A hospital stay

A few impressions after a loved-one’s hospital stay.

I’m spending time at a local hospital with a loved one for something that was ex ante scary but ex post became boring after nothing turned up in the usual tests.

A few things stand out from this experience: The impressively harmonious rainbow coalition that makes up the American health care workforce, the strange mix of technical virtuosity and incredible organizational inefficiency in hospital care, and just how different the patient experience is outside the environment of safety-net and urban teaching hospitals many of us know best….

(This post is cross-posted on the Century Foundation’s Taking Note section here.)

The impressively harmonious rainbow coalition that makes up the American health care workforce.

Our Catholic hospital played a sweet blessing over the loudspeaker while a headscarfed Arab-American nurse took vital signs before passing the case off to an Irish Catholic young woman with an impressive number of ear piercings. People of many racial, religious, and ethnic backgrounds wandered through the hospital room doing whatever it was that they needed to do.

Obviously the demographic composition of the cardiology fellows looks different from the nurses and the food staff. Still, I don’t know if I could identify an economic sector that reflects America as well, or that works as well in its diversity to get important things done. These busy and diverse people also treated us with a mixture of competence and kindness that is really quite admirable, and which should never be taken for granted.

The strange mix of technical virtuosity and incredible organizational inefficiency.

The virtuosity is palpable, even or especially in a community hospital not especially known for being high-tech. Much of the high-tech equipment is effectively operated by people with limited technical training. We tend to think that advanced devices increase the demand for highly skilled workers who can operate the technology. A lot of medical technology is intellectually labor- saving, making complex tasks simpler, and thus ready to be performed well by people with less advanced or less specialized training than you might suppose.

The inefficiencies are equally palpable. We arrived 6:30am yesterday and spent much of the day twiddling our thumbs waiting for an echocardiogram that was finally done 11am this morning. The attending was unavailable to sign a requisition form. There was a shift change. There was delay/someone forgot to do something. And so on. Many inefficiencies and mistakes occur because the managerial, organizational, and human-factor technologies lag so far behind behind the more material ones embedded in the fancy machines.

How different the patient experience is outside the environment of safety-net and urban teaching hospitals many of us know best.

This particular hospital is a good but hardly-prestigious suburban hospital somewhat insulated from the safety-net function of some peers. The ED wasn’t overcrowded or noisy or filled with uninsured people with complicated social-medical-poverty concerns. We had essentially no wait. The rooms were pretty nice. Parking was free and convenient. I wouldn’t want brain surgery there. Yet most of the time, one’s personal experience of care has little to do with the technical proficiency with which that care is provided.

Finally, the experience brought home the competitive dilemma facing many urban safety-net and teaching hospitals. They often provide excellent care. Yet they can be pretty uninviting places, too–in part because they bear economic and social burdens that other hospitals do not.

Author: Harold Pollack

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect, tnr.com, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.

3 thoughts on “A hospital stay”

  1. Having worked in and around the medical industry in the US for about 10 years, I prefer the care that I get at the local hospital here in Peru. The poor people’s hospital not the two upper class ones. Best doctors that I have ever dealt with. Two minor problems but they saved my life. In the best hospital in the US, I would have died. Here they expect the unexpected and creatively fix the problem.

    The last time that I was in an american hospital, the chemicals the place is poisoned with were shutting down my bronchial tubes. Couldn’t use my inhalers, “dog” doctor hadn’t prescribed. From operating table to standing out on the street in sheer pain but able to breathe, less than 25 minutes after coming out of anesthesia.

    I, also, owe him for prescribing Tylenol Number 4s for pain. After I told him specifically that I was severely allergic to acetaminophen and codeine. Had fresh blood pouring out my anus at Miami due to stomach bleeding. Got on the plane figuring I had a 50 percent chance of dying before Lima.

  2. Your post brings to mind Christopher Hitchens’s graceful description of entering the “sick country.” He writes:

    “The new land is quite welcoming in its way. Everybody smiles encouragingly and there appears to be absolutely no racism. A generally egalitarian spirit prevails, and those who run the place have obviously got where they are on merit and hard work. As against that, the humor is a touch feeble and repetitive, there seems to be almost no talk of sex, and the cuisine is the worst of any destination I have ever visited.”

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