the other side of the care experience
It is said that one can't really understand, empathize with, or begin to take adequate corrective action of a problem unless one experiences it for themselves. And that is especially true in the field of medicine. I'm sure we have all heard stories where a clinician, who had previously struggled with their place and exact role as a healer, becomes a more caring and sympathetic provider once they experience the medical care machine as a patient themselves. Watching a loved one go through a hospitalization, where your role at the bedside is to simply hold their hand and ease their fears, is even more enlightening. That is when you are able to really understand what it’s like to be at the mercy of a hospital’s processes.
I recently read a blog post by Robert M. Wachter, MD, Professor and Associate Chairman of the Department of Medicine at the University of California, San Francisco, and father of the “hospitalist” title. Dr. Wachter runs a popular blog, called “Wachter’s World,” on healthcare quality, safety, and policy. In his latest post #MomInHospital, Dr. Wachter blogged about his recent experience with his elderly mother, who was hospitalized at the very institution where he practiced for many years for a small bowel obstruction (SBO).
In his post, Dr. Wachter shares how it felt to be on the other side of the care experience, as a son supporting his elderly mother while she underwent tests and an agonizing waiting period to determine what the next steps should be for her SBO. He says this experience allowed him to really “soak in the processes and culture” of his hospital, from the perspective of a patient and their family. From his time there, he was able to identify six lessons, or areas for improvement, that hospitals can make to improve the patient’s experience.I would like to elaborate on one of these six lessons, and go even further to highlight how IT systems could have helped in Dr. Wachter’s situation. He talks of a “chokepoint” he noticed while his mom was being evaluated in the ED for a potential recurrent SBO. To his amazement, the physicians there go ahead and order a plain film, a KUB/Chest X-ray even though they initially put in an order for an abdominal CT scan. But because the CT techs need to have a current Creatinine Lab test before they decide it would be safe to administer IV contrast for the scan, they ordered those plain films knowing that the serum Creatinine test would (and often does) take a long time to get resulted, or at least show up on the results part of an ED physician's tracker! So now they are not only working around an inefficiency within the Lab and Lab resulting process, but are spending extra health care dollars and exposing someone to a redundant test with needless radiation exposure! If only there was a way of expediting that Creatinine results to x-ray, maybe by way of associating that bit of Lab data result to an order set, or better yet, accessing his Mom's health records in Florida (where she lives) via a Health Information Exchange (HIE). Aside from IT, the staff treating Dr. Wachter’s mother could have even done a rapid point-of-care Creatinine test, which has been shown to be efficient and reliable.Related to this point, Dr. Wachter seems to beg for the fast tracking and leveraging of HIEs and enhanced interoperability of health IT systems, when it became very obvious to the good doctor that the resident involved in his mother's care had no access to his mother's old diagnostic tests when the the junior physician came into the patient's room announcing that one of the scans showed probable lung cancer, despite the fact that all her old films showed the same, unchanged lung nodule.This article really spoke to me for a number of reasons, most importantly because I have had a similar experience recently. In early July, as I was preparing to venture off to Haiti on a medical mission, I received a phone call that my 83-year-old mother—who coincidentally lives in an area of south Florida not far from Dr. Wachter's mom—had suffered a stroke and was now in a small community hospital not far from her home. After cancelling my planned trip to Haiti, and finding a last minute flight from Boston to Florida (not to mention after only two hours of sleep as I had just returned home from an overnight shift as an ER doctor!) I arrived.Early the next morning, after the initial shock of seeing my mom like I had never seen her before—unable to speak, lethargic, paralyzed on her entire right side, laying there motionless—I sat at her bedside that day, and many days to follow, holding her hand, smiling at her when she was awake, thinking all sorts of things: Will she pull through this okay? Will she ever be same person as I have known her all these years? And while all this was happening, I found myself, her son, the doctor, acting as the liaison between her doctors and nurses as well as other concerned family and friends. Ialso had the role of interpreter for that complex “medspeak” back into English. Furthermore, I was a navigator helping to steer my family, especially my dad (and mom to a lesser extent, mostly because of her aphasia), through the dizzying course of medical decisions, medical procedures, and tests.It was probably after about the fifteenth time my father displayed that totally and unmistakably baffled look on his face, as if he didn't comprehend a thing said by the nurse, the therapist, and the various consultants coming in and out of my mom's room, that it dawned on me. Maybe there is a way to ease the pain of being an inpatient (and the family) by utilizing the IT system to improve the patient experience. Yes, the advent of the hospitalist—available, in house, often 24 hours a day—has to some extent improved the navigation and communication a bit, but why not think of other ways, utilizing the tools we have already.After that experience with my mother, and reading Dr. Wachter’s blog entry, I think we need to pay more attention to the inpatient experience as viewed from the eyes of the patient. Just imagine how we, as doctors, communicate with patients and how those patients must feel so lost and inundated with information that is hard to process and hard to understand. How they often don't understand the jargon and terminology we sometimes use, and how they have the near impossible task of dealing with conflicting recommendations and opinions from a multitude of healthcare providers who make up their care team. How can we make the patient experience during a hospital stay less complex, more interactive, and hopefully more satisfying? Is there a way to give the patient back a sense of control over their care, or at least the illusion of some control in the decisions that ultimately affect only them and their families?The patient portal, which is a mandate for Ambulatory physicians under ARRA’s Stage 2 Meaningful Use requirements, has been shown to be a great way for primary care physicians to interact with their patients. It has so far been met with various degrees of acceptance and success. Why not extend this concept to the inpatient side, where the patient and designated family would be able to access the chart during their stay, to understand what is happening to them? Obviously there would be certain security features and access controls in place, but in place of complex data there could be useful information for the patient to know to make their stay better, such as a list of their care team with photos to help them identify who is whom, as well as a way to message them to ask a question. It could also include a daily list of expected visits, tests, therapy sessions, etc. with approximate times these visits would happen from the previous day’s documentation by clinicians and nurses. A patient education knowledge base would also be helpful for patients to look up their diagnoses and conditions and better understand the ramifications of their treatments and condition. The portal could even include web links to sites such as "Patients Like Me," where patients with similar conditions can ask questions of one another.Furthermore, the inpatient patient portal could allow the patient to review, and by some mechanism verify, what has been documented in the chart. It would give back a sense of control to the patient, reduce the repetitive questions that all caregivers ask over and over again, and be yet another checkpoint that all the information entered into the record is accurate.Improving communications and making a patient feel like they are more in the driver's seat of their care would go a long way toimprove the hospital experience. I think only allowing the clinicians to have access to the information in the EHR can alienate the patient. Why not level the playing field by giving patients similar tools to become more of a stakeholder in their own care? It would make their experience less intimidating, and they would feel more like an active participant in their health.One may think that the older generations would not be accepting of, or interested in using, technology. Despite what might be perceived as a lack of interest in technology by seniors, they actually have been embracing it and becoming increasingly more tech savvy of late. Regardless, not all inpatients are elderly. Those patients in their 20’s, 30’s, and 40's are quite adept with such technology and to some extent actually expect it to be incorporated into most facets of their lives. Eventually, they may become a hospitalized patient and be looking for these tools. MEDITECH understands that patients are an important part of our customer base, and we have developed solutions such as the Patient & Consumer Health portal to meet their growing interest to be engaged. I think this is the right direction to go, and we need to be even more proactive in developing solutions that embrace the patient as an active participant, and key player, in the business of maintaining health.
