room lined up.  By saying no to all of it, we may have saved me, Medicare money and Hippocrates from rolling over in his grave.

10.            Mistaken identity is reducing but not vanishing. Think of every staff member as a snake oil salesman.  They are giving you pills and attempting procedures on you, but usually don’t know why, because their only job is to follow orders.  So ask questions—lots of them—all day.  It’s mostly your brain and your common sense standing between you and some nice young doctor treating you for what that lady in the next bed is suffering from.

Alexander "Sandy" Prisant, who lives in Florida with his wife Susan, is writing a long series of articles on his chronic kidney ailment; currently he awaits a kidney and heart transplant. To find earlier posts, simply go to the Search function on MyStory and type in his name. 

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