About a year ago, I shared the story of Betty who at 75 was placed in harm's way by the healthcare system.
In brief: First, Betty had been overmedicated which led to too much potassium and resulted in cardiac symptoms. Second, she was not using her appropriately prescribed inhaler because she did not understand the instructions from her doctor. In addition, the provided handout had tiny, hard-to-read type; the parts of the handout that were readable were the adverse side effects, which only served to cause her anxiety. Third, Betty's medication history was not accurate in the electronic health record (EHR). Fourth, her doctor did not believe her when she said the medication information in her record was indeed wrong. Fifth, the e-prescribing tool and process did not send the correct information to the pharmacy, which caused delays in acquiring the critical medication (as per her doctor) and further caused additional stress to the patient.
This past week, my wife and I again were blessed with the opportunity to bring Betty to her doctors and once more witness firsthand symptoms of a broken healthcare system.
Betty, now 76, was anxious before her appointment. She recently had a number of tests with pending results. Along with her recent experiences with the healthcare system, many things weighed heavily on her mind.
My wife, a nurse of 23 years, joined Betty in the exam room to both provide her support and to ask any questions Betty may have forgotten to ask.
The physician--who, by all accounts from other family members, is wonderful--began telling Betty, "You have a small abdominal aneurism, and I heard a bruits at your last visit but don't worry about that right now." As with many or most patients, Betty does not understand most medical jargon, but in this case, she did understand the term "abdominal aneurism." The reason being her father had died of a triple A (aortic abdominal aneurism) 25 years ago. Unfortunately with limited time, Betty's doctor never had the opportunity to listen to Betty's whole story and learn of how her father had died, nor did the EHR he was accessing reflect that complete family history. Needless to say, the idea of "not worrying" about a small abdominal aneurism was virtually impossible for Betty.
Next, Betty's physician stated, "You have a significant arterial blockage in your brachial complex." Without further explanation as to what this "thing" was, he then said, "I'll need to refer you to a vascular specialist." Thus, more medical jargon about brachial complexes and vascular specialists confused Betty even more. (Post-visit, my wife was able to explain.)
The physician continued to access the EHR and suddenly turned to Betty and asked, "I took you off of gemfibrozol, didn't I?" Betty responded that he had. He then said frustrated, "That medication is still listed here!" and proceeded to update her record.
He persisted and reviewed Betty's test results. He then realized that one of the most important tests he ordered was never conducted with the other batch of tests he ordered; Betty would need to go back to the hospital at a later date for the additional test.
Lastly, at the end of the visit, Betty handed her referral slip to my wife as they headed to the car. My wife looked at it and noticed that the diagnosis listed on the slip was "acute renal failure," but interestingly that is not Betty's diagnosis. Another unintentional error?
Have you or a loved one had similar experiences?
Are you fortunate enough to have a nurse in the family who can attend visits, provide support, interpret medical jargon, assist with prescription directions, quell anxieties and fears, and provide empathy and love?
Betty's physician who may be a wonderful doctor is clearly in a broken system:
- Productivity requirements limit his time to establish an authentic relationship with Betty and hear her entire story.
- Technology in his practice is primarily leveraged to quicken the pace of practice, that is, productivity and revenue generation.
- And specific to his EHR--"Garbage in; garbage out." In this example, the garbage out is the incorrect medication information, which almost proved very dangerous to Betty.
As another example, in a rush to implement a new EHR, a local physician practice under a large hospital system recently hired non-medical personnel to enter patient data into their new system. These individuals did not understand medical terminology, and the hospital system did not think it necessary to fund an audit function to ensure all the entered data was accurate. In some cases, a nurse and/or a physician found errors at a subsequent patient visit and remembered that information was not right (similar to the situation with Betty above). It's not highly reliable and incredibly dangerous.
Betty is blessed to have a nurse in the family who can advocate for her as a patient and provide support. And yet the healthcare system does not need to remain so broken as to require that we all hire a nurse to advocate on each's behalf at every doctor visit.
We hear the term "patient centered" quite often as in "patient-centered" medical home and "patient-centered" care, but unfortunately these often are just words.
- How can care be patient centered if the physician does not know the patient?
- How can care be patient centered if the bottom line is more important than the patient?
- How can care be patient centered if the system does not care enough to have accurate medical information available to the physician and patient at time of service?
If we are going to use the term "patient centered," then we must actually place the patient in the center and truly and tangibly honor the patient. We are long overdue.
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.