As often happens when we get older, our parents also get older, lots older. Which is a good thing. But life always throws in a few lemons just to keep it real. I’ve had to spend a lot of time in hospitals over the last two years with my dad. That means a lot of ‘down’ time between tests, doctors visits, medication etc. It gives one time to reflect on a lot of different topics but especially how healthcare is delivered to our population.
With Medicare For All being a hot topic among many candidates for federal and state office it has made me think about the difference in the quality of care delivered by different entities. As many of you know there is a big difference, especially if you have to deal with the VA or governmental delivered healthcare on the reservations. There is no better argument against single payor or government provided healthcare than watching a loved one have to deal with either of those entities.
Currently I am sitting in a hospital in Tucson that is run as essentially a joint venture between a private entity and a quasi-governmental institution. Last year I spent a lot of time in a privately-run hospital, also located in Tucson. There are some stark differences.
Before I expand on my point, let me say that both hospitals claim to deliver high quality care, aka results oriented care. They do treat patients well and have high recovery rates. But it’s the manner in which they deliver the care that is very different, and I think belies the underlying problems with having government bureaucracies involved in delivering healthcare.
In the privately run company, which we’ll call Hospital A, the attitude of the employees was outstanding. They genuinely seemed happy to be there and enjoyed their jobs. They were always upbeat and positive. I spoke to one of the intake nurses, who turned out to have grown up in Grant County. He explained that not only were they well paid, but they had great benefits, including vacation and personal time, gym memberships, etc., but a lot of perks that made them feel appreciated by management. Their supervisors were people that had done their jobs before being promoted. They also felt like management at all levels was accessible and responsive to their concerns. Even when they didn’t make a suggested change, management could explain why it wasn’t feasible at the time.
We saw a doctor every 2- 2 ½ hours, whether it was the internist or the surgeon. It was clear that the 2 doctors were communicating with each other and had read my dad’s chart before entering the room. Every staff person called him by name, which they did with each patient. More importantly, they took the time to listen to my dad and me, answering all of our questions, no matter how trivial. It was a positive, healing atmosphere in the entire facility. Oh, and the best breakfast burrito I’ve ever had was in the cafeteria, and only $3.50! Steaks were pretty good, too.
Now to the quasi-governmental facility, Hospital B. When I walked into the wing a couple of days ago, trying to find my dad’s room, no one acknowledged our presence or offered to help. They were standing in the ‘pit’ talking with each other. We eventually found the room. The RN was a very nice young man and pleasant to speak with but when I asked questions about anticipated care, diagnostic tests, etc. he said he had no idea. No one had uploaded a diagnostic or treatment plan to the computer yet. He was hesitant to answer when asked if he’d spoken to the doctor yet. I came to find out that Hospital B doesn’t necessarily assign a primary physician to his care, it is a team effort. That’s fine but the team concept here is much different from that at Hospital A.
Now on our way to Tucson, I did receive a phone call from a doctor at Hospital B asking several questions about Dad’s medical history, some of which I couldn’t answer. That frustrated the doctor, especially when I pointed out that some of the medical records from GRMC would answer the questions she had. It was clear she had not read the documents from GRMC that had been sent with him to Hospital B. She had relied upon the ER doctor at her facility to put ‘relevant’ information into his notes.
After waiting a couple of hours, not seeing a doctor, we went to the cafeteria. Great selection and really good food. I got a call from a doctor to discuss the treatment plan. It was not the same doctor to whom I’d spoken earlier. This doctor asked a couple of questions I’d already answered and again became frustrated with my limited knowledge on the identity or type of pacemaker in his chest. She didn’t know if they could do an MRI. I had to point out that he’d had one two nights before at GRMC so I thought it would be fine. She had no idea that he’d even been at GRMC.
In the time I’ve been at Hospital B, I have yet to see a doctor in the room speaking to my dad or the other patient with whom he shares a room. Turns out the doctors sit in a small office, 4 of them, reviewing medical records and test results on a screen, which can be assigned randomly or by specialty based upon a computer algorithm and dependent upon accurate information being input by another doctor, technician, or nurse. They will then call family members to discuss the results and plans. They do come in “at least once a day” to see the patients but usually only when they have “big items” to discuss, as the RN put it.
This morning, I saw a new nurse. I asked about the results of a CT scan that had been conducted yesterday at 1 p.m. No idea. Nothing in the notes. Shortly after that I saw a doctor for the first time. She said they were still trying to determine the type of pacemaker he has implanted, despite my having told multiple people here who his cardiologist is and that he’d had MRIs previously. That wasn’t in the notes she said. After 2 full days, we are essentially in the same place we were when arriving.
Once again this morning, his room is a mess. Unclean. There is a used gauze pad, bloody, on the floor, next to a latex glove that was dropped last night as well. On top of the closet is the same syringe, torn packaging for the syringe that was there from yesterday morning. Now there is a box of latex gloves and a small spray bottle with some substance inside as well. Not too mention several pieces of torn packaging from changing needles from the IV drip that are at least close to the trash can.
In talking to the staff at Hospital B, they said the emphasis here is on numbers: how many patients are seen per hour, how quickly they are ‘turned around,’ all geared towards achieving the highest ratings they can and maintaining their positions as a top hospital in the U.S. Those rating categories are discussed, according to the staff I’ve spoken to here, at almost every meeting. According to my fellow Grant Countian and other nurses at Hospital A, they only hear about those ratings after they are awarded and management is there to thank and congratulate them.
In my experience and completely unscientific research, Hospital A places an emphasis not only on patient care but caring about their most important asset, their employees. Not only does it show up in the way the staff interacts with their patients, but it helps them attract and retain the highest quality doctors, nurses, technicians, maintenance staff, cafeteria staff, all types of employees. It’s not just about numbers at Hospital A.
The other significant difference in my opinion. Hospital B receives subsidies from the federal government based upon a number of numerical factors ranging from diversity to mortality rates to pick a category. Hospital A does not receive similar funding. Yes, they raise private money and get similar research grants but no funding for operational support.
At Hospital B, it appears to be all about numbers and ‘bragging rights.’ Yes they do good work and get good results, at least good enough to be recognized by some newspaper and industry organization. But the relative atmospheres are very different. Hospital B feels very much like any other governmental bureaucracy; cold and uncaring, designed to treat everyone ‘equally.’ Funny thing is, Hospital A comes much closer to achieving that on a high level than does Hospital B. Unless you count treating everyone equally poorly.