Letter from a patient

October 28, 2007 at 8:24 pm (Clinical rotations)

Dear doctors,

I recently visited my mother in your hospital and have quite a few complaints that need your prompt attention. I demand that you drop everything you’re doing and fix the problems.

1. The T.V. in her room is broken. I had to wait a solid four hours for the repair man to arrive. And even then, all he could tell me is that the T.V. needed a new part that wouldn’t come in the mail for another 2 days. I was so bored that I actually had to read a book to let the hours pass. Things were getting so bad that I even considered talking to my mom. Occasionally I got lucky and the patient in the next bed would nod off and leave his remote unattended. Once I heard the snores, it was hello, Jerry.

To make matters worse, your nursing staff was rude to me when I tried to alert them to the problem with the T.V. I explained that the television wouldn’t turn on, thinking that the problem would be taken care of without any more effort on my part. When the repair man didn’t come by for an hour, I figured the nurses must have ignored me like they always do and forgotten to tell the engineers. So, I politely went back to the nurses’ station and explained that the T.V. was still broken. I was extremely upset when one nurse said, “I don’t know who that patient is,” while another said, “I heard you the first time and have already put in a work order.” As I left, I could hear the staff making remarks like, “What does he think this place is, a hotel?”

2. My mom needs to live. You doctors use fancy words like “end-stage renal disease this” or “incurable lymphoma that” and tell me that my mom has no chance to recover. You even went so far as to suggest that she should be labeled as “Do Not Resuscitate.” I need time to be with her in her last days—and you need to do everything you can to keep her alive. Sure, I haven’t talked to her in the past two years since her diagnosis, but my guilt is now your problem. Your social worker tried to strong arm me by saying, “You don’t have insurance and Medicare won’t cover the expenses.” As if medicine costs money. Don’t you know that health care is free?! I’ve seen Obama talk. All I have to do is get to a hospital and the costs are taken care of.

3. The food needs to be changed. Since my mom’s been slipping in and out of consciousness, I’ve taken to eating her meals whenever she passes out; I hate to see food go to waste. But the food is horrible. I was expecting at least McDonald’s quality, maybe Wendy’s. But all I get is this 1800 cal ADA nonsense that taste like cardboard. Where’s the salt shaker? You need to get me some takeout if I’m going to waste my time in this room without a working T.V.

I also don’t appreciate the nurses coming by after lunch every day and asking if my mom ate any of the meal, or if it was me. I don’t like their tone of voice and the notes that they’re scribbling.

4. You need a better recliner in the patients’ rooms. If I’m going to spend all of my free time visiting my mother, I demand a more comfortable chair to fall asleep in while I’m waiting for dinner to come by. Better yet, give me a futon with a pull-out bed for me to rest on. And bring me a nicer blanket than that pale paper-thin one your nurses keep handing out.

5. I need a private room. My mom’s a VIP. I wouldn’t be here if she wasn’t. I demand a private room so she doesn’t have to put up with distractions from the neighbor. I hate hearing the doctors come in every morning to ask the person in the other bed about his bowel movements and the color of his feces. Those doctors are nasty! They can take that attitude elsewhere and leave my mom in peace.

You must take care of these problems immediately or else I’ll be calling a lawyer.

Thanks for your prompt attention,
Every patient’s family member you’ve ever put up with


Permalink 3 Comments

Let God sort them out

October 21, 2007 at 8:12 pm (Clinical rotations)

This week I began my internal medicine rotation. Whereas the surgeons worked me to death a few months, I think that the internists are going to bore me to death. I mentioned earlier of surgeons who could evaluate a patient’s progress in less than 40 seconds. This week I ran into physicians who could spend 40 minutes going over every lab value in a patient’s workup. My team took 2 hours to see four patients. The attendings were wringing their hands over a particular woman’s sodium level. Never mind that she had no symptoms and that the concentration of sodium in her blood was two points below the limit, she got the full battery of tests—thyroid function, hepatitis screening, steroid levels… We probably could have solved the mystery if we had bothered to ask her if she began drinking more water than usual; but what do I know?

The story of the lady with a low sodium level is a perfect example of the over-treating of disease that occurs in hospitals. Her lab workup must have cost several hundred dollars for what is essentially a non-issue. The patient came in for a scheduled chemotherapy regiment. The discovery that her electrolytes were out of range was an incidental finding for which there really is no cure other than backing off the amount of fluids she’s receiving. Even if we do find a thyroid abnormality or a problem with the adrenal gland, she’ll still need to finish her current health battles before moving on to something else.

Over-treatment takes away from clinical skills and instead puts the pressure on the laboratory to come up with a diagnosis. We’re no longer training physicians, we’re training data interpreters—very expensive data interpreters. While one of those tests might come back positive, we could getting feel for the need of the thyroid study by rubbing the patient’s neck and asking her if she’s noticed any changes in the amount that she sweats everyday.

Over-treatment is not only unnecessarily expensive, it can also lead to further disease. I came across one patient this week her received a port—a valve implanted through the skin to push medications through. The port developed a blood clot that broke off and traveled to her lung, where she then developed a pulmonary embolism—the cause of death for international travelers that generated a media buzz a few years ago. To diagnose the pulmonary embolism, we rushed her off to radiology to get a CAT scan. She received intravenous contrast to better aid in visualize the clot in her lung. Unfortunately, since she’s diabetic, the dye injured her kidneys and sent her into renal failure. By the end of the week, my attending stated that the patient had too many co-morbid conditions to continue chemotherapy. He discharged her and recommended Hospice care.

Let’s summarize the sequence of events: come in for treatment of cancer, get a blood clot in the lung, have your kidneys damaged, and then get told you can’t have the treatment as initially planned and instead have six months to live. The moral of the story is that patients should be left to die alone at home instead of coming to the hospital to get killed off for $10,000.

Permalink 1 Comment

Health records online, and why it’ll be a failure

October 10, 2007 at 4:03 pm (Uncategorized)

Recently, Microsoft announced a new website to hold users’ health records. The project, called HealthVault, aims to store concerned citizens’ records for later retrieval by a physician or hospital staff. Google and AOL have also announced similar plans to create their own brands of healthcare databases.

According to Microsoft’s press releases, the company is teaming up with medical device manufactures so that patients can automatically upload the results of their glucose and blood pressure readings to HealthVault. No more keeping a paper log to bring to the doctor’s office on the next visit. Simply plug the device into the computer and the Internet takes care of the rest. The process of saving health records in a central location sounds like a good idea. However, this website is doomed to failure. HealthVault and other similar databases have their novelty right now, but will eventually fade into obscurity for three reasons.

1. Privacy concerns. Given the recent break-ins of credit card and other high profile corporate databases, Americans are going to be weary about putting their private information in a central location that can eventually be hacked. According to the Wall Street Journal article, of the available technological options for storing data, the online warehouse is the least popular.

2. No standards. At least three private companies have announced similar plans to launch healthcare databases. Noting that Microsoft has a history of not following standards tells me that this database will not be interchangeable with other health information aggregators. Hospitals will have to re-live the multiple insurance hell through the Internet age by adopting various methods of downloading data from a variety of online databases. Further, users will have difficulty switching. I doubt that moving from Google to AOL will be as simple as finding a new physician and writing to the old one to ask for a transfer in records.

3. These databases don’t hold enough usable information. While the benefits of having easily available charts for physicians to share is a major selling point, HealthVault will not contain enough useful information to become viable for hospital utilization. By only holding blood pressure and glucose readings, this website misses out on medication lists and progress notes—more worthwhile sets of information, particularly when seeing multiple providers.

In summary, while I would like to see an online database that stores patients’ health records, HealthVault falls short by not employing standards, nor containing enough data to be fully usable. Once a more centralized, preferably non-profit database opens up, I’m sure more physicians and patients will want to embrace it. I can imagine Medicare pushing us in that direction. The federal government could benefit from aggregating patients’ information to reduce billing costs by having a sole provider who can keep track of different specialists and prescriptions. Pharmacies could hook into this server to monitor refills and potential drug interactions when filling multiple medications.

Permalink 1 Comment

There’s somebody out there for everybody

October 1, 2007 at 11:42 am (Clinical rotations)

Lois is a 64-year-old improvised woman who comes to the clinic every three months for evaluation of her diabetes and high blood pressure. She is so poor that when a storm blew off part of her roof over a year ago, she simply went without shelter. Rain constantly pours into her home while mosquitoes lay new eggs in the standing water in her bedroom. After the bugs have bitten her repeatedly throughout the night, the marks and itchy bumps she’s left with the next morning become so unbearable that she picks at the small swellings until they bleed, enlarge, and become big, infected mountains all over her obese body.

She uses no air conditioning because she cannot afford the utilities. From her smell, I would imagine that daily use of soap and water are luxuries she cannot pay for either. Although she is a pleasant single grandmother, anyone looking at her can quickly determine the amount of damage that a lifetime of neglect can do to a body.

Recently, she presented to the clinic with burning with urination. Later we confirmed the diagnosis as chlamydia. The moral of the story is: if you’re single, don’t worry. There’s somebody out there for everybody.

Permalink 5 Comments