Monday, July 06, 2009

Medical Observations

We are getting more than our share of time to observe the medical system here in Houston but I bet it is the same anywhere in the USA.

First of all you make an appointment but then the receptionist always says, "Be here 15 minutes or 30 minutes early to fill out papers." So why don't they just make the appointment for 2:15 instead of 2:30. And what is it with all the papers? I think that Ned has already filled out a small forest of papers. What do they do with them? Is there some giant storehouse out between San Antonio and El Paso that houses all of them? What if they actually needed one of the papers some day, could they find it? Why don't they have the "papers" on line and you could fill them out on line at your leisure rather than arriving 15 minutes early. Storage and retrieval would definitely take up less space and be easier.

We've also observed a lot of doctors' offices. What else are you going to do while you sit there in the waiting room with no magazines. The office that has been the most fascinating has been the surgeon's office. His office is in St. Luke's Texas Heart Institute. He is one of eight doctors on Dr. Cooley's team. I think every doctor has a secretary, a nurse or two, a physician's assistant or two and maybe another medical person or two attached to them. Then there is all of the administrative staff who move those papers around and check you in. Everyone of them is bright and cheery and efficient. The space for the examination rooms is fairly small and it is a beehive of activity. Everyone knows their job and it looks like the team is suppose to achieve every efficiency so that the doctor can move smoothly from the operating room, to the exam room to patient to patient. It all seems to work well because by the time Ned had his clothes back on the secretary was there with his prescription or directions for the next step. I have the feeling that by the time we were in the parking lot that all medical comments had been entered in his file and it was put back in the file cabinet. Very efficient operation.

Every medical office that you go in takes vital signs; weight, blood pressure and temperature. If you see three doctors in one day, your vital signs are taken three times. I mean for God's sake, who wants to be reminded of their weight three times in one day.

And the questions......Ned has repeated "his story" so many times as he has traveled through this medical maze. I can understand that the doctor needs to ask questions of the patient but sometimes I don't understand why so many people need to ask the same questions. When we saw the radiation oncologist the nurse put us in the examination room and sat down and asked questions like when did you notice this problem, what other surgeries or illnesses have you had, which medicines are you taking and what has are the results of the medical tests so far. Of course she is sitting there with Ned's new file with this doctor that is already 1 inch thick with all of the prior medical reports. She carefully makes notes on everything Ned says and adds them to the file. She leaves the room and we think that the doctor will be in. Wrong. Next a Physician's Assistant comes in and he asks basically all the same questions again very carefully recording them to the "file." On one hand we are hoping that either the nurse or the physician's assistant briefs the doctor so he doesn't have to ask all those questions again but on the other hand we are worried about whether they will get Ned's story right. We didn't need to worry, the doctor comes in and more or less verifies all of the information. Maybe someone in the medical profession can explain the reason for the repetitive questions as you move up the chain to actually seeing the doctor.

And one more observation.....Ned's brain has been observed with an MRI, and it was found to be "unremarkable." That sounds like his brain is well, unremarkable....just a common, everyday old brain. But those of you who know Ned know that his brain is quite remarkable. "Unremarkable" in medical-speak means that there is no sign of the spread of the cancer to his brain. In this instance, we were both glad that his brain was considered "unremarkable."


Suzanne said...

I have a friend who is a (retired) neurologist. After being retired a while he decided to take a cushy job at Stanford Medical School working with parkinsons patients, his specialty. By the time people came to him they had run the gamut and the families were a little crazed and the patient a nervous wreck. The doctors didn't know what else to do with them.

He decided all the old ways weren't working so he just sat and let them talk to him. He just listened. And listened. Sometimes a couple of hours to each person in the family until they were done. Almost every time, he figured out that the patient was on too many meds, and the family, in their tiredness were overcompensating when they didn't need to, and in some cases abusive because of the stress. There's more, but that's the gist of it - after about an hour or two, they could go home with a few helpful suggestions medically and the permission to relax and most didn't need much follow up after that. Imagine in all the 15 minute visits these people had that someone couldn't figure some of this out - especially the over medication part.

Thus back to your blog - I don't think they ever think about what is in those papers or that anyone has a whole picture of who you are. Like robots.

Ok, that was a ramble out of nowhere, don't know what made me think of that.

Be sure to bring your own reading material - do they have wireless internet at the hospital? You could blog away.

best of luck in the weeks to come we'll see you soon!


American Mommy in Mexico said...

Part of the stimulus bill has a great deal earmarked for automating medical records so perhaps filling out forms will be a thing of the past in the near future.

I have often been amazed at the lack of coordination among health care providers (that is nice way of saying frustrated.) The other improvement they need is project management(er) to coordinate the various parts of a patient's care.
We could call that person a Patient Advocate ... but then again that would probably add more expense ...but maybe the savings in duplicated care, wasted time, extra tests would offfset ...

Jonna said...

Sometimes the hardest part of being sick is dealing with the bureaucracy of the care givers. I think often that they are as frustrated by it all as we are. Somehow it became more important to write things down than to really listen or read, CYA at its finest. I blame the lawyers but really, it's all of us who have contributed to this state of affairs.

john said...

The U. S. medical system sets the world standard for inefficiency, red tape and paperwork. It also sets the standard for excellence in medical care. Ned is in good hands.

Billie said...

Suzanne, I do need to bring my own reading material and we have been surprised by how few places have wireless internet or that the cell phones will even work.

Mommy and Jonna, I think that so much of the activity in the docs offices is to provide a defense if they are sued. Just putting some limits on that would make a difference.

John as you well know, the standard of innovation and excellence is high at the Houston Medical Center.

Betsy said...

While we can understand it's a system that has CYA built heavily into it because of the insurance and legal situations, it still feels good (and necessary) to vent now and then. Ned is getting the very best of care but that doesn't mean it can't be frustrating. Hang in there!