Staying Out Of The Hospital

A retired surgeon wrote an interesting essay in the New York Times about how he decided to intervene on his hospitalized daughter’s behalf when she became unstable. The story is sobering. Leaving aside the fact that what this doctor did would get you kicked out of almost any hospital in the U.S., the fact is that hospitals are a dangerous place to be. Your objective should be to avoid them at all costs.

This past summer, someone close to me was admitted to a hospital in Northern San Diego because of complications from a surgical procedure. After he was admitted, he spent almost all of his time in bed trying to rest. Why? Because every hour on the hour all night, the nursing staff came in to his room, turned on the overhead fluorescent lights, and started charting data on a white board adjacent to his bed. He was unable to sleep and rapidly lost strength to get up and walk or recover from his problems. This is what we do to terrorists to break them down – sleep deprivation!91a5c42d47adecdaf8556ebd66719b26

When I visited him two days into his stay, I put a stop to that. I also found an incentive spirometer, still in its wrapper, on his bed stand. This is a breathing device to help bed-bound people avoid pneumonia. His nurse was unable to explain why he had not been instructed in its use. I fixed that issue as well, but sure enough, and quite possibly because of the delay, he developed pneumonia on the third day. Pneumonia one acquires in the hospital is so dangerous, it actually is regarded as separate diagnosis than the pneumonia you might get outside of the hospital. He was lucky. He could have died. Many do – but he recovered.

Every doctor who has gone through the clinical years of training as a medical student, and then through residency, has seen numerous problems whereby the system breaks down. Orders may be written or executed improperly, leading to potential patient harm. There are also diagnostic errors in the form of misdiagnoses and in failures to make timely diagnoses.

A recent study suggested that preventable medical errors, most of which occur in hospitals, are now the third leading cause of death of Americans behind heart disease and cancer. In my opinion, the causes for this are many, but the primary ones are the understaffing and undertraining of care givers.

The large hospital systems are pressured to cut costs to create profits for shareholders and pay for administrators in the face of ever sicker Americans filling the beds. Administrative costs are huge. Many of the CEOs of these systems are being paid in excess of 20 million dollars per year. These pressures lead to the staffing issues contributing to medical errors.

HMOs “capitate” costs, meaning that each person (patient) within the HMO system essentially has an annual dollar amount assigned to him or her, and the profit of the system as a whole depends on spending substantially less than that amount (on average). Accordingly, the incentive is especially strong to reduce healthcare costs spent on HMO patients because that is a direct impact on their bottom line. The less spent on patients, the more that is left over at the end of the year as profits and bonuses.

The last time I worked for an HMO was 17 years ago when I was an ER doctor in Mississippi. In the ER and the ICUs (which I covered alone overnight as the only physician in the hospital), I would often need to intubate (place a breathing tube in) patients for various reasons. This can be very difficult in time-critical emergency situations, for example in trauma patients due to blood obscuring the airway. The HMO which owned the hospital decided to cut costs by eliminating the colorimetric device that is used to confirm that the breathing tube is in the correct position. They argued that its use was not standard of care in Mississippi, even though they had provided it up to that point and the other two hospitals in town still stocked it. I quit working at that hospital the following day.

A Preventive Approach including following an anti-inflammatory diet, maintaining your bone and muscle mass through proper exercise and nutrition, correcting your sleep quality and body fat percentage if needed, and ensuring that your endocrine system is optimized will give you the best chance of staying out of hospitals and away from the unpredictable danger that hospital admission represents.

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