Healthcare System Fail: Let’s Get Serious About Disparities


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AKA The Billie Holiday Blues on Christmas: A Friend Gets Tertiary Level Care at a Low-Quality Hospital

It’s the day before Christmas and I’ve been involved in a medical crisis that nobody ever wants to face. Someone I know, who is an insured minority male, was taken to the closest hospital to his house. It turns out that he has an extremely serious diagnosis, requiring complex surgery expeditiously, but judiciously. The first surgery for this condition will play a critical role in his long-term outcome. For this surgery, a second opinion is ALWAYS advised. He did not get one. Whether he was advised of this, we don’t know. From what he tells us, I don’t think he has a clue of what follows the surgery. All sorts of plans will be necessary for his future.

Studies show that for this condition, the best outcomes are at hospitals that treat a high volume of cases, hopefully performed by a surgeon who has done many of these cases. An academic hospital with an expert department is what informed patients would want. The discipline that is involved in treating him is not even listed on the hospital’s website.

He is also at a small hospital that gets very low marks on quality, for example, sepsis, blood infections, and more. It is a small hospital in a not desirable neighborhood (not in New York BTW), a fairly typical hospital of what is available for an impoverished community that treats minorities and immigrants in many parts of the USA.

Informing patients about what is known, uncertainties, and options should be standard practice, but the patient and family proved not very communicative—kind of old style with what doctors say. There  are key cultural differences here for minorities and the poor versus white middle class groups. I wonder whether all that has been written regarding e-patients fits for white middle class people predominantly. I doubt we have scratched the surface in helping minorities and long-term disenfranchised groups get the same access to top-quality care.

My friend insisted on getting the surgery over with as soon as possible and he is in surgery right now at the hospital that the ambulance took him to. Concerned friends and a doctor colleague who know this field, generously talked with him advising him (he has good insurance) to transfer elsewhere. However, he would not budge on what he wanted. He wanted the surgery where he was. So we are respecting his wishes and hoping for the best. We are all a bit of a wreck over this.

This is turning out to be a horrible holiday for all of us.

NEXT UP: What You Don’t Know About Hospital Transfers Could Harm You

 


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4 Responses to Healthcare System Fail: Let’s Get Serious About Disparities


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    Roni says:

    Thanks so much for sharing. Would it be possible to receive periodic updates about this patient? This story is a prime example why I chose to go back to school to get my MPH with a focus on health behavior. I saw the health discrepencies first hand after helping my mom deal with a cancer diagnosis. She was also diabetic and had heart disease. I have seen it all and it prompted a career change. This man’s story, unfortunately, is all too common, especially in small & rural areas. Cultural barriers are a major obstacle in obtaining quality care.

    Are you on Twitter? I only recently discovered your blog through a couple of stories on Zite. Would love to keep up with all that you do. Thanks.


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    Laura Newman (blogger) says:

    Glad to meet you Roni. Unfortunately, stories like this are emblematic of care that minorities get when they need in post. Glad to hear that you are in the field and working on improving it. We really need to organize people to ensure statutes are on the books that improve communication, bolster access to high-quality care for people who are all too accustomed to getting drek. Do stay in touch. I’ll try to keep you posted, but I have to respect my friend’s privacy.


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    Dev Rogers says:

    Bravo! Yes, a followup would be valuable as an education. How can this episode be the beginning of statistical analysis?


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    Paula says:

    This takes me back 20 years to a broken leg (certainly not life threatening) and being taken to a NJ hospital that was not staffed or equipped to deal with my injury. They told me they weren’t, but gave me no alternatives, and proceeded to compound (pun intended) my injury with their treatment.
    Luckily I recalled a conversation in which a friend of mine told me about having been hit by a car and being put back together at a hospital in NYC. I had the wherewithall to organize my own transfer by calling her for the name of the hospital and surgeon, then enlisting my parents (in another state) to find the phone numbers for me, and arranging my own transfer — all from my hospital bed, doped up and in hushed tones. Later I asked around about that NJ hospital and a cab driver told me he “wouldn’t take his dog there.” I still get chills thinking about what might have been.
    I’m sorry for your friend, and sorry that you were not able to convince him to get that second opinion. I hope he will have effective advocates during his hospital stay and recovery.
    As a family caregiver, I’m convinced of the value of patient advocates.


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