It was a dark and stormy night – actually it was another beautiful summer day here in Maine, Tuesday, August 29th. I had been experiencing a little shortness of breath when walking my dog Beau, so I made an appointment with my primary care doctor. Three days, two hospitals, and an ambulance transfer later, I was the proud container for two stents and had three daily medications I’ll be taking for a while.
I spend most of my days thinking about the health care system, but until now I’ve been incredibly lucky, having had minimal dealings with the system from the inside. While previously I’ve always tried to value the patient perspective, there is nothing quite like experiencing things for yourself. My direct exposure reinforced some of my ideas, caused me to re-examine others, and overall left me with a greater appreciation of all the individuals who make up our “system.”
I didn't think my shortness of breath was a big deal, but when my PCP did an EKG, she saw something that alarmed her and consulted with a cardiologist. A few hours later I was in the emergency room getting pumped full of blood thinners, so I didn't have a heart attack while they figured out what was going on. After a diagnostic catheterization at Mid-Coast Hospital revealed several blocked arteries, I was transferred to Maine Medical Center, where I had two stents inserted. Along the way, I couldn’t help myself and kept reflecting on our health care system – what was working, what wasn’t working and of course cost.
For what it’s worth, here are some random thoughts:
- Nurses are angels – not all of them and not all the time, but most of them and most of the time. From the one who after checking the pulse on my leg at two in the morning gave my ankle a squeeze of reassurance after I had told her how unsettled I was, to the one who laughed at my lame jokes when I was trying to think about anything but my heart. Nurses do a tremendous amount of work, have an incredible amount of knowledge and move through their day in a caring and concerned manner. They truly make the system work
- WTF, I was offered oxycodone – of course, not everything was positive (this is the real world after all) – I was shocked and appalled that when I said I had a headache, I was told I had been pre-approved for receive oxycodone for pain. I was there for heart issues, I wasn’t having surgery (catheterization is much less invasive), and there was no reason for me to have anything but Tylenol (which is what I took). Given what we now know about substance abuse issues, I should not have been offered such a powerful drug
- I like the hub and spoke/feeder system of smaller hospitals sending patients to centers for specific complicated procedures. That’s how it works in Maine for the placement of stents – while the community hospital I started at did a diagnostic catheterization when it was determined I needed stents places, I was sent on to Maine Med. This means that the only people doing the procedures are the ones most qualified to do so. Makes sense, doesn’t it? Of course, there are financial implications both for the system and for low-income family members, but those are complications to be addressed, not reasons to abandon the approach
- Riding in the back of an ambulance I was not checking prices, network participation or quality statistics. Talking about health care, I’ve often said that people don’t comparison price riding in an ambulance – so of course, when I was actually riding in one, I couldn’t help but consider the irony. But it was true, the last thing I was thinking about was being a good consumer – and call me crazy, but I don’t think we want to put that kind of stress on patients needing care by expecting them to do so
- Electronic records actually work – In the space of 72 hours I was at a doctor’s office and two hospitals – everyone knew who I was, what was going on, and what had come before. The interventionist had seen the film of the diagnostic catheterization; they knew my PCPs name (and had sent her my hospital records). EMRs get a lot of well justified bad press, but my experience reminded me that they are worth the trouble to get right
Was I thinking about all this to avoid thoughts of my mortality? Probably. But also, because this stuff is important. It is all incredibly complicated – coming up with solutions requires the participation of people with varied skill sets and perspectives. And finally, because as those who know me will understand, I can’t help myself. So, there you have it, if you were wondering what I’ve been this week, I’ve been on assignment inside the health care system.
