The Importance of Learning About Your Health

Can you answer these three questions from the Brief Health Literacy Screen (BHLS): 

1. How confident are you in filling out medical forms on your own?; 
2. How often do you have someone help you read hospital materials?;
3. How often do you have problems learning about your medical condition because of difficulty understanding written information?

They appear simple. Many people I think would say Very, Never, and Never. But then if you add in the complication of not knowing English very well, a lower level of education, or just being sick and not clear headed at the time, those could change easily to: Not at all, Often, and Frequently.

What is the result of this kind of problem? Longer hospital stays for one:

"Using the BHLS screen, 20% (1104/5540) had inadequate health literacy. Patients with low health literacy had an 11% longer average length of stay (6.0 vs 5.4 days). Among men, low health literacy was associated with a 17.8% longer length of stay, and among women, low health literacy was associated with a 7.7% longer length of stay."

Longer hospital stays result in more exposure to germs, bigger bills, less rest for the patient (who ever gets a good night's sleep in a hospital) which ends up with more patient stress.

A recent study showed all this and more. Read it here.

Reducing Cancer Care Costs and Hospital Stays

There are two really irritating things about cancer care for me. (Well there are really lots of things that irritate me about cancer care. I could make a giant list of them if anyone really cared but today I am going to focus on two things.

Cancer care is ridiculously expensive. You can take a drug for $100,000 that might increase your lifespan for a couple of months. A single chemo infusion can cost upwards of $20,000.

And at the least sign of germs or low blood counts, you are sent to the emergency room where they admit you. That is a really stupid part. You feel like crap on a Friday night, you call your oncologist and they send you to the emergency room for blood tests and then they admit you after you sit in a room full of car accident victims and finally end up in a really uncomfortable bed with IV antibiotics. Really not a good idea.

The second annoying issue is how quickly doctors throw more drugs at cancer patients. Here, take this too and this and this and this. Let's get you some skilled nurses at home to help you with some fancy new equipment. Each one adds another triple zero item to your bills.

(I could rant on about the annoying part of going to daily radiation for weeks and weeks.)

But finally there are two new ideas that are focused on reducing cancer care costs and hospital stays. (Its about time.) Anyway here are the two new ideas:

Oncologist Dr Barbara McAneny in Albuquerque, NM looked at how her cancer patients dealt with hospital stays and ER visits due to low blood counts and other chemo side effects. She convinced the rest of her practice to provide weekend and evening availability for shots. Then they added other 'off hour' services such as nighttime appointments and same day availability. This resulted in major cost savings and reduced hospital stays. This practice is now being expanded to other clinics across country.

Next, this program above has been expanded even more after July 1 of this year:

"The Centers for Medicare and Medicaid Services has long talked about alternative payment models (APM), and now they are a reality: as of July 1, CMS launched its first APM, for one of the priciest specialties in healthcare, oncology.

The so-called Oncology Care Model (OCM) is now in play in 195 practices across the country, and will last 5 years. Late last June, just before the OCM went live, CMS Acting Administrator Andy Slavitt tweeted: "Big news fr @CMSGov this morning. 3,200 oncologists (double the target) signed up 4 new payment model -- 25% of all cancer care smarter way."

In a nutshell, in addition to traditional E&M codes, the CMS is paying oncologists $160 a month per patient undergoing chemotherapy for 6 months, starting with the patient's first dose. Oncologists are supposed to use that money to set up programs that effectively manage patients' chemotherapy complications "and heighten the focus on furnishing services that specifically improve the patient experience or health outcomes," the agency said.

A key element is that practices must provide "patient access 24 hours a day, 7 days a week to an appropriate clinician who has real-time access to practice's medical records." This and some other aspects of the OCM were drawn from the "Come Home" program pioneered in Albuquerque, N.M., by oncologist Barbara McAneny, MD."

Okay, who wnts 24 hour access, 7 days a week during cancer treatment? Me! Look at smart business practices being applied to cancer patients, reducing care costs and hospital stays.

The Hospital Space for Relaxation

As you go through cancer treatment you need a place to sit quietly with friends and family. Every hospital has a space where families of patients can come together and relax with the hospital patient. There are little areas tucked away. Every hospital has one.

At the hospital I go to there is a little quiet space tucked away down by the chemotherapy infusion rooms which is comfortable and has a small lending library for patients and their family members.

At Children's Hospital in Boston, they have the Prouty Gardens. It has been there for sixty years and was donated for that specific purpose. Mrs. Prouty was told by the then hospital president, that it would stay until 'all children were well'. She then hired professionals to design and create the garden using her own money. On a plaque in the garden it says: “Because of Mrs. Prouty’s vision, this garden will exist as long as Children’s Hospital has patients, families, and staff to enjoy it’’. The value of this garden to patients and their families can not be measured.

Many families have spent time there with their children in their last days. They have even spread the ashes of their children there and have gone back to remember then there. Its a cemetery in some respects, even if its use as one was not intentional. Its a place of remembrance.

Now Children's Hospital is going to dig up Prouty Garden for the purpose of expansion. The claim is they need the space for more private rooms, a neonatal intensive care unit, and a heart center. Big business interests have taken over the wishes and desires of patients, former patients, deceased patients, and their family members.

On one level I can understand the need for the hospital to expand and add more space to treat more patients. All businesses run into the need to expand. They find more space where they could then expand. Children's Hospital has multiple campuses where they could expand elsewhere.

The idea of taking a space which has been used for contemplation and remembrance for so many for so long to build a huge building is very unjust. This whole idea just upsets me. The hospital went back on their word that has stood for decades. The only hope is that a judge will step in and rule to protect the garden.

A Post For Friends of Sick People

Barbara over at Let Life Happen blogged about visiting breast cancer patients. I feel this is a greatly ignored topic and want to add my two cents on this for the benefit of all patients.

First of all, before you visit a sick person, put yourself in their shoes. When are you feeling awful, do you want to entertain someone for hours? Do you want to answer dozens of phone calls asking the same thing? Don't you want to sleep or watch bad TV or sip herbal tea in your bathrobe with fuzzy slippers on your feet? If you are in pain, what is your preferred activity - lying in bed with your tablet or sitting up in a chair talking to people? Please think first before you go visit someone who is ill or even call them.

Second of all, if someone is in the hospital these days, chances are they are not doing very well. I have never gotten a good night's sleep in the hospital (because my blood is best between 3-5 AM when they come to get it and wake me up). I am probably not feeling well and am usually cranky as a result. I am probably in my pajamas (or a lovely Dr. Seymour Butts hospital gown) and not looking my best. Chances are I am in pain as well.

Never just drop by because you 'were in the hospital'. A few years back, a friend 'dropped by' because she had some blood work done at 8 AM on the day after a major surgery. A very bad thing to do. I don't know what she was thinking. Visiting hours didn't even start until 11 AM. I was in a lot of pain and really didn't want to see anyone.

Having a party in someone's hospital room is a really bad idea. A friend had heart surgery in his early-30s. My then-boyfriend and a bunch of other friends were going to visit him at the hospital a day or two after surgery. I refused to go. Why? Because I had been a patient and had surgery and knew I would not want that many visitors for a few hours a couple of days after surgery.

I can't tell you how many times in the hospital, I have seen hospital rooms full of a dozen visitors for several hours and the patient is dozing in bed (probably wishing they would all just leave and let them rest). A hospital room is not a party room.

Once a patient is home, that doesn't mean the door is open for non-stop visitors. They probably want to rest and recover. They might have visiting nurses and PT/OT for a few weeks. If you want to visit, call first. If you don't get them, leave a message and wait for them to get back to you.

Honestly the best bet for visiting someone after surgery or who is ill enough to require hospitalization is to call before any medical misadventures and ask about visiting them afterwards. Do not assume anything. Some people may welcome visitors and some may not. You cannot know unless you ask. Also, you might want to offer to stop and get them some groceries or bring a casserole. Just ask first.

When I am in the hospital, I tell everyone the only ones to visit me in the hospital are my husband and my immediate family. Everyone else can wait until I tell them I am ready.

Finally, if you have been exposed to or are harboring any germs yourself, stay away until you are healthy.

More on change

As part of moving, we are looking at a variety of locations. The biggest requirement is that my husband's commute stays reasonable. Well the first requirement is that we buy a more affordable house. But my husband's commute is the other significant factor.

Originally, I said we need to stay near the hospital where I am treated, relatively easy commute for me to work, stay near the gym I go to (because it is wonderful) and stay near my family members who live locally. Then we realized that as we downsize, my working will become a lesser requirement. And if I don't work, I can take a day each week to spend with family members so that is two things down.

The next issue of being near the wonderful gym I go to for dilapidated people is significant. But I hope if we move too far for it to be easy to get to three times a week, I might be able to find another gym with the right kind of equipment and supplement that with a physical therapist.

Finally, the remaining big issue is finding another hospital. I really don't want to but if necessary I would. I have been a mostly happy patient there for almost 35 years. All my medical records are there. But if it became more than a 45 minute drive, that might become an issue since I go there an average of once a week. I think that would become a last resort but could be under consideration. The bonus is that  it is about 10 minutes from my husband's job so that if he has a good commute chances are it would still be accessible for me.

I have considered if we move further out I might make a point of getting registered at a more local hospital so that the bulk of my medical history and allergies are there in case of an emergency visit. But I am not impressed with what would be the new local hospital's emergency room so that might be off the table.

Grr. I just want the damn move to be over so I can get through the all this packing and un packing.

Forward thinking

After getting eight feet of snow since January 25 (less than a month ago), I am trying to be forward thinking. We are not due to get a blizzard this week - which is fortunate because we have no more places to put the snow. The city of Boston called "Uncle" a while back. Today we woke up to 29 degrees. But nevertheless it will be around 5 degrees overnight tonight.

I look at my spring gardening catalogs and think about what to plant in the garden this year. I have no hope of planting anything soon as this is my front walk.

This would be a bit better.

(This is not my front walk, a cousin sent me the picture.)

But I digress. I am trying to be forward thinking. But I have a real  problem. The *(#&%$@&^ hospital has decided that it would be better to send an individual notice for each medical appointment a week or two before it, instead of a list of all appointments.

Look, I have chemobrain, fibro fog and general forgetfulness. I need you to send me long lists of appointments so I can keep track of them, especially when you change them on me. If I knew who to complain to on this I would.

But since I do have a doctor appointment tomorrow I will be sure to ask for an updated list so I can remember.

Call Me Appalled!

Yesterday was a long complicated day. It ended with me leaving the emergency room of a local hospital I rarely go to around 7pm. (I am fine, a friend needed some stitches). We were there for several hours and saw people coming and going.

As I was leaving, I noticed a woman taking her husband back to the car in a wheelchair. I saw them there when we got there several hours before. Her husband was groaning and in a lot of pain. She was steaming mad. And I don't blame her.

After they were there for hours, they were heading to another hospital as they were just told that hospital does not do surgery on weekends. Could you imagine? Why couldn't they have told them earlier?

I realize it would probably be a doctor to make the decision that he needed surgery but couldn't the triage nurse do anything about it so they were seen sooner before sitting there in obvious pain? I am appalled. I did recommend another hospital to her where I know they do surgery on weekends.

A day at the hospital

Over the past two days I have spent several hours at the hospital (not for me). Sometimes I drive other people there.

It was a bit of visiting cancerland on Wednesday as I was in the infusion area. One of the nurses asked me if it was weird to be back there and brought flashbacks. I said not really as its been long enough. And that is true. I am okay with it and it doesn't bring huge flashbacks. As long as I am not the one in the big chair with the IV in my arm.

Yesterday I was getting us tea in the cafeteria, there was a woman in front of me in line wearing a pink and white striped shirt, with a pink baseball hat over her bald head. She was clearly ready for Pinktober. And comfortable showing the world her ailment.

While waiting in the radiology department, we all got a snicker as a man walked out of the dressing room and brought his shirt and shoes to his wife. I could understand the shirt but not the shoes. Why walk in stocking feet in the hospital? Icky.

Later, in the lobby there was a woman in dressed in a hospital gown at the ATM machine with her IV pole. She was clearly a patient who went out for a walk to get some cash so she could go shopping at the gift shop. (Mental note to self, bring debit card for shopping at next inpatient stay.)

I made some small joke about taking an IV pole out for a daily walk as she went by. She replied with "they don't talk back and you can take them anywhere". Very true.

Enough hospitals for this week. I think all my appointments start next week. Crap.

VA Hospitals

The message here is do not go to a VA hospital. Especially for cancer care.
I find this appalling. We send men and women off to war and they are supposed to receive their medical care at VA hospitals around the country. What do they get? Poor and delayed care. And this results in deaths. The waits are twice what they are at other hospitals.

The saddest part of the video above is that there are probably so many more stories like this.

What is going on at the VA hospitals? Bureaucracy? Paperwork? Employees who don't care? No sense of urgency? I don't know but you won't catch me near one. Yesterday I blogged about the best hospitals, now these are some of the worst as far as I am concerned.

The Best Hospitals

US News and World Report just released its annual list of the best hospitals in the US. The hospital I go to is not in the top ten.

And I am not concerned. I mean what is the benefit of going to one of the top 10 hospitals inthe US? My bet is it comes down to two issues:

• More expensive bills
• Longer waits for appointments.

I have been told by someone who worked at one of the big name Boston hospitals that unless you are related to a senator, you can expect a long wait to get in to see a doctor. And a recent study of Boston hospitals showed that the big name hospitals offered the highest fees.

With all my medical crap, I am very comfortable with the medical care I receive at Lahey Medical Center which is ten minutes from home.And that recent study of fees in metro Boston put it near the bottom of that list.

My only complaint with the hospital is that I am there too damn often.

How expensive is your hospital?

I had no idea how expensive my hospital, Lahey Health (formerly known as Lahey Clinic) is compared to other hospitals. Its one of those hidden numbers that your insurance company and hospital conspire to keep unknown as they negotiate rates and fees.

I live just outside Boston, which is home to a few big name hospitals, and refuse to go into the city for treatment. The traffic would drive me crazy. And if I am not feeling well, I refuse to deal with the traffic and feel like crap at the same time.

I have friends who went into the city for treatment and whined about all the traffic they sat in and how early in the day they would have to start to get to a 9am infusion. I just assumed all hospitals cost about the same - namely a hell of a lot because nothing is cheap around here.

But now I know... and drum roll... its 12%-40% less than the big hospitals with the fancy names in town. They have a strategy of creating a network of community hospitals where most patients can go for care leaving the big teaching hospital for the sickest people. (Guess which one I go to?) They have been expanding their network over recent years.

Here is a comparison of the costs from 2012 for an inpatient stay.

 

The two hospitals that are lower than Lahey are located away from metropolitan Boston.

I will say I am happy to learn my medical care is not straining my insurance plan as much as if I went in town. And I am happier to enjoy my 10-12 minute drive through back roads with no traffic to medical care.

Leading by example

You know when you go to your doctor and they tell you to eat a healthy diet and you stop at the cafeteria for lunch before your next appointment and they offer fried chicken and fries with a danish for dessert. Well now that is starting to change. The newest trend for hospitals is to become healthier themselves.

No more Dunkin Donuts in the hospital lobby for one. No more fried anything for most. This is part of a new initiative started in 2012 nationally to make hospitals healthier instead of contributing to chronic illness through unhealthy food options. This includes reducing red meat consumption and providing more vegetarian and fish options. Hospitals are also encouraged to try to source food locally. Some have even started rooftop gardens.

In addition, hospitals are taking steps to reduce waste, use of toxic chemicals, more efficient heating and cooling systems, safer chemicals in cleaning products, and increased recycling efforts.

I am very happy to hear this as this is a trend toward 'practicing what they preach' instead of 'do as I say, not as I do'.

I have noticed this at the local hospital where I go. They provide water stations through out the building where patients, visitors and staff can refill water bottles or provided paper cups. Recycling bins are evident. Food choices are leaning toward healthier choices and the cafeteria salad bar has expanded greatly. I had a yummy salad there the other day which was full of sunflower seeds and other healthy options.

This should be the way of the future. I would hope to see all these efforts visible at hospitals nationally and at other commercial and industrial buildings.

The patient hand off

How many times have you been the patient and been handed off from one shift to the next? And  how often does that happen in a slightly overheard conversation between one nurse and the next or one doctor to the next? There never seems to be a formal system of it and it always seems to be rushed. It is a key place where misunderstandings over a patient's care can occur which result in medical errors.

I have learned things about my care from hearing the nurse tell the next nurse that my gall bladder surgery did result in some fairly significant internal bruising during the surgery. The nurse had previously told me that it wasn't that bad and should clear up in a day or two. I also learned that during my knee surgery I had become agitated during the surgery for an unknown reason and should be watched in case I was having a problem with the anesthesia. During a hospitalization I learned that I was doing well but my pain levels were running a little high (I already could tell them that).

Little rushed conversations in the corner or on the side of a busy hallway while updating a patient's file are not in the best interest of the patient. Especially if the nurse tells the next nurse about several patients without time for note taking - can  you say confusion?

Children's Hospital in Boston has come up with a team approach where the full team participates. This has cut medical errors in half. Maybe I should be a kid again and  go there for my next procedure? Or I hope that other hospitals follow suit.

Hospital visitors

When I am hospitalized, I have a list of people who can visit me. They include my husband, my parents, and my siblings. Anyone else has to call and ask. I am serious about this. If people visit unannounced, they will find out how rude I can really be.

My strong feelings about this are due to the fact that once, after a significant surgery, a friend had to stop at the hospital for an early morning appointment, the day after my surgery. So she decided to stop by my room at 830am. I was not ready for guests.

I was talking to someone who was a friend and a nurse who was giving me some information. I did not want to socialize. She didn't understand the concept of good manners and to think that the morning after major surgery might be a bad time to visit someone.

When I am in the hospital:

1. I probably feel like crap.
2. I probably look like crap.
3. I am probably cranky.

Its not that I don't want visitors at all - they do help the time go by - but my goal is to get better enough so I can leave as soon as possible. If I can't get my naps in, I won't be able to get better.  I find the concept of visiting people in the hospital for hours on end to be a bit ridiculous.

I actually feel sorry for the patient's whose families come to visit and stay for hours in big groups. If you are sick enough to be in the hospital, you don't want to host a party, you probably want to take a nap.

There is a hospital in Hawaii which has started the policy of visiting hours 24/7 and let the patients set their visiting times. This was done at patient request citing a study that found that people surrounded by family and friends heal faster and cope with their hospital stay better.

At first I was pretty appalled by this. But then I started to think.

There are lots of people who work odd shifts or have child care issues or travel distances or work nights and I can go on and on that have off hour schedules normally and are used to getting a lot of sleep during the day wherever they are so why should hospital visitation be any different?

Hospitals are where they wake you up for a sleeping pill or to take your blood and vital signs at 2am. So you might as well have a friend hang out with you for it.

So are you an inpatient or an outpatient?

The hospital and Medicare get to decide. Not your doctor who is actually treating you.

I found this pretty appalling. Medicare patients can be in the hospital for DAYS and be called and an outpatient because they are only being 'observed'. They get the same care as everyone else. But then they get a big fat bill if they were an outpatient.

Their doctor can even admit them and make them an inpatient but then the hospital can change it back to outpatient. Hospitals like this because they get reimbursed more that way.

"Medicare originally intended observation care as a way to give doctors time to evaluate whether a patient should be admitted to the hospital or is stable enough to go home, usually within 24 to 48 hours. But hospitals are increasingly keeping patients in observation status longer: 8 percent of Medicare recipients had observation stays longer than 48 hours in 2011, up from 3 percent in 2006.
Apparently the government can tell by looking at a rule book to figure out how sick you are, not but diagnosing you and reading your chart. Or, God forbid, even talking to you.

That increase may partly be a response to aggressive reviews of hospital billing practices in recent years. Medicare contractors have demanded refunds from hospitals that admit patients the government believes should have been treated as observation patients or outpatients. Medicare pays hospitals less for those patients."

And also hospitals are now rated on their readmission rates. If you aren't admitted the first time, you are not readmitted later on.

"Toby Edelman, senior policy attorney at the Center for Medicare Advocacy in Washington, D.C., said she believes hospitals also could be trying to avoid readmission penalties, which are assessed if too many patients are readmitted within 30 days. Harold Engler, for example, went home after five days, grew sicker, and then returned for another five-day observation stay. If he had been an inpatient, he would have counted as a readmission within 30 days."

Hospitals claim they are working on it because they computer tells them what to do. The computer even knows more than the government:

"Dr. James Hart, who heads a Beth Israel Deaconess committee that makes sure the hospital follows Medicare rules, said he could not comment on Engler’s case. But he said the hospital uses a sophisticated computer program that tries to match patients with the correct Medicare designation based on their illness and the intensity of hospital services required. “We are very focused on getting the level of care accurate,’’ he said."

Medicare knows this is a problem and even has created a brochure on this telling patients the difference. But if you are sick in bed, do you really care about semantics? No.

"Case managers generally inform patients of their status, especially if they require skilled nursing care, he said. But that doesn’t mean patients digest the information, at a time when they have so much to focus on. “Part of the challenge from a patient perspective is there really is an information overload,’’ Hart said."


You just want to feel better and go home where you can be in your own bed eating real food instead of the crappy hospital food they serve.

I knew Medicare had its issues but I didn't think it was out to impoverish seniors. I thought it was supposed to be the other way around. Clearly some changes need to be made here.

Update: 8/30/13 - One of the former heads of Medicare wants the rule on observation to be abolished.

Why don't have I have a patient navigator?

I need a patient navigator. The idea behind a patient navigator is to help newly diagnosed people deal with the mysteries of all these new doctors, treatments, and help them through the process by being there as the go-to person. Its part of the new patient centered care which is a great idea.

An experienced person is assigned to a newly diagnosed person. The experienced person can be someone who simply is more familiar with the hospital and how it works or can be someone who has been through the same ailment (s).

My health is complicated and I have lots of doctors so why don't I get a patient navigator? I think the real answer is that no one else has the same set of ailments as me. I know a couple people who have had both breast and thyroid cancer. I know other people with RA. I am not sure I know anyone else with fibromyalgia, yet - I am sure that will change.

The odds of getting breast cancer in a woman's life time is 12.4%
I couldn't find the odds of getting thyroid cancer but if there are 60,000 cases diagnosed in the US this year and which is about 1/4 the rate of getting breast cancer so we'll say its about 3.1%.
Fibromyalgia affects 2-4% of the population
Rheumatoid is diagnosed in an average of 41 of each 100,000 people.

If we do all that math the answer is three people. 0.124*0.031*0.04*41*3139.14=19.15 (see below for update)

What I did is 12.4% chance of getting breast cancer times 3.1% chance of getting thyroid cancer times 4% chance for getting fibromyalgia times those 41 RA patients in each 100,000 times 3139.14 for the 313,914,040 residents of the US.

So somewhere there are 18 other people who might be like me.

The other reason I don't have a patient navigator is I know the hospital I go to better than a lot of employees. I  have been a patient there since 1981. It opened in its suburban location in the late 1970s. I run into people there who say I have been here since the 1990s. But then I tell them about the hospital before the first renovations when we all checked in at the front desk in a big line. Anyone who worked there when I started going there has since retired.

This is why I don't have a patient navigator.

I guess I have to suck it up and figure it out on my own. I'm not very good at the sucking up part.

*Update on 4/11 I found that the lifetime risk of thyroid cancer is 1.03%  so that changes my little formula to 41*0.124*0.0103*0.04*3139.14 or 6.575268. So somewhere else in the US there might be 5 and 1/2 other people like me.

Secrets of medical costs

Someone referred me to this article which I read with great interest. First I started with this video:

Then I read the article called the "Bitter Pill: Why Medical Costs are Killing Us"

FInally I watched the second video where the writer answers questions on reactions to this story:

So where does all this education leave me? I am not as smart as I thought I was.

All along I was blaming high medical costs on pharmaceutical manufacturers who were passing on the research costs long after they were paid to the patients through high drug payments. I was blaming insurance companies for high insurance premiums, denial of claims for stupid reasons, and general ignorance.

I did not know that hospitals are a big part of the problem with their secret lists, huge mark ups, and high profits - even if they are non profit. They hide behind the HIPAA laws on patient privacy to hide their 'chargemaster' list of billing amounts.

There is also the issue of the standard CYA tests ordered by doctors out of fear of lawsuits instead of best treatment for the patient. But that is another blog post.

My take away from these videos and article is that our health care system is more messed up than I previously thought. People are getting rich at the costs of the poorest people or the ones forced into bankruptcy due to medical bills. More action needs to be take in this area.

While the Healthcare Reform Act focuses on getting insurance and medical care for more American's, it does not go far enough in addressing the financial side of patient billing and who pockets the money at the end.

The unsung heroes of modern medicine

We need to take a minute to remember a few things about our medical care. We see our doctors and nurses but what about everyone else?

• If you go to the doctor for a routine appointment, there is a receptionist and nurse and a doctor at the minimum.
• If you are sent for blood work, there is also the lab tech who draws your blood but also the people in the lab who test your blood.
• If you get an x-ray, there is the person who takes the x-ray plus the radiologist who reads them. Plus there are the people who maintain the machines.
• If you go for chemo, there is a receptionist, a nurse to take your vitals and draw blood, a medical oncologist to review your blood counts and recommend chemo doses, the nurse who gives you the infusion, the pharmacist who got all your meds ready.
• If you go for radiation, there is a receptionist, a radiation tech who gives you the radiation, a radiologist who reads your latest CT scan, a nurse who checks in on your and your radiation oncologist who supervises your care.
• If you have an operation there is an anesthesiologist, several nurses, assistant surgeon, etc.
• If you come to the hospital in an ambulance, there will be some EMTs, trauma nurses, a social worker, maybe a respiratory therapist, and more.
• What about residents in training, hospitalists who manage your care why you are an in patient?
• Never mind everyone else at the hospital or medical center who make the food, clean the rooms, coordinate care, schedule procedures, (wake you up to take your vitals in the middle of the night), and more.

Modern medicine is no longer about you and your doctor and the nurse. There are many other people who work to make sure everything is running correctly and patients get the care they need.

We often forget those in the background. This article made me remember them all. We shoudl take a moment to thank them all.

Best hospital - what does that mean?

US News and World Report just announced the 2012 listings of the best hospitals. There is a big hoohah going on about this year's listings as Mass General has replaced Johns Hopkins as the best hospital in the country for the first time. The listings starting in 1990 and JH led the list for 21 years. Well, yip-dee-doo-dah! What does this really mean?

Seriously? If a book is the top seller they can quantify this by looking at the numbers of copies sold. But how do you do this for hospitals? Obviously you can look at death rates, ratios of nurses to patients, readmission rates, etc.

US News states:

"Best Hospitals' central mission remains unchanged: to help those who need an unusual degree of skilled inpatient care decide where to get it, especially when there's time to make a choice. Other ratings and rankings typically examine how well hospitals perform fairly routine procedures, such as hernia repair and uncomplicated heart bypass surgery, and how successfully they manage relatively unthreatening conditions such as mild heart failure. That's fine for most hospital patients—in any given year, hardly anyone who visits a hospital spends a single night there. (There are about 20 outpatient visits for every hospital admission.) But for patients whose surgery or other care poses a technical challenge, or whose age, physical condition, or infirmities multiply the risk, good may not be good enough."

They then go on to talk about number of procedures, teaching hospitals, and more. I am not sure that I would switch hospitals based on a magazine article. Where I am treated is #7 in the state. There are six better hospitals in Boston but that involves traffic, expensive parking, breaking in new doctors, finding my way to different departments with out a road map, and all sorts of other complications.

Maybe if another icky cancer showed up, I might stop by the top rated cancer hospital and see if they have anything life saving to tell me that my #7 hospital is too far in the suburbs to know.

Hospital advertising

I have wondered why hospitals seem to spend more and more on advertising. Radio, tv, bill boards - they seem to be increasing more and more. I haven't figured this out until light dawned on me - some marketing person or advertising executive convinced them they needed to advertise.

Let's take a poll here - who chooses their medical care based on a billboard or tv ad? One vote here for no. I put a little bit more research into it than that. I might ask my doctor, ask friends and family, consider how long the drive would be (because of my inherent laziness), and maybe even go look at their websites.

This morning while watching the news, an ad came on for some hospital explaining breast tomography and how good it was at detecting tumors. So therefore you should go there for breast tomography. But they forgot the important point of why tomography - is it instead of mammograms? Or if you have a 'bad' mammogram? It didn't entice me to go there at all.

The news was just interrupted by a commercial advertising another hospital's cancer center. Every hospital seems to be advertising their cancer center more and more. Why, do they expect us all to be diagnosed and come running to them for treatment because we saw them on TV or on a billboard? Cancer center's seem to be the latest fad in hospital advertising. Everyone is getting one.  So it becomes an unending game of one-upmanship.

I am  a marketing person so I understand there can be many purposes to advertising - image enhancement or promotion for a sale or event. If they are focusing on enhancing their image, I'm not sure that tv ads are a good way to spend the money. TV ads are expensive to start - you need a budget that is a upper five figures to start. Maybe they could spend some of that money on patient care instead of advertising.