‘Critically Ill’ author Frederick Southwick on what ails our healthcare system
Mary Southwick was 34 when she developed pain on the bottom of one foot. After seeing a neurologist who said she had a nerve injury caused by dancing, she developed thrombophlebitis and was admitted to the hospital. An intern underdosed her heparin (blood thinner), and she suffered a large blood clot in a lung. This was soon followed by a heart attack, then respiratory failure, renal failure and shock.
Her physician husband interceded and transferred her care to a trusted cardiologist. Because her lungs filled with fluid, she had to be intubated and placed on a respirator. She also suffered kidney failure. While a tube was being placed to filter her blood to remove fluid, Southwick had two cardiac arrests. Remarkably, she made a full recovery.
Frederick Southwick, chief of infectious diseases at the University of Florida in Gainesville, says his wife’s trauma motivated him to write the book “Critically Ill: A 5-Point Plan to Cure Healthcare Delivery.” Here he offers some guidance to negotiate the healthcare system.
What is the major problem in our healthcare system?
Healthcare today is a “push business model.” By that I mean expensive procedures are pushed on patients. Too often, procedures are performed when the benefit is unclear. For example, if a new cardiac catheterization laboratory is opened, the cardiologist may be motivated to recommend this procedure even though an exercise stress test would be sufficient for many patients. So you need to ask, “Is this procedure indicated based on guidelines from your subspecialty society? Are there simpler, less expensive and less invasive tests that could be performed first?”
When is it time to dig in your heels and say, “I want a second opinion. I don’t understand this (test, procedure). Is it really necessary?”
When the doctor is recommending a costly and potentially dangerous diagnostic or treatment procedure, you need to ask, “Doctor, what is the likelihood that this procedure will be of benefit to me? Please give me a percentage, i.e. 20% chance of benefit. If the doctor can’t give you an estimate, dig your heels in and strongly consider a second opinion.
Do you need the physician to prove, with statistics and data, the benefits of your diagnosis/prognosis and his/her plan of action?
Yes, you should be shown the scientific data that support their recommendation. In healthcare, you do not necessarily get what you pay for. Studies have revealed that in certain areas of the country — New York City, Los Angeles and Miami being some of the most notorious regions — the cost of medical care is three times higher than other areas. Not only are these unnecessary extra tests and treatments more expensive, they also increase the risk of an unanticipated complication that can result in permanent injury or even death. Furthermore, this increased cost does not result in improved outcomes. Despite expending more money than any other industrialized country, the U.S. ranks 37th, based on commonly accepted health indicators.
Should hospitalized patients have someone with them 24/7?
When patients are hospitalized, it is helpful to have a family member present during the day. At night, few therapies are instituted unless there is an emergency; therefore, it usually is not as valuable to have someone with you at night. Whenever possible, a family member should be present when the physician team makes its rounds in the morning in order to ask questions and to help you to understand the team’s management plans. Your family should stay in close contact with the bedside nurses, who can help to relay your concerns to your physicians. A journal may prove helpful in assuring continuity and coordination of care. However, most hospitals now have electronic records that document who did what and when, obviating the need for a journal. You as a patient have the right to review your records at any time.
What are your tips for navigating the healthcare system?
There are websites that may be helpful in deciding what healthcare institution to go to. The Dartmouth Atlas rates each hospital on the cost per patient, as well as expenditures in the last two years of life. Consumer Reports Health now rates all hospitals just as it rates cars. You should look at https://www.hospitalcompare.hhs.gov. The Medicare website is very objective and uses the latest Medicare reimbursement data. Unfortunately, you almost need an accounting degree to understand what is going on.