Making Sense of the Topic Are L.A.'s Hospital's Safe?
on 7/16/2008 12:47:00 PM
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What I saw in this lecture was a very real tension between the real suffering of the patient and the heavy dose of expectations and standards to be met within these enormous factory-like hospital systems.
The topic centered around hospital-induced infections in Los Angeles.
The panelists, three. One from the people's perspective, a patients-rights advocate. Two from the practitioner's perspective, a director from UCLA Medical Center and some kind of Risk Management/PR person from Kaiser Permanente.
The fireworks officially set ablaze when the patients-rights advocate demands transparency in hospitals.
"Transparency" in the sense that the general public know of the shortcomings and limitations that hospitals and doctors have. Transparency is just another means of making sure that the hospitals are "accountable." "Accountable" meaning reliable and trustworthy.
Trustworthy hospitals mean that doctors, nurses, and other caregivers are treating their patients/everyone well.
Treating their patients/everyone well. Keyword "/everyone."
Meanwhile, on the flip-side, from a doctor or health-care giver's perspective, what the patients' rights advocate was advocating was probably just one more teardrop of annoyance to a bucket load of them. I felt that with every joke the UCLA Medical Center guy was making and the corresponding audience laughter on topics such as making the patients pay for their care.
Years of medical school, internships, paying loans, generally in attempt to help people's wellbeing, 24-hour workdays, no holidays or weekends, seeing countless patients a year and having to treat everyone individually. It's only a matter of time before everyone becomes anyone, which you don't mean to, but you're too tired to care. On top of that, hospitals in LA are going bankrupt and closing down. There seem to be less and less doctors and other resources around to do anything.
But these people on the outside, the patients, their advocates don't see any of this struggle. They probably struggle to, but that isn't seen at all and even more variable outside of the hospital context. Not when that medical practitioner's top-rated hospital is moving into a billion-dollar state-of-the-art facility in the broken neighborhood of Westwood. This prestige and wealth only serves as fuel to the fire --- more reason for the advocate to run full force at the system yelling at the practitioner to stop fucking up! If they can fight the big fish, the patients will be heard.
All that the UCLA dude and Kaiser woman could talk about were the way they managed their hospitals. He was keen to point out that he was like a "mayor" of a small town. The woman was proud to report that they had taken steps in Kaiser to improve safety as adapted from the airline industry, which I thought was something of an odd connection to make from a patient/consumer perspective because airlines give no shit at all about how you're doing even if you do pay to be pampered. Actually, on second thought, maybe there is a connection after all!
They were very specific about the management improvements they've implemented in each of their hospital systems. They were very much in love with the systems implemented. UCLA dude was happy to talk about all the numbers achieved in his time as top dog. #3 rated Medical Center in the United States. Hitting the 99th percentile on public health measures intra-hospital.
Essentially, he was hitting on stuff that patients don't give a beer dump about, which he actually knows intuitively and mentions, but as a defense mechanism has to bring up anyway. All he could point out were these rankings and numbers, which is impressive. But anytime someone's argument of defense relies entirely on numbers, usually there's something weak underneath the argument. Numbers and standards ideally should never be an ends to meet, especially in a field that depends on individual well-being.
...but unfortunately it seems that's what these large bureaucratic systems inevitably entail...some blind adherence and satisfaction to an abstraction, numbers that are highly relative, which say virtually nothing about the quality of care. There's nothing wrong with him or any other hospital manager focusing on numbers as a means to show that you're doing well, but as long as these hospitals are overworked and remain underresourced thanks to the HMO system, they're never going to progress to a level where doctors en masse will see eye to eye with patients.
Inicidentally, UCLA guy mentioned that 1 out of 3 people still wouldn't recommend UCLA Medical Center to a friend, but it's odd that this wasn't a focus of the discussion.
Inevitably, the UCLA and Kaiser people's involvement with the management end elicits talk about the responsibility laying with individuals. System works fine, our standards work fine, its the individuals who fuck up. Individual doctors, whom they weren't going to talk about at all in this public lecture setting. And the faceless individual impatient patients. This is where the tension flares up.
In addressing the specific concern of hospital-induced infections, Kaiser woman could only stress the importance of washing hands, as if this was the cure to AIDS. UCLA man said washing hands was important but not visiting the hospital was probably best. Patient advocate presses on these big level administrators to give more specifics about how things apply to the patients.
With so much rancor flying between the patients-rights advocate and the hospital admins, it usually means that both sides expect too much from each other and don't get what they want.
The patients expect too much from the hospital admins/doctors/staff, and hospital admins/doctors/staff expect too much from the patients.
Patients expect doctors to be nice, they want better working facilities, they expect everything to be perfect, they don't pay etc. etc.
However, it's always easy to blame the individual patient for being in the wrong. What makes it appear this way is that patients usually aren't the united front and powerful organization that a hospital is. An impersonal, methodologically organized group of people who have been in the business for years dealing with numerous people can't possibly be wrong over some individual patient's judgement can they?
Moreover, there's this American idea that you must pay for everything with money. Like other industries, it also seems as though patients should pay for all the work and extra anguish that doctors go through. It's a business, no free lunch. Patients should be grateful for whatever service they get and being so open to taking patients in.
Patients are "consumers" in the sense that they do demand a limited resource --- the doctors' service. However, they are NOT consumers in the sense that they will keep demanding a good or service. They are not really ready, willing, and able consumers, but people who believe that they are not well and thus seek an avenue to be well.
There is not much sympathy in American public discourse for patients, and this extends towards the attitude toward the patient in the hospital.
Judging from my mom's stories and the discourse in this dialogue, hospital staff seem to expect that patients should understand what they personally go through as doctors/etc. They seem to expect patients to know how things in the hospital work. They expect patients to check for conditions online as if they were the ones who went to medical school and could diagnose and treat themselves. And the kicker is that they actually want people out of the hospital. Doctors thinking everyone is invested in healthy like they are, expect too much of their patients, so they get tired and frustrated as well.
Thus the equilibrium of tension between doctors and patients in LA hospitals continues. It seems that nobody really gets what they want at a hospital, but it's there because it's business. What strikes me is that doctors really don't want patients to come to the hospital cause they have enough people coming over, but they also want to make sure that they keep up business, especially if they could pay for it.
In the end, the management folks at UCLA and Kaiser could only talk about how patients need to "arm" themselves with information.
There isn't much taught in the public discourse about handling health crises yourself. The internet and google search might be changing that a bit, but not everyone has the internet nor search abilities necessary quite yet. People generally aren't wired to practices of folk remedies, etc.
In America's education system and public discourse, we see and we learn that it is hospitals that we must go to first for any and all health care needs. It's the most visible object. So then here comes the patient expectation system. It's big, it's grand, somebody's got to know something when you go there, right? Doctors know what they're doing, they're rich, they'll help me.
People generally DO NOT want to be in the hospital, but they simply do not know any viable options and hospitals seem to have been marketed as the place to be when sick. There isn't any curriculum in schools for home remedies, alternative medicines, and public health measures are kind of a joke.
The business of healing strikes me as crisis-oriented, kind of like calling a plumber to unclog your sink. It makes me wonder whatever happened to the home visit doctor that I would see in Lassie and other assorted 50s television shows.
Labels: Challenge the Experts, Health Care, Lecture Notes, Los Angeles, Medical Anthropology