Posts Tagged ‘skill’

What you need in a hospital

September 16, 2010

In an earlier post I discussed what we need in a Congenital Heart Surgeon. Reader Heather let the cat out of the bag by mentioning that wasn’t all you needed… you need a good hospital, too.

How true, how true. As I have said many times before, the doctor you need does not practice in a town of 5,000 people. There aren’t enough patients in the community to allow him or her to sharpen their skills. Skill partially depends on volume – you do something often, you do it right, and you evaluate your results (and you keep evaluating them, constantly). That’s the only way to improve. You learn from someone who is experienced, then you do it yourself, knowing that anything less than 100% is unacceptable. As you gain skill, you learn how to do it better and faster.

That same fact applies to the hospital. You can have the best surgeon that ever put on a mask; but if the hospital you are in has very little experience with caring for post surgical patients, there could be problems. That applies to the type of surgery you are having, not to all surgeries. Caring for someone who just had heart bypass surgery and someone who just had congenital heart surgery is a lot different. Studies prove that the more experience a facility has, the better the outcome.

I love my community hospital. We have about 150 beds and I’m on a first name basis with a lot of the people there. I know the doctors and the nurses not only from the hospital, but I see them in the community. I saw one of my favorite nurses in the grocery store just last week. But that doesn’t mean I’m going to let them do heart surgery on me – they don’t have the skills. They are well-meaning people and I am sure they would do their best, but if I had surgery there, I’d probably come home in a box. We can’t have that, I’m claustrophobic!

A few months ago there was a plan being considered by England’s National Health Service to consolidate the number of Pediatric Heart Hospitals. A good number of people were understandably upset but the reasoning is logical: some of the units performed a relatively small number of surgeries. Consolidating the number of centers may make it inconvenient for some, but it will make the overall results better.

For us here in the States, that probably means a trip to a large city hospital. There are exceptions – Durham, North Carolina¬† (the home of Duke University Hospitals) is fairly small and Rochester, Minnesota (Home of the Mayo Clinic) is also a small city. But in most cases, we’re heading to The Big City – New York, Los Angeles, Nashville, Boston, Birmingham, Kansas City, Denver, Atlanta. These are only some of the destinations whenever the Heart Warriors I know head to the doctor. “Medical Tourism” is all the rage right now, but to us its old news. The average Heart Warrior is also a Road Warrior; we’ll go to where the best hospitals and doctors are.

And in the words of that great philosopher, Bruce Hornsby – That’s just the way it is.

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Hospital confusion

February 23, 2010

What in the world is going on here?

The local weather report says that there may be snow in the Atlanta area tomorrow! I’ve been down here in broiling heat, in rain, in cold weather, but never snow… traffic tomorrow could be really interesting.

We’ll probably get an early start, earlier than usual. One of the (many) things I like about the Adult Congenital Heart Defect Clinic at Emory, if you arrive earlier than your appointment time they will probably take you a bit early. Schedules do get backed up, but I’ve walked in the door at 8:00 AM for an 8:45 appointment. and been taken back at 8:30.

Also, I need to have my pacemaker checked. The Pacemaker lab is in the rear of the clinic, and the pacer techs usually give you a test during that “down time” after the nurse takes your vital signs but before the doctor makes his/her appearance. If you live a distance away, the Emory staff have no problems making all of your appointments on the same day to save you a second trip. That is much appreciated!

It is good to see a hospital where the left hand knows what the right hand is doing. Years ago (the early 1970’s) I had follow-up appointments at a large hospital that was quite a distance from my home. Early in the morning on appointment day we would all pile into the car and drive several hours, but we would be turned away!

“Funky Heart, to see Dr. John Doe,” my parents would say.

After a few minutes of looking through the files, the receptionist would respond with “You don’t have an appointment today.”

“Yes we do! Today is the 30th, isn’t it?”

“Today is the 30th, but you aren’t on the schedule. You’ll have to come back when you have an appointment.”

The card in daddy’s hand said we were due at 10:00 AM on the 30th, but we weren’t on the schedule… needless to say, it didn’t take very long to get tired of that! But the kicker would come two weeks later, when the telephone rang.

“This is Nurse Jones at Doctor Doe’s office, we were expecting you today and were concerned when you didn’t make it.”

HUH?

Fast forward to today, that hospital has put all the pieces together and is a very good hospital, with a GOOD Pediatric Cardiology department. I have a lot of friends who have had successful treatments there. I just have to assume all the mix-up and mistakes from way back when were more than likely caused by the times. The early 1970’s saw a lot of advances in Pediatric Cardiology and a lot more hospitals were willing to tackle the problem. There were bound to be growing pains.

I can’t really say anything good about the hospital, because back then everything seemed to be so confused. But on the other hand, I can’t say anything bad about the hospital, because that occurred almost 40 years ago and they have since done some wonderful work with some really sick kids. So if I am ever asked, I usually respond with “I understand that there is a good heart program at that hospital.”

It seems to be the best answer.