In the hospital recovery room, receiving patients from the OR goes like this: sometimes you have the chance to review their medical record between the time you are assigned and when they arrive. Sometimes (like when they are coming through the doors and someone calls your name), you don’t. A body shaped lump of warm white blankets wheels up in front of you. A few inches of face may be visible between linens and blue surgical cap may be visible. Make sure they’re breathing, O2 is good, responsive.
Report is given on the go, so you’ll only learn about what the surgery was, and how it went. Any health conditions directly related to the surgery. Age, sex, and allergies and you’re on your own.
The mystery burrito of hospital blankets starts to stir, Holler, “You’re all done Mr. Smith, you did great!” The person on the other side of the anesthesia starts to reveal themselves.
I’m a nurse ’cause I love people surprises. Post-colonoscopy sass-mouthed grandmothers. Sweet big bubbas with gallstones who can’t stop giving sugar to the wife. Toddlers that wail and leak fat tears on the shoulders of their parents, sounding like an ambulance getting farther away as they head out to return to familiar cribs.
Truly, there is only one patient that I hate to see. And it’s the system of more care, not the actual patient that drives me nuts. The healthy 90-year-old hip replacement. Not because I don’t believe there are robust 90 year olds who, with new hips, could maintain their activities in much less pain.
Rather, I have seen too many come in great health but for the hip. And after surgery and anesthesia, kick up an atrial fibrillation/SVT that will land them in the ICU short term and sentence them to powerful medication for life, more surgical intervention, and put them at risk for death in at least 4 ways. We’ve fixed your mobility issue and given you a lethal arrhythmia. Being elderly is a risk factor, even when you come in healthy.
First, the problem: health economists are working their butts of to explain why we pay so much and get so little improvement in overall health measures in America. Austin Frakt, in his NYT article elaborates the argument of it’s the prices, stupid. We pay more per service because our country does not price control and regulate as aggressively as other top-of-the-heap nations. But then in through the comments section comes the argument by a data wonk with a blog who says that our prices are in line with the inflation and wealth, and it is the quantity, stupid, of care that’s out of control.
In this academic fight it’s safe to bet there is truth in both arguments. As a patient I don’t think $800 is a reasonable price for a urine dipstick test. As a bedside caregiver, the number of unnecessary and unhelpful procedures I’ve witnessed make me an unhappy nurse, patient advocate, and taxpayer.
The article that came out through Kaiser Health News this week investigates how an 87 year old patient with a DNR and no desire for a shock to the heart ended up with a internal defibrillator (to the tune of $60,000 Medicare dollars). As a cosigner on surgical consent forms, I totally get how it happened. Patients are able to say the words that describe their procedure (“fix my heart beat”) but often have not been educated in global implications. Outside of surgical site infections they may not know what they’re potentially signing up for.
I’ve excerpted my favorite parts of the article, but it’s gold all the way through. This is a corner of health care we must address to lower costs and improve the lives of our patients.
Nearly 1 in 3 Medicare patients undergo an operation in their final year of life.
Educational toolkit for joint replacement, sounds like a plan:
After Kaiser Permanente Washington introduced the tools relating to joint replacement, the number of patients choosing to have hip replacement surgery fell 26 percent, while knee replacements declined 38 percent, according to a study in Health Affairs. (Kaiser Permanente is not affiliated with Kaiser Health News, which is an editorially independent program of the Kaiser Family Foundation.)
Stories are more engaging teaching tools than statistics. Plug: I am for hire to research and write the stories needed to do better patient education:
In a paper published last year in JAMA Surgery and the Journal of Pain and Symptom Management, Schwarze, Kruser and colleagues suggested creating narratives to illustrate surgical risks, rather than relying on statistics.
Instead of telling patients that surgery carries a 20 percent risk of stroke, for example, doctors should lay out the best, worst and most likely outcomes.