His Right Knee…Her Only Appendix

Danielle Lepar

Danielle Lepar

With 2011 here, Winter vacation is coming to a close.  While two weeks off never seems like quite enough, this particular break seemed especially short to me.  On December 24th, my sister was rushed to the hospital for stomach pain and remained there for several days.  While she is feeling much better now, several things took place during her stay that caused me to reflect on some important themes in public health.

My sister’s experience at the hospital reminded me of how our current medical system does not often provide patient-centered care.  I was first  introduced to this concept during a Health Management and Policy class in which we watched a speech  entitled, “My Right Knee,” by Don Berwick– former President of the Institute for Healthcare Improvement and current Administrator of the Centers for Medicare & Medicaid Services.  (A summary can also be found here.)  In his speech, Berwick highlighted 5 dimensions of quality care, which included: no needless deaths, no unwanted waiting, no needless pain, no helplessness, and no waste.  Only the first of these specifications was met in my sister’s situation. 

As far as waiting goes, it seemed to take forever for the recommendations of a provider to translate into action.  Orders for my sister’s care bounced between different doctors, physicians assistants, nurse practitioners, nurses and nurses assistants.  BAHH, talk about uncoordinated care!  It was like watching a game of telephone in that what actually happened to her was not always what she was originally told or changed in the course of communication, leaving my sister and family feeling confused and helpless.

While my sister’s abdominal pain was being successfully controlled with medication, diagnostic tests yielded no explanation for it.  Still, her providers pushed strongly for an exploratory surgery.  Since nothing was obviously wrong and her case was not emergent, I did not understand the immediate need for a surgery.  Was it really worth such an invasive procedure when things could, potentially, clear up on their own?  If things didn’t end up getting better, would the excess pain from surgery have been needless?  The same goes for “no waste.”  Would it be worth spending all the time, resources, money, recovery time, etc on a procedure that might not even be helpful?  Not to mention that surgery would result in a wasted appendix whether it was the root of the problem or not! 

I know that people live healthy, productive lives without an appendix, but that’s not the point.  The point is that, if we truly want to serve patients, our medical system should empower patients, not make them feel helpless.  I recognize that I have described an isolated incident and also do not question the fact that most providers strive to serve their patients the very best of their abilities.  But, if public health has taught me anything, it’s that we still have much to accomplish in terms of providing quality health care.  Hopefully, greater interdisciplinary and collaborative efforts in the future will help foster the structural change necessary to move in this forward direction.

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