Firsthand symptoms of a broken healthcare system

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Originally published by FierceHealthcare’s Hospital Impact
June 10, 2010

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It’s one thing to discuss anecdotal symptoms of a broken healthcare system. It’s something totally different to live with those symptoms, or to witness their impact on a loved one. The cost of a broken healthcare system to a dear individual is significant. The financial cost to us all of having a broken system is as well.

Today I am sharing a story about a family member Betty and her recent experience in our healthcare system.

Last week, I had the privilege (along with my bride) to accompany Betty to her doctor’s office for a follow-up visit after a recent hospitalization for chest pain, shortness of breath and numbness to her face and arms. Betty is 75 years old and she has been working with her doctor to manage her diabetes, high blood pressure and heart condition.

Leading up to her hospitalization Betty was informed that her primary doctor had over-prescribed her medications. And, in fact, it was during the precipitating emergency room visit, that the attending physician arrived at that conclusion.

As a result of the over-medicating, Betty’s potassium levels were elevated which led to her cardiac symptoms.

At discharge, the doctor discontinued several of her medications, including her diabetic and blood pressure meds (which included a diuretic), and prescribed her a new respiratory inhaler to be used daily as a maintenance medicine for her breathing.

NOTE: Little did we know that Betty would not start using this new inhaler, primarily because she could not understand the provided directions for use. (In addition to also becoming anxious when reading the pamphlet’s list of adverse side effects, which were not initially discussed with her, and could only be read in part due to the tiny, hard to read type.)

As luck would have it, Betty happened to be visiting with my family and I last week when again she had increased symptoms of shortness of breath and very swollen ankles, which also led to her use of her rescue inhaler more often than recommended.

And thus our intention at that point was to bring her to the doctor to be able to see and hear, firsthand, his care plan for her to ensure we were also in the game and positioned to support her healing as she had requested.

Upon arrival to the health center, we were greeted by an amazingly kind and loving nurse. She gently guided Betty and my bride to the exam room, the entire time providing comforting words of encouragement and promising to take great care of her. And then once in the room, she referenced Betty’s last visit and recent health challenges and through her assessment determined that Betty’s blood pressure was off, and that she was struggling with her breath and words.

The nurse checked Betty’s oxygen level and found it to be at 80 percent saturation, far lower than a normal level of 98 to 100 percent, and then immediately informed the doctor and started Betty on oxygen.

Soon, the doctor also began an examination. And after 10 minutes, Betty and my wife left the exam room with the understanding that the doctor had e-scribed two additional medications, including low dose Glypizide, added only in the morning with her other diabetic medicine, and low dose Spironlactone for her blood pressure and fluid retention. He stressed, “the diuretic medicine MUST BE FILLED and administered this very day!”

Now, add to this that the doctor was unaware of a particular blood pressure medication that Betty had been on for years (because the information did not cross over to the doctor’s new Electronic Medical Record (EMR)). And, in fact, the doctor almost misdiagnosed the situation because of the lack of data and his initial unwillingness to believe Betty over the incorrect data in the EMR when she reminded him that she was still on this medication.

Needless to say, Betty was quite stressed about the whole ordeal and quite anxious to get her meds.

We immediately went to the pharmacy where we were informed that only one of the meds had been e-scribed successfully, but the second — the diuretic that needed to be filled and administered the very same day — was never received.

We then called the doctor’s office to remind them to also call in the prescription — rather than simply e-scribing it again. All the while, Betty’s anxiety was increasing.

A couple of anxiety-filled hours later we had the diuretic and began the process of ensuring Betty knew how to administer the med.

Months later … Each day we continue to check in with Betty … and she is doing very well. She has her appropriate medications and understands how to administer them. Her anxiety about her meds is in check as now she has a resource who will provide her with an ear, a shoulder, an open heart, undivided attention and time (my bride) even though we live two states away.

But as seen in this patient story, data and technology, while being significant and important components of the solution to improve the healthcare system, cannot be seen as the entire fix.

We cannot lose focus on patients and their families, and must leverage technology to enhance the relationship and communication between the patient and family and their provider (be the provider a physician, a nurse, or other health care practitioner).

True relationships breed trust and understanding, and in this case, true relationship would have yielded a better outcome, kept Betty safe, and prevented a hospitalization.

We can do better.

We must.

Or we will continue to harm those we are entrusted to care for and care about.

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