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What Really Constitutes Good Patient Care?


This doctor has a problem with the sometimes cold efficiency of the patient-doctor experience in today's healthcare system.

Recently, a family member had an elective foot surgery at an ambulatory surgical center. Being on the other side of the patient-doctor experience illustrated the focus of the current healthcare system. From beginning to end, the goal of the experience was a successful surgical outcome provided in the most efficient manner.

Some might be wondering what is wrong with that goal. I will explain why, with a few specific examples from that day. The first is in the immediate post op period, after general anesthesia, my family member was asked to start drinking fluids and eating crackers, after being given pain meds. The problem was she developed nausea and was medicated. Within 30 minutes, physical therapy instructed her on exercises and the use of crutches. She had further nausea and was medicated again. At this point, we were "ready" to leave, as the procedure, post op recovery and physical therapy instruction had been accomplished. 

By all accounts, the above illustration occurs multiple times daily in facilities across the US and would be considered a successful patient experience by today's standards in terms of efficiency and outcome. However, in my view, the focus in "patient care" is on making the system more efficient, rather than taking "care" of the patient. My family member, a healthy middle aged women, had just had surgery involving general anesthesia, and was asked in a span of 1.5 hours to recover from this procedure, learn a new skill and when she had typical post op nausea, was medicated and sent home.

The distinction between the current model and my view on how it should be is the focus on the "patient". Every patient is different and they all have unique needs that require specific responses. At times, the response may just be observation and time. Checklists and protocols are necessary for safety and efficiency, but should not substitute for considering every patient and their unique medical circumstances. For my family member, the process resulted in a successful, efficient surgical outcome, but I wonder how many others moved quickly through this "efficient system" might not realize these same results or even suffer a consequence, because they require more individualized care.

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