Guest columnist Teri Dreher: Where has common sense in the health care system gone?

  • Teri Dreher

    Teri Dreher

 
By Teri Dreher
Guest columnist
Updated 6/14/2022 3:53 PM

I love what I do as a patient advocate working with local health care professionals, and I do believe our doctors, nurses, hospitals and other workers have the best interest of patients at heart.

But some days I wonder where common sense has gone in the health care system.

 

We have a new client who had fallen and hit her head. The trauma caused a brain bleed that required surgery because, left untreated, it would lead to stroke or brain damage.

The surgery went fine, but while she was in the hospital, they noticed she was very thin, could not eat solids and had lost a ton of weight in the past six months. The doctors ordered a lot of scans, which were all negative.

She's on Medicaid, so it was in the hospital's interest to discharge her as soon as possible. Though she had told her providers that she had pain in her esophagus and could not eat solids, she was quickly sent to rehab.

But guess what? She could not get stronger if she could not eat. She needed an endoscopy, a procedure to look into her esophagus with a scope and find out why she could not eat solids. Her family hired us to coordinate her care and make sure she gets what she needs.

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We found out that the wait time for an endoscopy was three weeks. Two weeks later, she was dehydrated and malnourished, and we had another emergency on our hands. After looking at the options, we took her back to the ER to have her admitted for dehydration and malnutrition and get an emergency endoscopy.

After six hours in the ER waiting room, she was about to pass out and her blood pressure was dangerously low. Though I had told the staff that she was seriously dehydrated, I noticed they had marked her diagnosis as simply "trouble swallowing" and raised their voices at me when I pleaded to get her into an actual ER bay.

This woman is lucky that her family members, who don't live nearby, could afford to pay for a private patient advocate, but it's an example of why poor people do not always get the best care. This is why I and my colleagues are passionate about helping low-income "senior orphans" through our nonprofit, Seniors Alone Guardianship and Advocacy Services, or SAGAS (www.seniorsalone.org).

One in four seniors in Illinois faces their health care challenges alone and live on less than $20,000 a year.

The endoscopy found that our client had severe strictures that prevented food from passing from her throat into her stomach. The following day, she had surgery to place a feeding tube, so she can finally get the calories she needs while her esophagus slowly heals, and she gets monthly dilations of the esophagus.

                                                                                                                                                                                                                       
 

But I want to know why nobody thought to do these procedures while she was first in the hospital, which would have saved a lot of time and anxiety for our client and her family.

This is the result of a "modern" health care system that has become so profit-driven that hospitals have to get people out ASAP when they don't have good insurance, or staff just don't have the time to apply common sense and do the right thing no matter what kind of insurance the patient has. To me, this is a serious ethical concern. The pandemic only made it worse. A lot of hospitals are hemorrhaging money; most could not survive without government support.

The pandemic also affected the time doctors and nurses have to listen to patients, and there are fewer eyes on patients because of staffing shortages.

Traveling nurses have filled the gaps, but that's not without problems. Nursing is really a team activity, and it's hard to have a cohesive team when there's so much churn in personnel. I was not very surprised to learn that a study published in the American Journal of Infection Control in March found a correlation (but not causation) between the reliance on traveling nurses and increased infection rates at two Illinois hospitals.

Take my client's story as a cautionary tale of how the gaps in modern health care can negatively, maybe fatally, impact care. Everyone -- and I mean everyone -- should have a spouse, a child or a trusted friend to advocate for them in the hospital and to be the voice of common sense when it seems to be lacking.

• Teri Dreher is a board-certified patient advocate. A critical care nurse for 30+ years, she is founder of NShore Patient Advocates (www.NorthShoreRN.com).

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