©️ 2023, Michael J. Young, MD
A 100-Year-Old’s Hospital Experience
Up until 5 years ago, I practiced medicine for nearly 3 decades. Frustrated with our current health care delivery environment, I left clinical practice and joined the faculty of the University of Illinois at Chicago to teach. The health care delivery system I left progressed–in the wrong direction.
My 100-year-old mother is a strong woman–how else does one live to this age? About a week ago, my mother developed what she described to be a ‘cold’. Typical for her, she denied having anything ‘serious’. Despite receiving the standard COVID vaccinations and boosters, she tested positive for COVID and her condition quickly deteriorated. Consequently, we took her to the local Hospital. The ER was packed, but my mother was triaged, and treatment was initiated. The medical staff who tended to her were kind and attentive. But that is where the accolades end.
Given that her regular physician was not on staff at the hospital, my mother was assigned to a Primary Care Physician, and typical in today’s hospital environment, a Hospitalist. A Hospitalist is a physician hired by the hospital to tend to patients while they are in the facility. As many primary care practices are now owned by a corporate-hospital system, the Primary Physicians are generally delegated to the office. In theory, having a Hospitalist manage in-patients would mitigate office interruptions and allow improved care.
The theory is flawed.
What actually occurs in our newfangled health care environment is neither efficient nor optimal. This health care delivery system leads to delays in treatment, increased costs, and potential errors. Although it’s not part of a corporate-hospital system’s financial priorities, a sick patient in the hospital needs a known face in a time of need. Currently, the sick, frightened, patients are confronted with a slew of new care-providers.
The Hospitalists rotated daily, so continuity of care was reduced. What I witnessed was the fulfillment of requirement, with an attitude of indifference. What is lost in the mechanized, industrialized care is a forgotten principle of medicine: we should be treating a patient with a disease–not a disease in a patient. But time is money.
Day one: A nurse practitioner (NP) entered her room and examined her. He nervously answered my questions and stated he would check with the doctor. I understand the role of the NP and have worked with many who were outstanding. When would this discussion take place? Most likely after the floor’s rounding was completed and a dozen other patients had been seen. Delays, interpretation errors, and communication issues were ripe for mistake.
Day two: A different Hospitalist visited today. After his hurried entrance and exit, I asked the nurse to page the Primary Physician. Later, I received his return call: our discussion was brief–because as the busy doctor stated, “I’m busy”.
Day three: A Sunday. No physician came in to check on the patient.
Day four: My mom’s kidney function is deteriorating from the COVID medication. As she is clinically improved and completed the standard three-day treatment regiment, I ask for the drug to be discontinued. Her Primary suggests discharging her the following day. Later, a pulmonary doctor visits and suggests another dose of COVID medication. Did he review her kidney function data? I suspect the Primary Care Physician never discussed these results or plans with the specialist.
Day of discharge: Apparently, the Primary informed no one of this decision. The Primary Physician was unreachable, and the multiple mid-level care providers couldn’t give the necessary approval. It was a merry-go-round of activity with no direction or accountability. Seven hours were spent waiting for the discharge to be completed.
Where do we begin our evaluation of this health care encounter? The Primary was anything but primary. Perhaps he was just an outlier of the many capable physicians in practice today. Maybe we just got assigned the one who was unavailable, uninterested, and poorly organized. But the specialists didn’t cross-communicate, and the multiple Hospitalists made their unengaged speed-rounds without effective patient or family discussion. I’m sure they generated a plethora of computerized notes that will also be used for billing purposes. This family of physicians had difficulty navigating a hospital’s poorly coordinated workflow.
No doubt the patient left the hospital improved. I am sincerely grateful for that. But the process of obtaining good health care mandated a significant amount of family oversight and advocacy. Without our active participation, the layering of care among the specialists, mid-levels, Hospitalists, and the Primary, appeared confusing, at times conflicting, and potentially dangerous. Most obvious was a lack of care organization. No surprise to read there are 10,000 serious complication cases resulting from medical errors each day. Medical errors which also cost the U.S. one trillion dollars each year.
But just as distressing was the observation of apathy among many of the providers. Perhaps this is because medicine is now treated as a business transaction by the new order of corporate ownership. Many doctors no longer own or manage their practices–the hospitals and corporate investors do. What the Industrial-Medical-Complex designed as a means to maximize profit has resulted in dysfunction for actual health care.
As an insider in health care, this episode of observing how our hospitals function was an embarrassment to experience. Its time for the doctors to take back their medical practices from the corporations, deliver care, and eliminate the greed of Corporate America from our most precious commodity, our health.
Michael J. Young, MD, FACS
University of Illinois at Chicago, College of Medicine
Department of Urology and Department of Biomedical Engineering
Research Assistant Professor
Innovation Center Medical Advisor
Author of: The Illness of Medicine, Experiences of Clinical Practice, GMBooks, Pub., 2018