Recently a New York Times article http://well.blogs.nytimes.com * noted: “Everyone on the ward fell hard for the patient in the room at the end of the hall. Her roommate was loud, demanding and a complete nuisance — nobody spent more time in that part of the room than was absolutely necessary. But the gently smiling, impeccably mannered little 90-year-old, admitted to the window bed with a touch of pneumonia, was a big favorite.”
“The doctors joked with her, the nurses stroked her head and brought antibiotics and nebulizers right on time, and her private-duty attendant organized her pillows and fed her little snacks. She looked like a million dollars when they sent her home.”
“Two days later she was back in the emergency room, wheezing and choking all over again, her readmission an embarrassment to the professional staff — and, for the hospital, a big fat fine from Medicare in a new effort to discourage these repeat performances.”
“Cases like hers torture health policy makers, partly because nobody can quite figure out who is to blame. The system’s culpable habits are legion: discharging patients who are still sick, providing them with incomprehensible instructions, forgetting they’re too weak to get to the pharmacy, overlooking the booby traps at home, providing no coherent follow-up. Sometimes the outpatient doctor doesn’t even know the patient has been admitted.”
“But patients are not always innocent either: They routinely ignore some or all of their discharge instructions, or merrily resume the bad habits that got them into trouble in the first place. And divine providence, of course, supplies us with an array of remitting and relapsing disorders whose behavior no one without a crystal ball could predict.”
* to read the full NYTs article “Revolving Doors at Hospitals” by Abigail Zuger, highlight and click on open hyperlink http://well.blogs.nytimes.com/2014/06/09/revolving-doors-at-hospitals/?_php=true&_type=blogs&emc=edit_tnt_20140609&nlid=58462464&tntemail0=y&utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=13138333&_hsenc=p2ANqtz-_wMNibIISRGnbGT9WzBld04U33XNUm-npnLJqDZZ-lH_oxNyxmFmbNess_HMg1Lxu1nkURLcpH35eABz6URUxFZhfs51TFdvGAUcaZR4sOrJXzzKQ&_hsmi=13138333&_r=0
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Jonathan M. Metsch, Dr.P.H., is Clinical Professor, Preventive Medicine, Icahn School of Medicine at Mount Sinai; and Adjunct Professor, Baruch College ( C.U.N.Y.), Rutgers School of Public Health, and Rutgers School of Public Affairs and Administration.
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