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Leftism Is Heartless
I was a third-year medical student (otherwise known as a scut-monkey – responsible for every job in the hospital that no one else wants to do) when we had a 96-year-old woman come in with pneumonia. The resident in charge of me told me to get her old hospital records. I asked the patient if she’d ever been in the hospital, and she said that she had, just once, in this very hospital. Great, I thought – that makes it much easier. No records transfers. This was the early 1990s, and we still had paper charts, which were archived in the basement after six months. So I was hoping her hospitalization was recent.
I asked her when her hospitalization was. She answered, “When I was four years old. Maybe five. I really don’t remember it very well.” I just stared at her. That would be around the year 1897. Maybe 1898 or 1899. That won’t be on the front rack. It was 11 p.m. My hopes for sleep that night were fading fast. So I trudge down to the basement, walk past endless racks of charts, and start digging through boxes back by the heating and air equipment.
One advantage I had was that no one had disturbed these boxes in some time. So unlike the more recent charts, everything was about where you’d expect it to be. And sure enough, I found her chart. I sat down on a box and started reading.
She had gotten very sick very quickly, and her father had carried her into the hospital. She couldn’t walk. She had a fever of 104.5F, was barely conscious, and recoiled when the doctor touched her abdomen. They removed a gangrenous appendix that night and put in drains to help with the infection. There were no antibiotics available at that time.
She remained semi-conscious for days. The surgeon would check on her, and occasionally put in a new drain, sometimes did a sort of lavage, and each day he described exactly how she was doing and what his plan was. I felt like I was making rounds with him in real-time, even though he’d probably been dead for 75 years.
He did a great job. She was in the hospital for over three weeks, nearly dying twice. But eventually, she started eating again, and eventually went home. She walked out of the hospital, after being carried in a few weeks earlier.
And due to the skill of the surgeon and the nurses, despite what now looks like primitive equipment and techniques, I was now seeing this patient 90 years later, after she had had a wonderful life with children, grandchildren, and so on. Her surgeon was dead and gone, but she was not. Outstanding work, sir.
What I remember most clearly, though, was the chart. The entire chart for her hospitalization of over three weeks was one sheet of paper. Filled on one side, and about halfway down on the backside.
And I knew exactly what had happened, every step of the way.
Our charts now are sort of the opposite of that.
They are enormous. I’ll have a patient spend one night in the hospital for a routine CHF exacerbation, I’ll request records, and I’ll get 75 pages of, um, just all kinds of stuff. It’s incredible, really, how much data they can collect on one patient in 24 hours. But here’s the problem.
When I look at those records, what I really want to know is, what did the hospital doctor think was wrong, what did she do to treat it, and how does she think this is likely to go? What might go wrong? What should I be watching for?
The chart I get will include, on page 56, the name of the nurse who changed the patient’s sheets that morning. But it will not include the two or three sentences that I’m looking for. What happened exactly?
It’s like asking for a glass of water and getting thrown into the pool.
Paperless chart systems are designed to generate as much paperwork as possible as quickly as possible. Because in modern medicine, we get paid to produce paperwork, not to take care of sick people. Now, when I make rounds in the hospital, there are nurses up and down the halls working on their mobile PC units. It’s unusual to find a nurse with an actual patient. Because the patients don’t matter. But the documentation does. Thank you, Medicare.
One of the entries from the surgeon in 1898 was something like, “I changed the drain to a new site yesterday. Pt much worse today. I fear that may have been a mistake. We’ll see.” Or something like that.
That is very helpful. He’s telling you what he’s observing, and what he’s thinking. Which is very important. In fact, it’s all that really matters.
In today’s legal environment, such thinking is prohibited. Or at least, you keep it to yourself. Which means that honest communication between doctors has been banned, for all intents and purposes. So if I want to know what happened, I have to talk to the doctor personally, off the record, and ask, “Hey, Sarah, you sent an unstable CHF patient home on freakin’ Spironolactone in 24 hours? What’s up?” And she’ll explain. And it will probably make sense. Off the record. Then, and only then, will I know what’s going on.
So it’s like going back to before we had charts. The only way to get any real information is word of mouth. Like in the days before Sanskrit.
So charts work for Medicare reimbursement. Sort of. I guess.
But they don’t work for doctors. Or patients. Or nurses. They have become useless. Worse than useless. They distract nurses and doctors from what used to be the most important part of all this: The patient.
It makes me sad.
That’s why I’m a bleeding-heart conservative. Leftism is heartless. Big government is heartless. Centralized control is heartless. It always is. There is no other way.
I’m not heartless. That’s why I went into medicine to begin with.
I don’t fit in this system.
The system doesn’t care about my concerns, of course. It’s heartless.
My patients do care. But they don’t matter any more than I do.
In a leftist system, all that matters is leftism.
And leftism is heartless.
Published in General
I used to supervise the folks whose job (among other things) it was to round on all hospital departments in the wee hours of the morning, to take every patient’s printed chart (which are still required in these paperless days), remove the–oh, I don’t know– 20, 50, 80, 120, 250 sheets of paperlessness from each of them, toss those sheets in the to-be-shredded-and-burned trash, and replace them with the 50-80-100-150, 400 sheets of updated paperlessness that had printed overnight for every single chart. A middling-size community hospital, and we printed well over a million pages each month (one of the reasons that distributors of toner cartridges fall all over themselves to get hospital business), on the patient units alone. I’ve been retired for a few years, but I don’t imagine it’s changed. There’s really no way to update the printed chart piecemeal, so just toss the existing one, and put in the new one. For every single patient. Every single day.
A role I’ve taken on many times over the years for family members and loved ones. (Ask me sometime about the crusty old one-legged Marine with a flesh-eating bacterial infection, who Mr. She and I sprung from one of the UPMC hospitals because his only wish for himself was that he should die at home. I managed to accomplish that, and he died a few days later, on November 10, as it happened. That might have been my greatest achievement in this regard.)
This year, my patient advocacy role extended to keeping Mr. She out of hospital for the reasons you mention. Our family doctor (who’s also a personal friend) was quite willing to admit him to a dementia ward if I thought I couldn’t care for him adequately and keep him safe at home. But I had awful visions of him being taken inside, the door being slammed in my face, my never seeing him again, and his being scared, confused, angry, and eventually dying alone. So we muddled along and through to the end here.
I really feel for folks who end up in hospital and who don’t have edgy, nosy, controlling, argumentative, overbearing, and loving OCD family members to keep the “system” honest.
Such things are incredibly important in veterinary medicine as well. Like babies, animals can’t tell you how they feel.
Along with crying and sleeping, that*all* that babies do.
When our grandson is born, it’s possible we won’t be allowed in the waiting room inside the hospital. Earlier this year, families were told to wait in their cars in the parking lot, and someone would run out and give them the news when the baby was born.
Uh uh, not me. I’m either sitting inside or by the phone at home.
I spent 50 years teaching medical students and office staff to NEVER use a patient’s first name unless they ask you to do it. Then came HIPPA.
Daughter has daughter #3 due in March. I’ve been with her for the other two births. If never dawned on me when we got the happy news that the hospital rules would still be in place come March 2021. But it looks that way …
I have several friends that also have grandchildren on the way, my daughter has been making onesies for us to give as gifts (and congrats on the pending birth, @stad. Lovely news)
This is what is printed on the onesies;
I always liked the ones that say “Mommie just wanted a back rub”.
Charts are for beating on juries with – it can’t be malpractice if the chart weighs the same as a duck.
Thank you for this valuable look into the world of digitized records.
One of the reasons for these records, I believe, is that if the hospital staff goofs up, and the patient’s family realizes it, when their lawyer asks for the records, the hospital can give them those 295 pages of records, but leave out the four pages that would show malpractice.
Having done elder care for almost 20 years, I heard so many stories such as the one regarding the appendectomy you just described. I was fortunate to be working in an affluent area of the world, so that often my patients would be elderly nurses, or elderly doctors.
It was amazing to find out that in the early 1930’s, in upstate Minnesota or Idaho, when a preemie was born, the nurses would heat bricks up inside the fireplace, then wrap the warm bricks in towels, and then lay the newborn in the midst of this primitive set up. It was even more amazing to find out that most of the time, their efforts were successful.
Six years ago, during a time period when I had a real doctor, I asked him what my weight had been six months earlier. It took him almost 10 minutes to figure out where that digitized info was, and how to read it. All I could think while he was scrolling through the endless data on me, was that if I was in a critical condition and he needed specific information quickly, how would he find it in time to save me? (I was a rather healthy patient so how could there even be that much info on me?)
I’m not sure everyone recognizes the significance of the newborn pooping. That is how you detect imperforate anus, which is not that rare.
Mr She is so lucky to have you. What us scary for us women is that statistically speaking, we might outlive everyone else in our inner circle, and then who will advocate for us?
Annefy is quite right that currently, that due to COVID, a patient is now alone inside the hospital or nursing home with no visitors allowed. This leaves the patient open to all the pitfalls of being totally vulnerable to neglect, including nursing and doctor errors.
@annefy
As a proof of what goes on when families and friends re not allowed visitors:
The last close friend I had who was in a hospital was there in 2016. She was a 93 year old lady who had had a mini stroke that had left her malnourished and de-hydrated. As far as hydration she was being pumped up with fluids via an IV. But some nitwit had decided 24 hours in, that she could eat on her own. So no nutrients were being supplied through the IV after that evaluation.
I arrived 48 hours after she had been told she could eat on her own. It was true she could eat do this – if the oatmeal, whipped creamy potatoes, and other foods were not underneath a heavy metal cover, or wrapped in aluminum foil. Basically despite being in the hospital to get built up, she was starving again. She’d been living on cartons of milk: two or three each day.
Not one of the nursing assistants, nurses or doctors noticed this was happening.
I can only imagine what is going on while our most vulnerable are left without family and friends. Then the public is told that “COVID cases are rising.” Yes they are, because of the stupidity of our modern world with all its complications.
All hospital patients being admitted are tested for COVID. If they test positive, they are possibly doomed. The patient will immediately be doped up, using a cocktail of fentanyl and oxycontin. Then that drugged up patient is encouraged to realize that due to their COVID status, the sooner they agree to being put on a ventilator, the better off they are.
That ventilator is being insisted on, even if the reason for being in the hospital is an auto accident or stabbing wound, and even if that patient has no real COVID symptoms.
In 1969, I operated on a 1 pound 10 ounce premie for intestinal atresia. She survived and went home. I have often wondered what happened to her. There were no infant respirators and she did fine breathing on her own. I was busy as a surgery resident and never wrote it up but she was the smallest premie to have surgery at the time.
It’s not just the medical records. I once practiced in a small town in south Louisiana. There was a general surgeon there who was 90 years old and still practicing. He had been a top rated college athlete, a distance runner I believe, and had practiced in the area for over 60 years. I discovered that if I needed someone to see a diabetic foot ulcer, he was the one to send the patient to see. The patients would come back to me in a few months healed. That was a long time ago, but diabetic foot ulcers are notoriously hard to heal, and caring for them has become a specialty in itself. But this old country surgeon had a better track record than anyone I have seen come across before or since, even with all the technology that is available today, which is remarkable. I asked one of the other doctors who had been in the area for a long time why he got such good results. The reply was that he trained in the pre-antibiotic era, hence, his surgical technique had to be exquisite and immaculate to avoid wound infections. Those skills served him and his patients well. That had a profound effect on me. In the same area, one of my patients told me how his grandfather died. He was a country GP. He was getting up in years. A call came that one of this patients was in labor. The patient lived on an island in a swamp and there was no way for the patient to come to him, so he grabbed his bag and headed to the patient. He had to pole a pirogue across the swamp. He develoeped chest pain while he was doing this. He knew he was having a heart attack. He kept going. He got to the cottage of his patient, delivered the baby, and laid down and died. They named the child after the doctor.
Dang straight. It’s set the bar.
I can’t believe that this digitization has anything to do with being a Republican or being a Democrat.
It has to do with whether or not an individual could benefit from the massive amounts of monies that went into digitizing hospital and clinic records.
For instance, circa the late 1990’s, the Sutter Hospital franchise, in the San Francisco Bay area, pretended to the public that each hospital in its system needed to have its own group of programmers to develop that individual hospital’s digitization programs. Slush fund creation at its very finest.
Although I will grant you that the 2009 ObamaCare legislation included a 20 billion dollar slush fund, to assist hospitals in rural districts to cope with the need for digitization. Although highly doubtful, if this was an honest mistake, and not a slush fund, then I have no idea what the people putting that together understood about rural hospitals. Most of them are totally hooked into the same franchises like Sutter or Adventist and so were up and digitized by 2005 at the latest. Rural hospital personnel were not using a chisel and stone slate to record their patients’ records, at least not in California.
Obviously, if it weighs the same as a duck, then it must be made of wood! So you win!
Many hospitals these days (mine was one of them starting almost twenty years ago) implement software applications and controls that prevent the attachment of unrecognized devices to the network via things like USB ports, and restrict the access of internal storage devices to approved purposes. We were, quite literally, feeling our way through the early days of digital storage, the RIS/PACS and other departmental storage vaults, dealing with images coming–with or without the patient–on CD from other institutions, the advent of mobile apps which doctors expected to run on their cell phones, and be able to use while in the hospital, securing patient data if it was to leave the organization in any electronic format at all (email being the prime bugbear there), and a veritable plethora of other stuff (including how to keep ill-wishers determined to get into our “stuff” from the outside at bay. It’s what keeps a certain type of healthcare IT manager awake at night stewing over whether or not there might be a hole somewhere you could drive a truck, and a whole lot of patient information with it, through and out the door. And I spent many a sleepless night doing just that, because the penalties for just one unauthorized release of private health information can be catastrophic.
It’s a real balancing act–getting things secure enough to pass compliance audits and to be able to present well should the organization be sued, while still leaving things open enough that hospital and medical staff can do their jobs without infringement or hassle.
But if anyone’s thinking of bringing in a device to attach to hospital computers, I’d suggest (wait for it!) asking someone in IT if what you’re proposing to do will work, beforehand.
When my father died I was left with his filing cabinet full of patient records from his clinical practice. I was amazed. Records from his entire 37 year practice were in one cabinet. It was all on 5 by 7 inch cards. A note for a clinic visit might be something like, “Flu shot”, and that was it.
Years ago the Medicare inspectors came through my father’s clinic and told him he’d have to start using SOAP notes and more “complete” records so they could audit his work. He refused and refused to accept Medicare.
Almost everything that we don’t like about the medical system is due to the way the government regulates it.
First, the good news:
A friend of mine had a heart attack the other day. Some vital vessel they call the Widowmaker was virtually completely blocked. His symptoms were that he felt sort of crummy, wanted to go home from work (he’s an elementary school gym teacher) and lie down. His chest felt tight.
He drove himself to the local E.R where they started loading him up with thrombolytics. The pain and pressure were, by that point, intense. He was loaded onto a LifeFlight helicopter. En route to the big hospital, he died. But those LifeFlight crews can, I swear it, somehow keep life going inside a wet paper bag; they brought him back. (Our theory is that my late husband was on the other side of the line, shoving him back, telling him “not now. Not yet.”) Electric paddles and all. He went straight into surgery from the helipad, they blew in a stent (through the wrist! That’s new to me!) and within an hour or so he was Facetiming with his daughter. One of my oldest friend is not a widow today. Every time I think about that, I tear up. God bless doctors. God bless medicine. God bless Life Flight.
Bad News—there isn’t any, from that story. All splendid.
But my experience with loved ones whose illnesses and issues are more of the chronic variety tells me that yes! yes! as @Annefy says, no one should be in the hospital without a fiercely interested loved one in more or less constant, obnoxious attention.
It is really interesting to hear the stories from active and former doctors and nurses. It ‘splains a lot. (I briefly worked as a nurses’ aide—we did a lot of Intake and Outgo…eating and pooping…is that not a thing anymore?)
HIPPA is not our friend. As I recall, HIPPA came about because of AIDS, and the tender concern felt by healthcare bureaucrats for the privacy of persons infected, whose loved ones might stop loving them if they found out they were gay.
Before HIPPA, my mother could call the hospital where I was in labor, and have a nurse tell her “Oh, yes, she’s eight centimeters!” Now, they wouldn’t even tell her I was in the hospital at all.
This is particularly dangerous when the patient is non compos mentis; I’ve a loved one with a serious mental illness. She was in the E.R. for two days before we tracked her down, because along with “I’m a close personal friend of the Dalai Lama” and “I’m a conjoined twin” and “I have seven babies but the CIA has stolen them” she said “no, I don’t want you to call anyone.” Meanwhile, plastered all over the “Behavioral Health” portion of the E.R., and again displayed at the mental hospital, there were signs proclaiming her “right” to refuse care and leave. Being psychotic and delusional does not mean you can’t read, it turns out.
The same, surely, is true of any patient whose injury, illness, medication or age renders them confused and unable to process or retain information. Even with the best, most rational record-keeping in the world, a nurse (stranger) isn’t going to know what she would need to know in order to provide good care for such a patient, or even to separate a patient’s truth from delusion —after all, conservative author Arthur Brooks, to name one unlikely person, really is a close friend of the Dalai Lama.
I can’t say for sure, but I do believe the notion (bolstered by Freud) that families are dangerous, intolerant and untrustworthy is a leftist one. Especially since “compassionate” healthcare providers and bureaucrats get to find out all sorts of stuff about us, existing as they do to protect us from our toxic relations.
I do this for a living, and some of this still seems like Star Trek to me. It really is remarkable what we can do these days. I’m 52 years old, and so much of the medicine I practice today was simply unimaginable when I was in medical school.
Our government tinkers with our medical system at our peril.
I love it!
We looked for an “Oopsie!” outfit, but settled on terminal cuteness . . .
Amen, brother.
It has to do with the desire for centralized control of our health care system. Which is mostly (although not exclusively) a Democrat goal.
I recently finished listening to Epidemics: Hate and Compassion from the Plague of Athens to AIDS by Samuel Cohn (2018). If it wasn’t so expensive in paper or as an e-book, I would have gotten that, too, so I could better cite examples.
But in many epidemics throughout history, in many cultures, one thing that could provoke people to violence was the taking of sick people away from their homes and families to be treated in an impersonal hospital or quarantine house. It made me think of current times when covid patients are not allowed to be with family.
I always thought it was demeaning in a hospital or nursing home to presume to call people one doesn’t even know by their first names. But I guess I’ve gotten resigned to it. It no longer raises my hackles, perhaps because under the current system the whole experience is demeaning.
However, I still have to laugh at the Death with Dignity people who think that getting one’s self offed in a medical setting is somehow dignified. If I want dignity, a medical setting is the last place I’d go. Getting propped up to be shot by a firing squad might have some dignity to it, but not an injection in an impersonal hospital where strangers in white coats call you by your first name.
I completely agree.
The first-name thing seems pretty common with lawyers, too. You get called “George” or whatever, but the lawyer expects to be called “Mr Smith” or whatever, and will usually “correct” you if you call him “Sam” or whatever.
I’m 58 years old, and I still call the woman who lives next door to my mom (they moved in when I was in 4th grade) “Mrs. [neighbor]”. In my mind, her first name *is* “Mrs”.