Tuesday, June 28, 2005

What the analysts missed: maybe we just like our pets better.


Why can't people hospitals be more like those for animals?
By Judy Foreman, Globe Columnist | June 28, 2005

After decades of writing about medicine, I finally found the (nearly) perfect hospital.

It was a gloomy Sunday afternoon last month. My little guy couldn't tell me what was wrong, but his breathing was labored, he wouldn't eat, and he could barely walk.

I took him to the emergency room, where the doctor left no doubt that he was dying. Congestive heart failure, she said. Pneumonia, too. They took him straight to the intensive-care unit.

His cardiologist, Dr. Nancy Laste, began giving him oxygen, antibiotics and diuretics. Day after day, he hung in, and so did she, though she was nine months pregnant.

That's not what impressed me. What did was that virtually every day for a week, Laste called me around 9 a.m. and again at 5 p.m. Other staffers telephoned with updates, too. I could also call any time and have someone read me the latest notes on the computer.

As you may have guessed, my ''little guy" was my 14-year old cat, Dude, and the hospital was MSPCA-Angell in Boston -- which saved his life.

But the whole experience has left me frustrated. If an animal hospital can do so well at keeping family members in the loop, why can't people hospitals?

''That's the $64 billion question: Why can't we do this for humans?" said Gerald Kominski, associate director of the UCLA Center for Health Policy Research. ''A lot of people have had this experience: The quality of service they get in so many other sectors of the economy far exceeds what we get in health care."

Robert Blendon, a professor of health policy and political analysis at the Harvard School of Public Health and the Kennedy School of Government, had a German shepherd who was hospitalized in Philadelphia.

''The cardiology resident called me every single day. Yet I've had the personal experience with human relatives where I could never get through to the physician or resident." Discharge instructions, he added, are also often ''better in well-trained veterinary programs than in many discharges from [people's] hospitals."

At the Institute for Healthcare Improvement in Cambridge, a nonprofit think tank, executive vice president Maureen Bisognano uses a training video called ''It's a Dog's World" to make a similar point.

It shows a man and his dog going for a walk and falling in a creek. The dog gets whisked to an animal hospital, the man to a people's hospital. The dog is treated quickly and caringly. The man encounters rudeness, long waits, a bewildering array of caretakers and finally makes it home. The phone rings. The wife answers, thanks the doctor for calling and promises to give him the medications -- in his dog food.

If it's such a common observation among health-policy analysts that we do better with animals than with people, why can't we fix the people part?

Much of the problem with human healthcare, the analysts say, boils down to money, fear of lawsuits, the short length of hospital stays, the sheer size and complexity of modern hospitals, and, of course, priorities.

Massachusetts General Hospital, for instance, sees 1.5 million outpatients a year who speak 60 different languages; at any given moment, MGH has more than 800 inpatients. Angell sees 43,000 animals a year of whom 60 are inpatients on any given day.

On the other hand, nursing ratios are not that different. At Angell, there's one nurse caring for every eight patients. In human hospitals, the nationwide average is one nurse caring for every six, eight, or 10 patients, depending on the severity of the case, according to the American Nurses Association.

To be sure, the money flow is different. At Angell, pet owners pay -- and pay and pay -- out of pocket, while most human patients have some insurance. At Angell, the average inpatient bill is $1,500 to $2,000. (Financial aid is sometimes available.)

This freely flowing money means doctors and hospital staff don't have to spend endless hours filling out forms. They don't have to ''game the system" by trying to figure out under what obscure insurance ''code" to bill a specific procedure.

''Veterinarians don't have nearly the administrative paperwork burden that human doctors do, so they can focus on what they believe is best for their patients," said Suzanne Delbanco, CEO of The Leapfrog Group, a coalition of 175 corporations trying to improve the quality of healthcare.

A people hospital, Kominski said, ''has so many demands on it that this customer-orientation ends up being a much lower priority than trying to get the clinical side right."

But with a better attitude, couldn't a people's hospital set up a system like Angell's where a family member could call in for updates? Clearly the patient would have to give permission to satisfy federal privacy rules and hospitals would have to verify a caller's identity and make sure its information was accurate.

But ''there's no question we could do it technically," said Dr. Daniel Sands, an internist at Beth Israel Deaconess Medical Center and information technology specialist who helped pioneer the hospital's PatientSite system, a national model that allows patients access to parts of their electronic records. Perhaps, he suggested, there could be a secure website to keep families abreast of their loved one's condition.

''The problem," Sands said, ''is how to get to the point where this is routine care. Doctors are so overburdened with work and that type of work -- talking to families -- is something they don't get reimbursed for."

But it's not just about money, or legalities, or time. When Dude was at his sickest, Laste held off on blood tests for a day because his condition was so fragile she did not want to stress him further. In people hospitals, patients are awakened at all hours for blood tests or CT scans, even though they, too, need their rest.

Sure, Angell is different. Where else would you find a penguin with sinusitis? Or a snake having chemotherapy? In what other ICU would you see the touching but hilarious scene of humans closed inside big dog cages, feeding and hugging their furry loved ones. Still, I'd be tempted to check in there myself. There is only one thing I wouldn't like -- all those barking dogs in the ICU.

Judy Foreman is a freelance columnist who can be reached at foreman@globe.com.

© Copyright 2005 The New York Times Company


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