Arnold Kling has sad news about his father and also a very important point:
…[in the hospital] what you deal with are people who are doing their job. For example,
the cardiologist’s job is to make sure his heart does not give out,
even if it means he lies on his back for so long that the prospects for
restoring diginity recede. Everyone wants to shunt him around, giving
him more Hansonian medicine, which detracts from his ability to remain
lucid.For the larger goal of trying to do the best with his remaining life, nobody is in charge and nobody is empowered.
Always a sad phase of life to deal with losing parents.
Has no one in the family heard of hospice? The concept is to prevent over treating and to promote dignity (admittedly I have limited information but this sounds like an option).
Sometimes families have to get involved and push for what they want, rather than simply letting events take a medical course. Hopefully dad made his own wishes known orally and/or in a living will.
Be nice to your kids. Teach them to be skeptical of authority. If you have a point person, it is likely they will fill this role.
If you don’t have a point person in the hospital, god help you.
To answer my own question, I think it’s because of the crowding out effect of the single-payer debate. Tragic. A non-solution blinds us to the reall problems and opportunities.
As the first commenter pointed out, it appears that Arnold’s father would be far more comfortable in hospice care. I’m sorry that he, or the family, couldn’t or wouldn’t select that option because hospice care was designed to specifically meet his stated goal: Similarly, what I want for my father is the best possible combination of dignity, lucidity, and absence of pain. Acute care hospitals are just not set up to provide that. I wish them the best.
I read that story too. I wish him and his dad well. I always enjoy his columns.
Something else:
I forgot to mention this. You also need to get the nurses on your side. They know how to work the system and you don’t, even if you have the will to. It fascinated me how much latitude people displayed at the hospital. Bad analogy- the skilled positions come in and do their job (and just their job), but the basic blocking and tackling could vary considerably.
Anecdote: at one point, I was so annoyed by the constant badgering we got every 15 minutes (the hospital operates at the convenience of the system, not the patient) that I made my displeasure known to the next nurse assigned to us. We never saw a nurse again. Maybe she was just hands-off style, but I think it was she didn’t want to hang around. She probably spent more time with other patients. Contrast that with the nurse who wasn’t even assigned to us who came by to visit because we brought cookies to the hospital and she liked us.
So, it probably works best to have a kind of good-cop / bad-cop routine. You need that one hard-@$$, but the nurses will not like them, so you obviously don’t want that to be the patient. Then, you need someone who is sweet as honey but still assertive. That can be the patient if they are up to it.
Bill Mill: I don’t have broad ideas on improving the system in its entirety. However, people tend to do the job they are paid for and do what’s expected of them. I think if you did have someone assigned to the well-being of each individual as they came in, they might take care of the patient’s overall experience better. The problem here is that a hospital stay is a 24 hour thing and even the best nurse you could hope for is probably only there for 12 hours and may be on vacation or reassigned the next day.
Aside from that, buy anyone you know at a hospital a book on Lean Thinking and remind them what their product is.
Bill Mill:
Programmer with an ER doc fiancee? You are in a unique position to determine if the holy grail of electronifying the system is really the solution people think it is. I don’t. In the short term, it is akin computers in elementary schools.
However, it could be with the right programming. Good programming could reduce the “transaction costs” and friction of a better incentive system.
Example: I think the system is set up because the people in it like it that way, more or less. By having multiple nurses, they can all get away. If you had one nurse assigned to you, they would be accountable. How could programming address this?
Maybe the best thing you could do is write a book. I’m serious. Partner with an economist and maybe an industrial engineer and you and your fiancee could really do some damage. Who would be better positioned to do this than such a team?
As to your clinic idea, that sounds really hard. However, I do think that with the right billionaires backing it, the medical industry is ripe for a hospital franchise that addresses the whole customer experience. With all the money people spend on medicine while hating every second of it, imagine what they’d pay if it was an enjoyable experience. Also, the problem is one of being to draw in enough doctors and skilled nurses and technicians to such a venture. However, from what I know, doctors hate the current hospital management system, so it wouldn’t be hard to find the right recipe for them that gives them the benefits of a corporate job without making them feel like they work for GE.
What I’m saying is, I know very little. Nobody knows much. I’ve gone the route of trying to make a minor contribution. To work on the overall problem would be a career. You could do it if you wanted to.
I apologize for hijacking an economics thread that was basically a sympathy post with non-economics chatter that isn’t sympathetic. But it strikes a chord with me.
http://www.ama-assn.org/amednews/2007/11/05/bisb1105.htm
This is just one example of how costs could be reduced at a hospital. And these cost savings could be used to improve conditions for patient and staff. Then the snowball starts rolling.
People aren’t idiots. They are already doing more things than I can think of. But chances are, each of the 10 best hospitals are probably doing 10% of what they could be doing. Visit the best and take notes on the best practices. Maybe someone already wrote this book. Maybe not from a behavioral economics perspective.
This looks like an interesting start:
http://www.bos.frb.org/economic/conf/conf50/papers/frank.pdf
http://en.wikipedia.org/wiki/David_Cutler
David Cutler is Dean of the Social Sciences Professor of Economics at Harvard University. He served in the administration of Bill Clinton and was an advisor to the presidential campaign of John Kerry.
A “pay for performance” advocate to the Clintons and Kerry? Maybe a good sign. But they’d probably overdo it. I kind of view the government as society’s complaint department. They are among the first to recognize there is a problem. That’s their role. The problem is when they try to solve it.
There is definitely a problem. Here’s another anecdote of how bad it is. We were there, and the doctor literally decided to do a specific type of procedure because of the piece of equipment the nurse happened to be able to find in the cart. I kid you not. Why they can’t pay some highschool girl (yes, I’m stereotyping) minimum wage to make sure all the carts are stocked is beyond me. Well, I can think of one reason; you can’t let just anyone into the stockroom where they keep the drugs, but that seems to have some easy fixes. Besides, I’ve heard that there are already so many nurses on drugs that if they started rigorous drug testing hospitals would go out of business.
I’ve got my hands full. This is obviously a keen interest of mine. If anyone has any ideas how a biomedical engineering grad student with an interest in economics and policy and a heart for the medical industry could make his hobby help him achieve his PhD rather than just sucking away his time commenting on blogs (I know, “stop!”), I’d appreciate it. If I don’t finish my PhD, I’ll probably not do anything medically related (it’s a hard industry to break into and make money, and without my PhD I won’t have that sunk cost anchoring me to it), so a good idea will be a service to humanity
More (read the last line)
http://www.bos.frb.org/economic/conf/conf50/papers/frank.pdf
The median physician estimate of survival time was 75 days after admission to
hospice, while the median actual survival time was 26 days. In addition, physicians
then communicate more optimistic prognoses to patients than they actually believe.
For example, in the Lamont and Christakis study of cancer patients physicians
reported optimistic outlooks about patients to their colleagues about 12% of the time,
whereas the same physicians reported optimistic outlooks to the same patients 41% of
the time.22 The true prognosis was only communicated to 37% of the cancer patients.
The unrealistic optimism potentially affects both the physicians’ decisions about the
therapies to pursue and the patient’s demand for care. Optimism has been posited to
lead physicians to over-prescribe intensive interventions aimed at cure while underreferring
to hospice.20
I’m always fascinated when people who know about something assume everyone else knows about it. Of course people don’t know about hospice. The experts we pay to tell us about it, don’t!
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The instruction to make nice with the nurses can’t hurt
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