This essay appears in today’s edition of the Coins2Day Brainstorm Health Daily. Get it delivered straight to your inbox.
Put on your white coat and imagine you’re a young med student. Now consider the following scenario.
A patient comes to the ER by ambulance on a late Friday night with a 102 fever, complaining of bad digestive problems: She hasn’t been able to keep anything down…or in…for 24 hours. She’s admitted. Blood’s drawn. Fever wanes overnight. She looks better. Walking around. She’s discharged and sent home at 7:30 in the morning.
Two days later, on Monday night at 9:00 p.m., the blood cultures from the patient finally come back. In one of the two culture bottles, there’s a surprise: Gram negative rods (GNR) of bacteria—a class that includes E. Coli, Salmonella, Shigella, Klebsiella, Pseudomonas, among others, and that has within its lineup a murderer’s row of multidrug-resistant strains. The other culture is clean.
There’s a good chance the positive reading has come from cross-contamination in the lab. GNR are as common in hospitals these days as red Jell-O. But if the infection is real, it could be very grave—particularly in elderly patients. The woman in this case is 86 years old. And she’s diabetic, with evidence of kidney disease to boot. So the patient is told to come in to the ER right away. Scared, she rushes to the hospital, leaving her cellphone at home.
When she arrives, she’s put on a gurney in the ER, covered by a sheet, where she waits for five hours. Then, at 2:30 a.m., the new, initial blood work comes back: No sign of bacteria. It could take another 48 hours for whatever pathogen might be living quietly in the cultures to grow, but for now the patient’s blood looks clean.
Okay—now here’s your test, O wide-eyed med student: What do you do?
If you said, “Discharge the patient at 2:30 in the morning and send her home alone in the wintry night in a cab,” well then I’ve got a job for you: Welcome to today’s modern hospital system.
In full disclosure, that 86-year-old woman is my mother-in-law, and this happened last night—or, rather, early this morning. I’m tempted to reveal the name of the hospital, but honestly it doesn’t matter. Because this scenario showcases a slew of problems that are endemic to our modern healthcare system—from the utter lack of bacterial control in clinical settings and the associated infections that result…to a process that shuttles vulnerable patients in and out of emergency rooms for piecemeal diagnosis and treatment…to overcrowded, overburdened hospitals that still mindlessly cling to patient-management processes that haven’t worked for decades.
All of this is ripe for disruption. All of this is BEGGING for disruption. And perhaps—just perhaps—as Congress figures out its “replace” for Obamacare, we’ll get a chance to see some fresh ideas put to the test.
In the meantime, you innovators out there—and, hopefully, that will include some of the med school graduating class of ’17—now is your chance to figure out a better way.
