I’m here in the cold northeast helping my 80something aunt out for a couple of days as she recovers from shoulder replacement surgery. It’s been a great real-life example of the good and the bad in our healthcare system.
The good part is that the surgery went well and the hospital arranged for post-discharge physical and occupational therapy, as well as a home health nurse to check on my aunt, all of whom are great.
But the main problems come with the coordination of care for my aunt, as well as the communication. Our changing healthcare system relies on greater patient empowerment and patient-centered care. That, in turn, relies on educating patients about their condition. That so did not happen here. Here’s where I think the failures occurred:
— My aunt’s doctors did not set realistic expectations. She talked to several people who’d had the surgery before who told her what a breeze it would be. So when she experienced swelling, bruising, nausea, pain, etc., she thought something was terribly wrong and she panicked. Her doctors — and the nurses — should have prepared her for what such a major surgery would involve, particularly for someone her age.
— Her doctors are not communicating with each other. The surgeon and his surgical fellow didn’t communicate with my aunt’s primary care physician, with whom she has a 25-year relationship, before or after her surgery, except to complete the necessary paperwork. However, neither did the PCP reach out to the surgeons.
Healthcare reform depends on greater coordination of care, with the PCP, ideally, managing the entire spectrum for the patient. If that were the case in this situation, then the PCP would be coordinating and communicating with the surgeons, physical therapist, home health nurse, etc. I’m not blaming her for not doing that; she’s not paid to do it under the current fee-for-service system. That will, hopefully, change with new reimbursement models that focus on outcomes and quality rather than quantity.
— The discharge process was inadequate. No one told my aunt why she was prescribed aspirin (to prevent blood clots) so when she saw bruising on her arm she stopped taking it. She didn’t know how to use the breathing machine — or why to use it (to prevent pneumonia) — until today, 10 days after her surgery. She didn’t know that she was supposed to wear the support stockings (also to prevent blood clots). The instructions should have been written down in clear language she could understand and read later.
Now, it takes two to tango. So there are also things that we, as patients, need to do (that my aunt has not done so well) to ensure a smooth recovery.
— Make sure that one doctor is in charge and will coordinate all your care so you’re not going back and forth between doctors, each of whom might be telling you something different.
— Don’t expect that you will have the same or even similar experiences as other people who had the same procedure. Everyone is different. . .every surgery is different. . . every recovery is different.
— Learn to rest. My aunt has not stopped for a minute. . .she is worrying over everything, calling everyone, even spent nearly an hour on the phone with Comcast. You cannot heal if you don’t rest.
— Be realistic with your expectations. Expecting to read four books and have a relaxing “vacation” after major surgery is like a first-time mother expecting that she’ll learn Italian on her maternity leave.
Hopefully, the lessons learned here will help you or someone you love when they need surgery or are recovering from a major illness. Because I’m not coming to take care of you! 🙂