Now This is Gross

Yesterday my husband had arthroscopic surgery at Jeff to repair a meniscal tear. All went well and he is feeling fine today. Clinically, I have no complaints. (He scheduled the surgery before the announcement of the Gross Clinic sale or I would have tried to get him to go elsewhere.)

I spend quite a bit of time at various hospitals and health care institutions as a health care lawyer, meeting with clients (generally, doctors and other health care professionals). On occasion, as part of my role as their business attorney, I interact with hospital administrators and in-house counsel in their negotiations and dealings with hospitals. I don't often write about heath care legal related issues, because that would be too much like work. This post, however, is a little different.

Having spent the entire day at Jeff yesterday (from about 8 am to 6 pm) from the perspective of a family member of a patient, I now understand how TJU made the decision to sell The Gross Clinic. Because my husband's procedure was not serious, I was able to sit back and observe how the hospital operates from the patient/family member's viewpoint. I watched how we were treated, as well as those around me during the day.

A word that I heard used several times during the day by family members waiting for friends/family undergoing surgery (as well as a friend that I ran into whose mother was undergoing serious surgery) was "insensitive." That is probably the best word to describe Jeff as an institution -- they should keep it in mind the next time they redo their logo. Rather than JeffCare, it should be Jeff -- We Don't Care: About Anybody.

The short procedure unit is set up with the nursing station in the center and hospital beds set up all around the perimeter, with the pull-around curtains as the only semblance of privacy. The space (which also serves as the recovery room) is the hospital equivalent of the airlines -- a tight squeeze between each bed. There's barely enough room for the family member to stand or sit (although they encourage you to accompany the patient to the waiting area). Now I realize that this dehumanizing setup (which works to save on nursing staff) is the same everywhere, not just Jeff, other than the extremely tight quarters.

It reminded me of what used to be called the "Clinic Ward" when I was younger -- the large, open space room set aside for charity patients. Those patients with insurance and/or money got a room, either a single or double. Health care is the great equalizer -- everyone is now treated the same -- lousy.

Once the patient is taken down to the surgical floor for the procedure, the family member is sent to the Family Surgical Waiting Room. It is a large room with a few tables and a bunch of chairs. TVs are also set up at various points. There is one pay phone in the back of the room -- no courtesy phones are available (although in this age of cell phone availability, I guess that's not as big an issue).

Scheduling is for the convenience of the surgeon, not the patient or family. Hours and hours pass with no word. Does it mean there is a problem or just a delay? You are told to come early, the schedule generally gets delayed (without any updates provided unless you inquire) and there is then the waiting time for the actual surgery and recovery. Like me, everyone was there for most, if not all, of the day. Coffee is provided, but no snacks (or snack area) nearby. The only place to eat is in the Atrium, several floors below the surgical floor.

There was one community computer, but it wasn't working. A number of people had laptops (like me), but although I detected a wireless connection, we couldn't get any internet access. When we inquired, the reaction was as though we were the first people to raise the question.

There is no "working area/space" that is a little quieter (with internet access) for those like me who could use the time productively (rather than worrying about our loved one). Why wouldn't wireless access be provided as a courtesy for people? A simple, easy way to add to the comfort of those spending the day there?

When the word comes about the outcome of the surgery, you are summoned to a telephone in the back of the room. A disembodied voice tells you that everything went fine, blah, blah, blah. The orthopod can't be bothered making a personal appearance? He's just down the hall (after all, you came down to the surgical floor to wait for the results). I assume that if the news is bad, you'll get a personal audience to break the news. All I could think about as he spoke was no wonder people decide to sue when things go wrong -- it's not as though they have a relationship with (or even know) the doctor.

You end your stay by reuniting with your family member in the recovery room. And this end of the process, privacy is not an option. All of the curtains are left open, with patients in various stages of coming out of anesthesia, to make it easier for the nursing staff to monitor the patients. Once the patient can go to the bathroom, out you go.

Now, in all of this, I must say that the nursing staff and the other healthcare workers we came in contact with were very helpful and caring. Rather, the problems are systemic. You just have an overall sense that you are just a cog in this machine called a hospital. The bureaucrats that run the place aren't interested in you or yours -- it's just business. The place could just as well be Walmart as Jeff. They just sell healthcare, not housewares. In other words, the healthcare system is truly broken.

And again I go back to the fact that it's part of the overall attitude -- inconsiderate and insensitive. No one thinks about things from the patient perspective. Customer satisfaction is meant for those businesses where the customer pays directly for the product. In the health care system, the patient is the consumer, but not the direct customer. Patients are mostly referred to surgeons and hospitals by another doctor, the family care physician. Insurance pays most, if not all, of the costs of care. We are too far removed to be a true concern to these institutions.

In closing, I loved this comment by Welcome to Phillyville about the sale of the Eakins painting:

Next up for the Jeff Board of Directors, implementing that new fund raising plan to have Jeff heart surgeons remove vital organs from unsuspecting patients and demand ransom payments or else the organs will be sold off the black market to fund ever larger and more imposing parking garages.

Touche.