Warning: What follows is a bit of a rant. If you aren’t prepared for a rant yet this morning (or whatever time of day it may be in your part of the world), go have a cup of coffee or other stimulant of choice and then come back and read this.
America takes pride in the qualities of its medical system. For the life of me, I cannot understand why this is so. For the truth is that the pride we take in our health care system is completely misplaced; our medical system is, in fact, clunky, awkward, and, often, utterly and spectacularly incompetent.
Take Helen’s case. Helen is my wife of several decades and she is suffering from a non-life-threatening condition requiring surgery; a not insignificant form of surgery that requires up to a four-day stay in the hospital for recuperation once accomplished, but one that is fairly routine nonetheless. But before the surgery can take place, she must have four different preliminary tests performed – possibly in the nature of ‘cover your ass’ tests for the benefit of the surgeon involved from what I can tell, but who can tell much of anything in the fog of jargon and half-information our medical system persists in using to ‘inform’ its patients? Meanwhile she is suffering from significant constant discomfort and occasional real pain.
Helen was informed in mid-July of the necessity for the surgery, and at the same time the surgery was set for October 23. She was told that she would be contacted within a matter of days by a staffer to schedule the necessary preliminary tests. She waited a week and heard nothing, so she phoned asking when the tests were to be scheduled. She got the staffer’s voice mail and left a message. (Can you see the punch line coming with just this much of a hint? Of course you can! Have you ever had something similar happen to you? If you live in America, of course you have! Delay is the grand tradition of American doctors, clinics and hospitals, and we, the people, take the delays and missteps for granted because we’re inured to them.)
To shorten a long, involved story, Helen finally managed to make contact with the doctor’s staff yesterday after having made at least four unreturned calls, only to be informed that they would likely have to reschedule her October 23rd surgery date because the tests haven’t yet been scheduled and it was likely that they could not be scheduled and completed in time. In fact, the threat of rescheduling was the first thing out of the nurse’s mouth. This fact makes a sort of perverted sense given my experiences with our health care system. After all, why scramble to fix the results of your organization’s incompetence when you can just make the patient wait a bit longer? Especially when waiting about while the so-called professionals screw around is the essence and art of becoming an All-American Patient. (I wonder if they give the equivalent of the Heisman Trophy to whomever among us mugs is the best at it, and, if so, what level of passivity must be achieved to have a fighting (please forgive the oxymoronic adjective) chance for the award?)
When Helen questioned the nurse about what had happened, she was told that the staffer who was supposed to contact her had ‘left the Clinic’s employ’ (I suspect that’s a euphemism for ‘fired’ – perhaps, for incompetence?) and that the Clinic’s IT staff had erased his voice mail messages because he was no longer an employee – apparently without anyone having listened to them first. This is no doubt an excellent IT practice, but an amazing demonstration of medical incompetence (perhaps even malpractice) when someone’s life (not Helen’s, thank God) might be on the line.
When Helen related this story to me, she indicated that the staff person to whom she spoke yesterday seemed to act as if this screw up was par for the course. In fact, given the nature of the American health care system, it probably is. We have striking proof of its general incompetence this morning from Dallas, if the nurses’ union there is to be believed. An Ebola patient was transported with high drama and visibility by attendants in hazmat suits to a hospital there for care, only to be left unattended in a room full of people for several hours while hospital administrators tried to decide what to do with him. Meanwhile, nurses in ordinary scrubs were delegated to watch over him. Now at least two nurses have contracted the Ebola virus as well, with a warning this morning from Dallas officials that more cases are likely on the way.
We are about to witness a demonstration of the only real skill that most hospital administrators possess in abundance – the art and practice of covering your own ass. Since this is the only entertainment we patients are usually allowed when things like this happen, sit back and enjoy the show – for you can be certain that there will nothing else on offer.
Helen’s situation is not nearly so serious. But she is in constant discomfort and some pain, and the system seems not to care. If something like this had happened in my law practice resulting in a problem that could be fixed but only with the expenditure of extraordinary effort, I would have told the offending staffer: “Fix it, and I mean now. Don’t even think about taking the easy way out by rescheduling, but do whatever you must do to get it done in time and don’t come back to me with any excuses about why you cannot. If you do return and tell me it can’t be done, consider your statement as your offer of resignation and I will decide, based upon the facts then known, whether or not to accept it.”
But our health care system doesn’t work this way for it has too long been fouled by the impenetrable sludge of incompetence. Our medical system badly needs a colonoscopy – well, actually, it badly needs to undergo the preparation for a colonoscopy; you know, the part where….. But, I digress.
When I first started as a patient with the Clinic involved many years ago, I did so because of my neighbor. My neighbor was a doctor and, in fact, the doctor who was the chief administrator of the Clinic at the time. He became my personal doctor even though his time was limited, and when he retired he referred me to my present doctor. Somewhere between my first visit to the clinic many years ago and today, doctors were pushed out of administration and the professional administrators took over – you know, the guys with the long set of incomprehensible initials after their names standing for degrees neither you nor I have ever heard of. The professional administrators must be good at something, but whatever it is it isn’t the timely provision of high quality, no-hassle medical services. I doubt they are the sole cause of our current health care system’s extensive problems, but I suspect they are the principal contributors. After all, professional bureaucrats the world over are responsible for a lot of misery and anguish – all for the sake of improving the bottom line with the least amount of effort for the purpose of maximizing their own compensation.
But perhaps I am pointing the finger in the wrong direction. As Franz Kafka once said, “Every revolution evaporates and leaves behind only the slime of a new bureaucracy.” Perhaps the inefficiency of our health care system has a much longer history than I know.
How’s Helen doing? Well, she’s still waiting to learn the fate of her October surgery and so am I. Sometimes I wish I could learn the gentle art of the patience she usually displays, but most of the time I just get mad. But I’ve found that getting mad is not such a bad thing, especially when you’re forced to navigate very long rivers of turgid sludge.
