Where Is The Outrage - Part II
Here is a true story about an "elderly lady" living very independently and alone until recently, in a city with no other family members anywhere close. She falls and breaks a hip, often a sure sign of decline for this age group. Taken unconscious by ambulance to the nearest hospital, she has very successful orthopaedic surgery. The break is easily fixed and the surgeon predicts a full recovery after extensive physical therapy.
Discharged from the hospital after 6 days to a rehab facility across town, her physical and mental condition deteriorates badly instead of improving. Only after three full weeks does anyone finally contact her primary care physician who reveals she had been on an antidepressant for years. This med had not been administered at the hospital or the rehab facility. The complete loss of appetite (which makes her too weak for the PT critical to her recovery), disorientation and anxiety are consistent with the withdrawal symptoms from the antidepressant.
How could such antediluvian behavior occur in today's modern world of medicine? Is it possible a patient could be so unaware of her own drug regimen (or, incapable of communicating)? Is it possible the patient's family - out of state or not - could so poorly advocate for her care coordination? Is it possible a hospital could be so uninterested in contacting the primary care physician (in this case, from a different "integrated health system"), relying instead on their own "hospitalists" to develop from scratch a treatment plan?
A national database of patient health histories would go a long way toward improving the care of patients like the one in this anecdote. There are innovative initiatives that can make this a reality; Google Health may be one of the best because their on line patient records tool is portable and users can access and control them from anywhere.
People change insurers and doctors. Emergencies obviously do not always happen near our hospital or health system of choice. Some might like the idea of an Orwellian Big Brother owning our health records but personally, my family and I will learn from the story above and take charge of our own records and be better prepared than the "elderly lady" above . . . . . . .. who just happens to be my mother . . . . . . . . and is still teaching her kid, even so late in her life.
Labels: Boomer Wellness, Health IT
posted by Jon Rauser @ 8:35 AM
3 Comments
As President & Owner of a successful health insurance brokerage in downtown Milwaukee - 
3 Comments:
Jon,
I hope everything is now well with your mother.
You are right, portable medical records are valuable and important. There are several quality options out there including on-line products like google health and credit card like programs that have all of your information. Both types are secure and accurate so long as the consumer/patient loads everything on them. They are great, but they have serrious limitations, mainly that they are controlled by the patient.
Unfortunately that's a non-starter issue in my opinion. I agree that patients can make all sorts of important and vital healthcare decisions and I also absolutely support the idea that patients need to be actively involved in managing their health, but maintaining medical records is where I have to draw the line.
Medical records are just that; medical. They should be managed by medical professionals, and they need to be readily available regardless of a patient's condition or mental status, they must also be accurate.
I think this is one issue where the medical field needs to step up to the plate and take responsibility. Secretary Leavitt has set a reasonable and secure standard that would allow for this information to be centralized and avaialble to every medical provider upon release.
In my 20 plus years of experience I have run into hundreds of patients that inaccurately reported their previous medical conditons or have even forgotten that they had surgery. We need to have a system that works for everyone. We all pay an enormous sum for our healthcare, let's make the "system" live up to the oath that it's taken, to do no harm. Part of that is knowing what they are doing and having a central system of records in this age of information seems the least they can do.
Well Eric, I understand the inherent risk of patients (mis)managing their own medical records. Others have expressed seperate concerns about privacy. (I guess they also do not like on-line banking?)
So, shall I assume you would advocate doing nothing while we wait for the perfect 'system'? Sorry, small incremental improvements are just fine with me. They're easier to tweak for improvement than grandiose/omnibus government programs that simply evolve from well intentioned to sluggish ineffectiveness through bureacratic malaise.
Touche-
Of course you are right that incremental accomplishment is far better than nothing and I do agree that a centralized system in practicum is light years away. So I should restate; whatever an individual patient does to protect themselves in terms of maintaining records is effort well spent and should be applauded. It could save their life!!
My point was more that we can't let the medical community off the hook for somthing this vital. As to the question of privacy; does anyone actually believe that these records don't already exist? If you've ever been to the doctor and were billed though any payer you have a national patient ID. The system exists, just not to our benefit.
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