(Start Here) Back to complaining about how medicine is done in this country: I talk to the specialist’s assistant and she’s going to try to see what can be done to get me into an operating room as soon as possible. When I thought “I’ll go where the doctors are!” I didn’t think “I’ll go where everyone is as busy as possible!” which is why operating rooms are hard to get hold of. I know enough about these things (barely) to realize that it’s a complex undertaking – you’ve got to get all the right people, anesthesiologists, specialists, nurses, etc. – in the right place at the right time with the patient there and all the information. To me, that’s simply a matter of waiting for a call. But when she calls me and tells me they can either get me in friday or sometime in January, a bunch of stuff becomes my problem. Pre-operation I have to have blood work (make sure it clots OK and that I’m not spouting pathogens) an EKG (heart working OK and not going to cut out on the table) etc. So I need to go to a clinic and have all that done and for some reason that makes no sense, it can’t be done at Hopkins because the operating room they found is someplace else and suddenly it’s my responsibility to go get that done and then make sure the results are returned on time and FAXed to the specialist with enough time before the surgery. All the wonderfully interconnected and computerized machinery of modern medicine breaks down to: the patient is responsible for getting this critical data collected and delivered, and FAX is the preferred method. I guess FAX is the modern choice because carrier pigeons poop on things or something.* I go to patientfirst and get the blood drawn and the EKG and all that, then head home. My job is to call the specialist’s assistant and make sure all the data is there by the 21st at the latest. The 21st rolls around and the data’s not there by noon. I call patientfirst and ask them, “Oh, it’s all sitting here. We’ll FAX it right now!” It gets there, and I get the list of things I need to do for the surgery on the 22nd. Seriously, though, the medical marvels of the 21st century (OMFG! MRI! CT Scans!) are connected at the bottom-end through a system that would isn’t even clever enough to be called “Byzantine” – it’s clearly a bunch of operational kludges and territorialism with – probably – some good old-fashioned financially motivated obstruction thrown in for good measure. How can there be such stellar technology as a fucking MRI when there’s no, what might you call it, “regional hospital scheduling system”? I understand that doctors are reluctant to have someone else touch their schedules but IT people can fix that; there are techniques such as provisional requests, block locks, authority granting and revocation – it’s not rocket science! It’s not even MRI science! I consider myself incredibly fortunate that I a) Have enough money that I can take the week it’s taken to deal with this b) Have an employer that is understanding c) Am fairly compos mentis. If pain was driving me mad, or I didn’t have a decent mobile phone and internet search skills, it’d be easy to fall completely off the map. Americans, we can do better than this bullshit. While our “leaders” piss trillions of dollars into the war-machine and posture about cutting costs, and how to make sure the insurance companies can keep their profits and medicine can remain profitable, we’ve got a health system that resembles a bunch of parts from a Lamborghini stuck on the chassis of a 1989 Jeep Wrangler: it doesn’t make sense. A Lamborghini with a trailer-hitch doesn’t make sense, either, but with the Lamborghini prices that medicine commands, the system needs to be revamped from the top to the bottom – not just the part where people argue about how much regulation government gets to do.
(* How about a centralized database in which we patients can grant access to an accumulated central repository of data about us, indexed by time? And let us hold and generate our password, allow us to permit or deny groups of hospitals or doctors, specific providers or networks, and decide what documents are available to whom and when? Let us specify what’s available under an emergency override request in case we’re unconscious, and what isn’t. Give the system resonable defaults and a simple “wizard” that asks you a few questions and lets you set up an access policy. Google could build something like that in a couple months, really. Then, they could work on a combined logistical system that allowed doctors and specialists to cross-refer without a patient having to get handed a business card and be told “call these guys when they open on monday and see what they say. G’bye!”)
My Mouth Wired Shut 