6-24-11 Friday  + 8 months

Status:  Well, it’s been a few weeks since I wrote, and that’s always a good sign.  Slowly improving now that I have my hyperglycemia under control, not too high in the afternoon, and not too low in the morning.  It’s all a matter of timing and carbohydrates.  It’s better when your pancreas does all the work for you.  A deft balancing act of secreting insulin as your blood sugar rises, and converting glycogen storage in the liver into glucose as it decreases.  A precise thermostat, but imagine what you’d have to do to control the temperature in your house without a thermostat. You’d be standing by your HVAC system constantly turning it on and off.  That’s what I do all day long with food and pills.

Events: Did have a visit this last Monday at the Hopkins ophthalmologists for a checkup of my dry eyes, but it was a bad day for the healthcare delivery system (it’s been said that it’s not a system, it doesn’t deliver health, and nobody cares).

We arrived early for our 1:30 PM appointment.  Filled out the usual forms and waited about ½ hour before a technician came for us, and did a routine visual acuity check (eye chart).  Then back out into the waiting room and were told that the doctor would see us in 15-20 minutes.  We waited until 3 PM and were told that there were still 5 patients ahead of us.  Lisa had to make a 6:30 flight from DC, and if we stayed she would miss it.  We cancelled our appt, set up a new one, and I remarked that a scheduled 1:30 PM appointment that wouldn’t occur until 4:00 or 5:00 PM wasn’t acceptable.  The clerk said that she tries to speed up the doctor.  I said I wanted the doctor to spend as much time as he needs with patients, the problem was that they schedule too many patients.  We left for a hour ride back home – a wasted day.

Comments: The problem with our health care system isn’t that we don’t incorporate the latest research or that doctors and nurses are not well-trained, it’s that the system is generally not tuned to patient needs.  In this particular case, the priority is maximizing revenue for the Ophthalmology Department, not decreasing waiting time for patients.  If they schedule fewer patients in a day, they’ll make less money.  Since my scenario most likely happens every day in their clinic, you’d think someone would go to the department head and say, “We’re keeping patients waiting for an inordinate amount of time.  What can we do?”  But anyone complaining already knows the answer, “Well we could start by cutting your salary or nor purchasing the latest Lasik device.”

So despite the fact that the entire system’s mission is to focus on the patient, the implementation of that mission is driven, for the most part, by other forces.  When I was young the entire family was taken care of by a general practitioner who would come to the house with his little black bag.  He didn’t make much money, but he was well-respected, and you knew he cared for your well being as his first and only priority.  A lot to be said for that.

I’ll catch up with you on our next visit.




11 Responses to “”

  1. Jill O'Mahony Stewart Says:

    Bruce: Sounds like a book in the offing. You are right, the patient’s time has no value whatsoever. Thanks for being so candid wearing your patient’s hat with a physician’s perspective. Glad to hear that we AREN’T hearing as often from you because the news is good!! Love, Jill

  2. Karen Jaffe Says:

    And those that are in favor of repealing the Obama Healthcare “plan” or cutting Medicare benefits are they interested in the patients? It must be that they are absolutely healthy, have healthy family and friends or are too rich to worry about it?
    (sorry for the tirade)
    Hope they treat you better next time!


  3. Art Ulene Says:

    Bruce…. Next time, try Kaiser Permanente for your health care. I don’t know if htey even do marrow transplants (I’ll find out), but I can tell your that their cardiac surgery stats are better than everyone else in town (including UCLA and USC) and their mammography rates are higher than anyone in town…. and they don’t keep patients waiting that long. You did the right thing by leaving. That way you didn’t have to punch the doctor in the nose. I left an orthopedists office after waiting 3 hours. The secretary said that was almost routine. Love to you and Lisa… art

  4. Chaya again Says:

    That would be a country raised Doctor and Surgeon

  5. Peggie Neill Says:

    Bruce –
    It’s an upbeat day to get a new post from you, even if some of the subject matter is frustrating. Great to see you continue to improve. I continue to keep you and Lisa and kids in mind. No doubt that the small pleasures of summer are being savored by all of you.
    About the wait times, there’s probably a huge number of your medical friends who can write volumes, me included. It’s often very similar reasons across different institutions/entities – staffing is one. But I think a bigger one is that it takes so much energy to really pull off change, and the majority of clinical people in health care pour their energy into just trying to keep up the pace, take care of the main things in the day, avoid the near misses, etc Places that prioritize collaborative efforts across parts of systems/medical centers, etc are the ones that seem to be making some measurable positive changes. trying to get momentum to get change initialed, inspiring other institutions to change – well, some days it seems like the Holy Grail.

    Savor the summer – you more than earned it. Thanks for letting us accompany you on the journey. You inspire change.


  6. wendy Says:

    Dear B- While I am compassionate about your wasted day and frustration, I’m grateful that you aren’t on dialysis. Our patients main complaint isn’t the care they get once they get into the chair for 3- 5 hours of dialysis,but rather the extra 15 minutes to 1 1/2 hours they can have to wait to just get into that chair, which happens all too often. And they come 3 times a week for the rest of their lives.

    As their social worker, my role is to help them adjust to this new life on dialysis and unfortunately also to this predictable factor/ I stress the importance to use coping skills to not stress themselves, which I provide, like breathing, imagery, visualization, tapping aloing with the explanation that there is “nothing we have been able to do to change their running late at times.” Pretty sorry state and not fun for me to deal with all to often. So BREATH, and remember the difference between what you can change and what you need to do for “your health” when you can’t change the “healthcare system” You’ve been through too much to let this get to you. Breath

  7. Bill Schaffner Says:

    Love that good news, the ophthalorologists not withstanding.



  8. Roxanne K. Young Says:

    Bruce, I recently went for my regular mammogram, and six (count ’em) women who arrived after me went before me. I finally started crying (!) and asked what was wrong (I was starting to think something was wrong with ME, not them). They checked their charts and discovered that they thought I had already been through. Happily, I was able to vent on the follow-up e-mail about patient satisfaction. This is Northwestern; I expected better. Hang in! Roxanne

  9. Laurie Samuels Says:

    The best news is that you continue to improve…. the rest is just an inconvenience/nuisance (albeit frustrating).
    Continuing love to you and Lisa (aka Superwoman)!

  10. Donita Gross Says:

    Hello Bruce,

    At last I found the address for your blog….so am glad to catch up with your progress. Happy that it sounds like it’s moving in the right direction. While I probably don’t always understand the depths of your medical knowledge and treatments, it does help me better appreciate the nature of your illness. Am back in Wisconsin for the summer….though we’re just now beginning to get some nice warm weather. You remain in my thoughts and good wishes, always. Take care and be safe.


  11. Gail Lehmann Says:

    Bruce, I read your experience waiting in the doctor’s office just after I got off the phone with my 90 year old Mother-in-law. Her GP kept her waiting 3 hours and she saw that he scheduled 3 patients at the same time as her appointment. She guessed that he is very popular and never turns anyone away and since Medicare pays so little, he tries to see as many patients as possible. When she left, she told the nurse that she will NEVER wait that long again and that if they need to give her to one of his associates that is just fine with her.
    Her body is failing, but her mind is sharp!
    I will tell her your story.
    Thanks for sharing the trials and tribulations of the healthcare system.

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