Saturday, August 27, 2016

State Of Medicine Report 8.27.2016

The Implosion of healthcare is happening all around me. I am witness to it every day.

The health care teams have been going 'all out' and 'full pace' for so long, that it's starting to take it's toll.  I mentioned last time how many people are getting hurt on the job. They are on disability, and not making money. This puts even more strain on the staff who is left to do the work.

Recently, there were so many sick calls, that only one 'break' person was available for the nurses.

One scrub tech had to mop his own floor in his room for turnover, because the cleaning crew was not adequately staffed.

It is becoming more commonplace for patients to have their cases rescheduled because the OR is running at capacity. When something unexpected happens, and the cases in the lineup before take more time, something gets 'bumped'.

I come from a facility where there used to always be one room open, all set up and ready to go, for trauma patients and emergencies. We had everything ready, including arterial lines and i.v.'s, to save time--and for patient safety.

Over the years, this room was scheduled--booked for cases--and the new trauma had to go in after another case finished and would bump that room.

It's to make money. And we haven't been allowed to set up any lines ahead of time for a long time. This is because they expire in twenty-four hours, and it adds up to the price.

A woman went to a well-known hospital for advanced cancer surgery. There were complications. The surgeon was on vacation. She went to another hospital near her home. A staple line where bowel had been cut and reconnected together was leaking into the abdomen for a week. This woman almost died, had she waited longer. It was a difficult case. A visiting cross-cover anesthesiologist got the case, and handled it well. The physiologic shifts due to this overwhelming infection make the anesthesia very complex and challenging. She is going to be okay, but has a long road ahead of her.

Another patient--with same anesthesiologist--had a blood vessel that was closed with a surgical instrument open during a case. There was near exsanguination. Again, the same person handled it well. This is very rare, very unusual an occurrence. But with hospitals driving for cheaper and cheaper costs, the instruments are not the same as in the past, and sometimes failure is seen.

One had to go back to surgery--something routine--but was bumped from one day to the next. Due to the caseload, the O.R. delayed the surgeon one hour. Then he went and delayed us another two hours. This is three hours unpaid for me, staff being paid to be on standby, and the patient in pre-op holding. It was a very quick case. However, there was a miscommunication, and a certain type of drain was not in the O.R.   New people didn't know what it was. Another hospital was called--do you have one? No. Patient is on the table, cut open, instruments inside, and there is no equipment that if it had been in the room would have finished the case in five minutes.  Another hospital had it, a courier was sent. Then, the night nurse in charge went downstairs to the central supply room and looked at the equipment and found two! She knew what she was looking for but the new ones didn't know. Everything was fine and the patient did well. There was just unnecessary anesthesia time.

This surgeon is a sad story.

He used to do hearts. His partner was offered a position to be a staff surgeon for the hospital foundation. He was supporting his family who worked in his office as his employees. He wasn't asked to the exclusive deal like his partner, either. But this is happening left and right, people 'making a deal with the devil' (his words) and signing away their rights as independent practitioners and working for an organization. As it turned out, his partner was given an unfair share of the workload with the senior cardiac surgeon--there were two. So for a pay cut, he quit, and is back to being his own independent practitioner at another hospital. He dodged the bullet, my surgeon--and he said he saw that one coming. He stopped doing hearts and only does thoracic (chest) to be able to continue working for himself!!!  Medically, to me, this is like an animal chewing off its leg in the jaw trap in order to be free. All those years of training, for what?!

(Just for reference--heart surgeons used to be paid very well for their services. But now, thanks to managed care, all the care--visits before surgery, six hours of surgery, rounding on the patient in the hospital after surgery, discharging them home, and follow up care--brings in a total of around six hundred dollars for all that work. And all that risk! Surgeons can be sued at any time for malpractice if something goes wrong.   For more reference--all the prenatal visits, birth, hospital care, and post-natal visits--earn an OB-GYN about nine hundred dollars. )

After chewing off the leg--to be free--and stopping doing the work he was trained to do, the same is true for me. I did a fellowship in cardiothoracic, pediatric and adult. But the same heart room I started, upstairs, was so malignant a woman who was a tech there used to go home and cry every night. Her husband told me (he works there too). Four people went up to that heart room and begged to come back to our main O.R.!!  So all that training I had, too, was 'for nothing' in a way, although I enjoyed my work in the field and my expertise helps me to this day with patients who have heart disease and undergo other kinds of surgery.

The story gets sadder for the patients. The new nurses and scrub techs watch the clock. At the end of their shift, they want to go home and have their 'life'.

Sometimes patients are on the table at the end of their shift.

No one wants to stay late.  Even though the hospital pays double time for overtime in those cases.

Except one. She's about my age. And she says, 'It's the nature of the work! It's the job! The patients need you.' So she always volunteers to stay.  That's professionalism. And it's on the way out.

Another hospital just cancelled a case with my surgeon. It was for later that night. There was 'a disaster' and 'it couldn't go'--but the people notifying him were avoiding telling him WHY. He needed to know.  He kept asking.  The state inspectors had closed the O.R. at that other place that day.  And instead of taking responsibility, putting patients first, and telling him at once so he could transfer the patient--who still needed surgery--to another hospital so he could finish the case...they kept it quiet and waited until the last minute where there was no option for him to scramble. The life-saving surgery for this patient was delayed.

I know of another nurse who started a surgery center who is out on 'stress leave' and is never coming back.  It was the politics of the other nurses that did her in. It's a shame after a fine career to end it like that.

The worst from the week was seeing a patient's wife in tears in the hall. The surgery was difficult, and had to be stopped.  It needs to be rescheduled for another day.  She was happy with the care, but totally distraught over the money.

Their healthcare system, the same 'Big Box' hospital as my mother, wanted to do a larger operation, and wouldn't cover the minimally invasive one. So they sold a car, came up with twenty-thousand dollars, and paid to get it done once and for all.  But it wasn't 'once'.  As it stands, I still haven't gotten paid yet for my six hours of work (they paid for like, three, because that was the estimate, but everything went to the surgeon as one flat fee.) because it is up to the surgeon who still has to finish the job. My boss told me how much I am to be paid, and I know. It's an awkward situation. I was asked if I would be available for the return part--but unfortunately I am not. And I don't think the next anesthesiologist is going to work for free. The family can't come up with more money. It's up to the surgeon to do the right thing, and to take the hit for the O.R. expenses and take it out of his fee.

He says the hospital has doubled the costs for cash patients. And charges twice THAT for patients who pay cash who come from out of state, like many of his patients do. (He's famous).

It's sad.

There has never been a better time for healthcare to embrace energy medicine. During that whole case, with the need to come back pretty obvious the whole time--I was sending Reiki and asking for help from Archangel Raphael.  Sure enough, the patient DID notice instant improvement in the symptoms. I hope it's enough...

I share all these things so you will know the difference between what is really happening on the front lines, and not what they tell you in the news.   One way or another, things are going to work out. But Obamacare has hurt lots of people--doctors and hospitals are going unpaid--and patients who are self-employed and buy their own insurance--like the couple with the surgery that they paid cash to go outside their insurance system--are really getting the short end of the stick. They can barely afford the insurance bill every month, and the copayments and deductibles are so high, no one is 'getting anything done'.  As a result, our patients who do make it to the O.R. are sicker, more complex, and straining the staff to their limits.  We are exposed to many things in our work which are contagious.  We are on the front lines. And everything is changing right and left--this is how I see it and I hope this information is of value and interest to you.

Aloha and Mahalos,

Reiki Doc