Juxtaposition – our son’s finger and our car’s battery
Yesterday. Two real events, one healthcare delivery-related, the other, the diagnosis and treatment of a car battery problem. Those two events coincided with my completing reading a worthwhile, 17-page article by David Goldhill, “How American Health Care Killed My Father.” The relevance of Goldhill’s article was striking. First the healthcare event.
Emergency Department and Post-acute Surgical Care
Our eight-year old son was unfortunate enough to have had his finger crushed in a door at school. It was an accident, unrelated to the intentional or avoidable behaviors of anyone. It was very scary, and will likely become only a sad memory. Thanks to careful, cautious and competent work by the emergency department at a community hospital, and follow-up with a hand surgeon, our son is likely to have a functionally and cosmetically normal finger within a few months. What about the quality and costs issues?
The costs, coordination and follow-up care issues were typical of U.S. healthcare. We were told in the ED that the follow-up surgeon, scheduled for the next day, would be covered by health insurance. When we arrived at his office the next morning, we were told that wasn’t true. The office was in no way connected to either our pediatrician’s office or the emergency department (relationships or shared records text, or radiographic images), or any sort of system that would help organize and convey the management, costs and follow-up issues.
The surgeon was in another state, and according to Google directions, an hour away accounting for known traffic. This is in a major metropolitan area with a high density of doctors, academic medical centers, and the NIH (across the street from the hospital). That said, surgeon-in-another-state’s skill and the surgical outcome of the re-implantation to date are superb. We are truly grateful, although we had no real discretion to make a choice, assess price or other options.
We had no real choices in this situation, other than to follow a guild-based referral that was costly, inconvenient, and fragmented. See my post on selecting an orthopedic physician for our daughter in the post Relativity and Reality . In that instance, it took sophisticated consumer parents and four medical opinions to arrive at a clearly superior option – an option that factors in over a decade of Comparative Effectiveness Research that’s already completed but not locally valued. With our daughter, we had the luxury of time and a huge measure of parental energy. Conversely, the quality of the opinions for our son was objectively limited and the costs incurred were significant.
DieHard Battery Care
Contrast all of that with my DieHard battery experience. I’m thinking about apologizing for the not-so-subtle slight to the U.S. healthcare system by even making this comparison. But I’m not ready to apologize. I'm also eager to acknowledge that surgical skill cannot be compared adequately to commodity automotive service ... at least not superficially.
I needed to jump start my eight-year old car (jumper cables to another car’s battery) a few weeks back after a cold snap, combined with a child leaving an interior light on in the vehicle's backseat. The car seemed back to normal after the jump, but then seemed a little questionable over the ensuing weeks. So last night after work, I pulled into the local Sears automotive center, conveniently three miles from home.
We were quickly triaged. Two minutes later, my car was inside their large garage, the battery was attached to a test rig, and the same agent was completing my registration process. This included reviewing my car’s service record while the battery was being tested, automatically, against simulated loads. No more than ten total minutes from my arrival and I was told, “Your battery needs to be replaced, and the prorated price, with service will be $48.” I signed the printed history and physical document that included an assessment, detailed plan and estimates for length of stay and final, negotiated price.
My daughter and I went to dinner, came back, and found, in addition to the set expectations, there was a print-out of a comprehensive check-list for this problem, and results of performing the checklist attached to the bill. In other language, there was a clinical discharge summary that was complete to a best-practice standard of battery care. The alternator and other electrical things had been tested and documented to be okay.
My take-home lessons:
• My juxtaposed experiences served to support Goldhill’s conclusions. Pouring more reform money into a healthcare system that uses the government and others to pay for care will not improve quality, access or the cost dynamics of care delivery. Neither emergent care or episodic.