Uncertainty Abounds For The Hospitalized Patient

Medicine has undoubtedly come a long way. Paternalism has been ditched in favor of a shared decision making approach, diagnoses and treatments are (largely) based on scientific evidence, and information is not outright withheld from patients out of some misplaced belief that they are not capable of handling the truth. Some of the modern pain points that patients now face involve access to specialists, skyrocketing cost, misinformation and miseducation surrounding prognosis, and confusion about end-of-life care. In addition to all of this (and much more)– one thing that has not improved for hospitalized patients is the uncertainty of their day.

A typical day unfolds as follows: Provider-X sees the patient once at the start of the day, while nurses diligently attend to the moment-to-moment care, and various departments work to execute the plans that have been ‘ordered’ by the physician. Throughout the day, a handful of other providers walk in consulting on the patient, and inevitably at some point a wrench is thrown into the plans. The poor patient sits around, while their providers attend to their many other patients, duties, boxes to check, forms to fill, and other distractions. At some point the patient or family member voices concern because they feel they’ve been forgotten. After some delay, the provider walks in and sheepishly apologizes for events that are largely out of their control. Welcome to inpatient medical care. The majority of the 5600 hospitals in the US are not flawless assembly lines of medical care that we would imagine them to be based on $3 trillion of annual healthcare spending.

It’s frustrating to see advances in medicine constantly weighed down by ancient inefficiencies in the system. Quite often, hospitalized patients have little sense of what will get done, when, and for what purpose. This is drastically different to their away-from-healthcare experiences where technology has ensured that people are well aware of weather, transportation delays, and possible variations in price, quality and quantity. The problem doesn’t just extend to when exactly diagnostic tests or invasive procedures will be performed. Patients often don’t know which specialist consultants will examine them, when physical therapy will work with them, or whether a social worker is available to talk. The sad fact is — as their doctor — I equally in the dark in many cases. It is not unusual that I spend a significant part of my day chasing around my colleagues (and they in turn page, text, call and email me to find out what my plan of action is for our patients).

If you’ve been to a hospital recently, you’ll notice that the truly ‘innovative’ ones have a display on the wall facing the patient that contains useful information like the date, the names of the doctor and nurse, and what the diagnostic plan is for the day. What is shocking about this potentially revolutionary communication tool is that at the majority of institutions this is actually a whiteboard. Unsurprisingly, I often see inaccurate and outdated information that is less than helpful for a patient attempting to discern the big picture surrounding their care.

When a patient endures the torture of being kept hungry and thirsty, only to have a scheduled test canceled, they’re often told that it was because “emergent cases take precedence.” Of course protocols about which patient should get first priority do make sense. In most places though, the ‘system’ doesn’t seem to provide continuous feedback of care-flow inside of hospitals. If it does, the information is certainly not shared effectively with healthcare team members or the patients themselves. Individual patients and their families suffer in the ensuing uncertainty as they’re the last ones to find out about whats going on, and often with some delay. Imagine how patients may feel if their whiteboard were electronic and resembled an airport departure screen to actually update them in real time them with useful information about delays, cancellations, and perhaps even (gasp!) ETAs of providers.

Some may argue that giving approximate or expected times for anything in the hospital is ridiculous, pandering to a concierge approach to medicine, and ultimately does not change the outcome for the patient. I disagree. Patients deserve better while in their most vulnerable state; with illness, pain and anxiety. Perhaps a good motivator for change is the indisputable fact — that we will all be patients one day. We surely would not accept the existing level of chaos in care coordination for ourselves or for loved ones, and we clearly have the technology to enact change. So why don’t we?

© 2018 Varun Verma, MD www.varunvermamd.com

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Dr. Verma is a board certified internal medicine physician. He believes that quality healthcare is a human right and has worked around the United States and internationally.