For My Next Trick...

I took a nasty little tumble from my bike two weeks ago and banged up my right leg pretty good.

Since this is the 'hurty leg' that looked like a Bloomin' Onion seven years ago following a nice MVA, I was a bit worried and went to see my wonderful ortho doc for xrays and an exam (Disclaimer: University of Maryland Ortho rocks).

Luckily it's nothing a little physical terrorism won't fix. It did, however, get me thinking.

I do spend an inordinate amount of time thinking about hospitals, as I've spent some time in a few and want to spend my future career hanging around the industry.

Next time I need surgery for my puzzle-piece ankle, this is the kind of hospital I'd select.

Well, I'd select it providing it actually existed. Which it would SOMEDAY if H/HC entrepreneurs & docs/nurses/PAs ran the world hand-in-hand with a patient advisory committee and designed a specialty ortho dream team showpiece.

My hospital:

  • Allows me to view and preschedule surgery times with my ortho doc online. I can IM his assistant and ask her a question about the Friday 11am slot. I can select my PA and even request the same anesthesiologist who did my pre-surgical consult last January (That guy was a character and tried to sell me on a popliteal block. He put in a great effort, but I wasn't having it - after upwards of 15 surgeries I know what works for me). I can also request the Ogee pump (thank God for Ogee...)
  • Offers free valet parking so my mom/husband/etc. doesn't have to lug stuff in after dropping me off at the front with crutches, pillow, etc.
  • Lets me check in via an automated kiosk a la the airlines (but this one hardly ever breaks - hey, while I'm dreaming of a physician-owned, consumer-focused specialty ortho hospital I may as well dream big).
  • After I check in, I pick up a flashing light/beeper thingie like they hand out at Olive Garden from a very nice Patient Advocate, a local college kid who's studying pre-med. This will buzz and be generally annoying when it's time for me to register and hand over my life savings, I mean my insurance card, but gripping it tightly and constantly asking it "Are you alive in there? Is it my turn yet?" will make me feel like I'm doing something constructive. Plus it would look REALLY cool. Unless they call me a psych consult. Maybe it would have a special color tag that coordinates with my arm band to communicate if I have, say, an allergy to drape adhesive.
  • When I'm gathering up said buzzy-thingie the Patient Advocate would offer me some things to do while I wait in the nice, open airy room to be summoned by a recovery room/OR nurse. This would include some volunteer activities like copy editing a draft of the Ankle Patient e-newsletter, knitting an extra large footie that will fit over a Bledsoe boot for an uninsured patient, etc.
  • While I'm sitting in the waiting area, having finished my edits and handed in the draft signed "Red Pen Was Here," I select from a pre-paid "menu" of options. This looks like the itemized quote they give you at Jiffy Lube or the vet's office prior to performing services. For instance, I know I won't care whether or not I'm in single patient room immediately post op, as I'll be shaking and shivering and yelling and blissfully unaware of all this afterwards, except feeling as if my bones are freezing from the inside out. Thinking of this, I check the box that lets me request a down blanket for $10. It will be waiting on my bed. For an extra $100, I can have the twin size monogrammed and use it to tuck my nauseous self in for the car ride home.
  • I preorder a snack for recovery, knowing I'll want Saltines and Ginger-Ale as soon as the anti-emetic takes effect. I check the med they recommend and discover it's different than the one they used last time (flipping backwards to an itemized list of services/products they used in prior surgeries - which I could also select NOT to receive if I wasn't extremely anal and a medical geek and didn't want to know this kind of stuff), which took two doses to work. Goody.
  • I realize I'm pretty nervous about this surgery and my recovery program/return to work timeline, so I request a Physical Therapy consult via button on my beeper thingie. The PT on call, part of my integrated care team, is chairside in under 15. That's what I call service. I could also have requested a counselor, a chaplain, or a nurse to speak with and allay my concerns in a private therapy-type room just off the main waiting area.
  • Just as we're finishing up, my beeper goes off and I head back for my preop prep. My progress is calm and unhurried but I'm moving along, especially since I know I've requested my mom's favorite tea be delivered bedside before I go under and I'll have use of an IPOD playing Enya as they wheel me back to OR-land.
Yes, this is pretty crazy. Some of the ideas are completely outlandish. Others not so much. Some are already in use in the hospital setting, including 'concierge' care type options and meal delivery choices.

I imagined Rapid Response Teams as the precursors to Integrated Care Teams (or PS Teams, for Personal Service).

All the fluffy service options won't REALLY cause me to forget I'm going in to have surgery, and there are risks, and I will be in pain. And things may go wrong. And then many of the desires above will seem trivial. But that's life, and medicine.

But these things sure can lessen the sting of preparing for surgery, and being ready helps patients feel like we're involved in our care processes, and perhaps a few baby steps closer to having some control over our own health and wellness.

As doctors, nurses, hospital administrators, fellow patients - which is more important in the long run, and more transformative to our system? Stopping us from getting sicker, or teaching us how to live well?

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