I Mourn For My Profession And The American Healthcare System: A Recent Story
By
Leonard Zwelling
I am not sure when I first took on the belief that I was in a profession, a club, a guild that was both exclusive and powerful. My profession could change people’s lives. Absorbing this fact changed mine.
Medicine became a calling. It was never a job. It was far more. At the Hippocratic Oath ceremony in the Duke Chapel the day before medical school graduation, my class was solemn. We all knew we were passing into the realm of the sacred. From then on, we had to put the patient first in all things. We were to be of service henceforth.
That was in 1973.
Today, I am the patient. In the past few years, I have had major evaluations of my back and interventional anesthesiology to control the pain of a spine racked by a running career earlier in my life.
I also have a terrible cardiac conduction system. Its aberrant beats–premature atrial contractions mostly, but fibrillation at times– led to my cardiac cath and coronary by-pass surgery in 2002. My conduction bundles may be lousy, but their strange beats saved my life by getting me on the cath table, but the CABG did not fix the poor conduction system. Eventually I had to have two atrial ablations. Despite these, my EKG kept getting worse.
On April 21, this year, I got the ineluctable pacemaker that was always in my future after I went into second-degree block during a stress test.
I want to spend a little time reacting as a patient.
I was asked to be at the Fannin Tower (the old St. Luke’s office building) for the pacemaker insertion at 10 AM, April 21. I was on time. After an hour in the waiting room, I was escorted to a hospital room where I sat for two or three hours. Interestingly, an IV line was inserted and I was hooked up to a saline drip. However, the IV pole’s base was too large to fit into the bathroom. The door had to remain open while the toilet was in use.
Then, I was moved on a rock-hard gurney to an open area outside the cath lab where I lay for almost three more hours. Remember, I am NPO. No water; no food since the night before.
Finally, eight hours after arriving at the Fannin Tower, at 6 PM, the pacemaker was inserted. That part went swimmingly well. This was a longer fast than I was accustomed to on Yom Kippur.
Six weeks later, I am scheduled for my pacemaker check. I again arrived at Fannin Tower and the office of the cardiac electrophysiologist. The woman from Medtronic (the pacemaker company) threw a device over my shoulder which landed just above the pacemaker scar. She could see my heart beat on her tablet and could control my pacemaker. It was working fine. Was I done? Not quite yet. I needed a chest x-ray to check the position of the lead wires. However, there is no longer radiology available in the Fannin Tower and I had to go to St. Luke’s Hospital for the imaging study.
Beware of this place.
The following Monday, I walked into the St. Luke’s lobby and asked where radiology was as I had a scheduled chest x-ray. I was sent on a wild goose chase trying to use the signage there to find patient registration. It took me ten minutes and plowing through a restroom with paper towels flowing out of the garbage bin. What a mess!
Registration went well. I was sent to the basement to get my x-ray. This time the directions were better. I found the waiting room. Patients were there, but there was a sign on the receptionist’s desk: Be Back Soon. It was 3 PM on a Monday.
Eventually someone showed up and took my paperwork. About five minutes later, a radiology technician came and got me. He led me down a hall past rooms of patients on stretchers awaiting MRIs and CT scans. It had the feel of a military dispensary with battle field victims awaiting imaging, something out of “Gone With the Wind.”
The technician couldn’t find the right room. He asked someone for directions who led us around the corner to a different hallway. The technician tried a couple of doors before he found one with a vacant machine available. Needless to say, it took him three attempts to shoot my AP chest x-ray. He got the lateral the first time. He said it was his first day. I was treated to extra radiation exposure because of his incompetence.
I then made my way back to my car and went home mystified that the churning St. Luke’s care machine that had saved my life with open heart surgery in 2002 had devolved into a shadow of its former self under the ownership of CHI.
I find that no matter which of my many parts need medical work, I have to do a lot of the administrative tasks to get things done and I have to push extra hard to get adequate information.
Are the doctors simply too busy?
Are the staffs unaware of the patients’ needs?
This is the essence of why I have a concierge physician. Communicating with the medical system and the care teams, especially through those dreadful My Chart portals, can be overwhelming. And if a medical professional, as I am, has trouble, imagine how civilians (my father-in-law’s word for non-doctors) have to cope.
Parts of the medical system are not professional at all. They are not patient-friendly. In fact, they can be downright abusive.
Aspects of my profession have become hopelessly unprofessional. Although the doctors are still quite polished, getting to them can be an odyssey.
Interestingly, as I was writing this, I scheduled some tests at MD Anderson—on the phone. That worked perfectly. Talking to real people is still the way to get things done. Computers cannot fix badly designed systems. And even AI listens poorly. People, on the other hand, are much better at it.
As I approach a pending surgical procedure at Methodist, by contrast, while scheduling with the surgeon was a challenge, his staff and bedside manner were superb.
So, there is hope if you know how to wend your way through the medical maze that may stand between you and good care.
As I have learned so many times over the years, I may well have gone to medical school to save my own life by knowing when I am really in need of care, and then being able to find that care in the Texas Medical Center after 42 years of practice. It can be done, but it is not for the faint of heart. It takes persistence and good friends to refer you. I’m lucky. I seem to have both—so far.
