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