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Firsthand symptoms of a broken healthcare system

Posted Jun 10 2010 11:34am

by Thomas Dahlborg

It's one thing to discuss anecdotal symptoms of our broken healthcare system. It's something totally different to live with those symptoms, or to witness their impact on a loved one. The cost of a broken healthcare system to a dear individual is significant. The financial cost to us all of having a broken system can be significant, as well.

Today I want to tell a story about a family member "Betty" and her recent experience in our healthcare system.

Last week, I had the privilege (along with my wife) to bring Betty to her doctor's office for a follow-up visit after a recent hospitalization for chest pain, shortness of breath and numbness to her face and arms. Betty is 75 and she has been working with her doctor to manage her diabetes, high blood pressure and heart condition. Recently she was informed that her primary doctor had over-prescribed her medications. During the emergency room visit, it was the attending physician who concluded that Betty was, in fact, overmedicated; as a result, she was having cardiac symptoms due to too much potassium in her body. At discharge, the doctor discontinued several of her medications, including diabetic meds and blood pressure meds (which included a diuretic), and prescribed her a new respiratory inhaler to be used daily as a maintenance medicine for her breathing.

Little did we know that Betty would not start using this new inhaler primarily because she could not understand the provided directions for use. She also became anxious when reading the pamphlet's list of adverse side effects, which were written in tiny, hard-to-read type.

As luck would have it Betty happened to be visiting with my family for the last week. During this visit she had increased symptoms of shortness of breath and very swollen ankles, thus requiring her to use her rescue inhaler more often than recommended.

Our intention last week was to bring her to the doctor to be able to see, firsthand, his care plan for her current medical condition. Upon arrival to the health center, we were greeted by an amazingly kind and loving nurse. She gently guided Betty and my wife to the exam room, the entire time providing comforting words of encouragement, and referencing Betty's last visit and recent health challenges. The nurse also determined through physical assessment that Betty's blood pressure was off, and that she was struggling with her breath and words. The nurse checked Betty's oxygen level and found it to be at 80 percent saturation, far lower than a normal level of 98 to 100 percent saturation. The nurse immediately informed the doctor and started Betty on oxygen.

Soon, the doctor also began an examination. After 10 minutes, Betty and my wife left the exam room with the understanding that the doctor had e-scribed two new medications. The two new medicines included low dose Glypizide, added only in the morning with her other diabetic medicine, and low dose Spironlactone for her blood pressure and fluid retention. The doctor stressed that the diuretic medicine MUST BE FILLED and administered that very day!

Now, add to this that the doctor was unaware of a particular blood pressure medication that Betty had been on for years because the information did not cross over to the doctor's new Electronic Medical Record (EMR). And in fact the doctor almost misdiagnosed the situation because of the lack of data and his unwillingness to believe Betty when she reminded him that she was, in fact, still on this medication.

Betty was quite stressed about the whole ordeal and quite anxious to get her meds. We immediately went to the pharmacy where we were informed that only one of the meds had been e-scribed successfully, but a second--the diuretic that needed to be filled and administered the very same day--was never received. We then called the doctor's office to remind them to call in the prescription--rather than simply e-scribing it in. All the while, Betty became more and more anxious that she needed her diuretic. A couple of anxiety-filled hours later we had the diuretic and began the process of ensuring Betty knew how to administer the med.

We continue to check in with Betty and she is now doing very well. She has her appropriate medications and understands how to administer them. Her anxiety about her meds is in check as now she has a resource who will provide her with an ear, a shoulder, an open heart, undivided attention and time (my wife).

But as seen in this patient story, technology, while being a significant part of the solution to improve the healthcare system, cannot be seen as the entire fix. We cannot lose focus on patients, and must leverage technology to enhance the time and relationship between the patient and the practitioner (be the practitioner a physician, a nurse, or other health care provider).

True relationships breed trust and understanding, and in this case, a true relationship would have yielded a better outcome and prevented a hospitalization.

Thomas H. Dahlborg, M.S.M., is executive director of the physician practice True North Health Center , where he focuses on improving growth while ensuring access for the uninsured and the elderly. He has 21 years of experience creating competitive advantages, analyzing customer expectations, and developing and implementing focused and aligned strategic deployment plans. Formerly he served as the chief business strategy officer at Network Health, a comprehensive Medicaid health plan based in Cambridge, Mass.; and was COO of the U.S. Family Health Plan at Martin's Point Health Care in Portland, Maine.

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