The American health care delivery system is reaching a point of crisis.
Costs are escalating as outcomes and quality of care are diminishing. Our healthcare focuses on crisis management and treating problems aggressively with medicines and interventions of uncertain benefit, while neglecting true health and wellness.
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It is estimated that $1 trillion annually is being spent on unnecessary care, much of which occurs in the hospital, and some of which leads to harm. Medicare, although concerned about rising health care costs, does little to address the real issues and actually but subtly encourages aggressive management when less could indeed be more. Hospital-acquired infections and death from medical errors are far too numerous, often occurring in patients who did not have to be hospitalized in the first place. Patients and physicians are frustrated, while private insurers and both Medicare and Medicaid are becoming unable to fund this excessively costly care without raising premiums or exhausting trust funds. Something certainly must be done.
We wish to focus on one glaring problem occurring in hospitals that is relatively easy to fix and whose resolution could improve outcomes. Currently, as many hospitals close their doors to primary care physicians (PCPs) and instead rely on hospitalists, there often is a lack of communication between these doctors that can lead directly to costly mistreatment.
A true and common story will set the stage.
Mrs. P suffers from dementia and lives in a nursing home. One day, she became unresponsive. The nurse on duty could find no obvious reason and so immediately called 911 and sent her to the hospital. While she quickly woke up, the emergency medicine physician admitted her for further evaluation. Her assigned hospitalist found bacteria in the urine and treated her for a urinary tract infection, calling in an infectious disease consultation and starting her on a potent intravenous antibiotic. He also requested consultations from a cardiologist and a neurologist to determine the cause of her unresponsiveness, and they ordered further tests including an MRI and an echocardiogram. Mrs. P became more confused, was exposed to aggressive evaluation and treatment, and was losing her strength as a result of bed confinement. She was ultimately sent back to her facility after tens of thousands of dollars of medical care, worse off than when she arrived. She was fortunate to have not suffered further harm from her hospital-induced delirium and the potent medicines she received.
Let’s dissect what happened and why.
The emergency medicine physician was faced with a lethargic person who could not give a coherent history, hence she was subjected to an extensive work-up and then admitted to the hospital. The hospitalist, likewise, was faced with a patient he had never met before, with only the emergency room records as guidance. He detected neurologic, infectious and cardiac problems, and so called for specialist consultations and extensive testing.