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You mean, aside from the inflamed appendix?

April 13, 2010
by kate
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There’s a line from the movie A Few Good Men (one of my favorites), during a scene when the characters are preparing to question a doctor under oath, that goes something like this:

“So there was no evidence of foul play?” “You mean, aside from the dead body?”

(Cue the dramatic music)

Last week, my husband went to the doctor after experiencing stomach pains for a few days. He was ordered to get a CT scan — as soon as his doctor read the results, he sent Dan to the hospital with what appeared to be acute appendicitis. That’s when the fun really started. When he arrived at the ER, the resident who examined him said she didn’t think his symptoms matched appendicitis, and suggested he might need further tests.

Apparently, she hadn’t seen the results of the scan, which Dan had to bring with him on a disc to the ER. Once she looked at them (and consulted with his physician), it was confirmed that Dan did need surgery.

Now, I understand that diagnosing abdominal pains can be very tricky, especially if the symptoms don’t match up exactly. What I don’t understand is why, in this age of health IT, results from CT scans can’t be more easily communicated and transmitted from a physician’s office to a hospital. There’s no reason a patient who has just been told he needs surgery should be counted on to transport a disc containing very vital information. And don’t even get me started on the fact that he had to repeat his symptoms and relevant information about 6-8 times (no exaggeration).

I know that IT can only get us so far — that the human element is such a critical factor in the care of patients (the nurses and other staff were so helpful, and made Dan’s hospital stay much more tolerable). But in today’s world, IT can play a huge role in more easily and quickly diagnosing and treating conditions, particularly in the emergency setting. In Dan’s case, relying solely on human instinct may have resulted in a burst appendix.

When it comes to optimal patient care, I think the key is a combination of IT and the human touch. Let technology transmit the information, and people do the caring. (Dan, by the way, is recovering nicely from his surgery.)

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Comments

Kate,
I'm glad that Dan is having a good outcome. Often, that seems to eliminate the pressure to improve the system, doesn't it?

I've spent a few days in an ED and hospital this past week, supporting and advocating for a loved one. Overall, great care with an atypical presentation. My high level observations:


1) A good history is still an amazing thing. The fourth physician to interview the patient ferreted out a critical detail missed by those before her. (Ferreting out - to search tenaciously for and find something.)

2) Excessive waiting for a physician or a test, in an ED or an inpatient, because "there are sicker patients than you who are taking priority" just isn't an empathetic posture. I don't know that it ever was. But now, it's simply a statement that our care delivery system is not built for timely coordination of care.

3) Every geriatric patient has multiple medical issues and their overlap will not be reliably understood by human or electronic clinical decision support any time soon.

Kate - you bring up an important point that other HI bloggers have identified in prior posts, medical imaging is woefully absent from ARRA/HITECH. Reform and regulation will be the only way to eliminate the barriers that prevent all a patients images from being included in their medical record.
There is simply so much money available to entrepreneurs and doctors for opening their own imaging facility that greed is dictating the rules rather than the need to create a comprehensive record that includes medical images.

Thanks for your comment, Joe. I was very surprised to see that imaging has been somewhat lost in the shuffle with ARRA-HITECH. As physician & hospital organizations submit comments regarding meaningful use, I'm hoping this is something that will be addressed.

Kate,

Your post pointed up a key gap that afflicts most patients even in 2010the reliance on patients to provide key links in the communication of patient record information, results, etc. This had real consequences in your husband's situation, and alas, I'm sure that scenario is repeated thousands of times daily in EDs and hospitals across the country. This speaks to why we are producing the content we are on the magazineto help our readers help their organizations move forward in all these important areas. Thank goodness your husband's situation ultimately worked out for the best!

kate

Kate Huvane, Associate Editor of...