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Readers Write 4/30/09

April 29, 2009 Readers Write 18 Comments

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Note to the US Healthcare System: Treat Me Like a Dog
By Peter Longo

hamlinI think everyone knows the US healthcare delivery system seems to have more challenges than solutions. From my vantage point, working in healthcare technology,I sometimes wonder if we can ever put all the crazy puzzle pieces together. I never thought that one day, soon after a long overdue physical and a trip to my dog’s vet, I would deem it in so need of repair that I begged to be treated like a dog.

Recently my beloved dog Hamlin’s digestive system grew tired of his “Cowboy Chow” dog food. Without a moment’s notice, my wife quickly went out and purchased him three other kinds to choose from. (I wonder if tonight I complain about dinner, will my wife run out to three different restaurants and find me something I prefer?)

Even the newly purveyed dog food did not settle Hamlin’s stomach. My wife, busy escorting three kids about town, informed me I had to take him to the vet. Since I work for a healthcare technology firm, I assumed going to a doggy doctor would be fun and enlightening; a respite from seeing human hospitals and doctor offices.

Hamlin and I eagerly pranced into the office with me ready for the inevitable “doctor wait”. Interestingly enough, I was greeted at the counter by a smiling receptionist calling out Hamlin’s name. But of course, they were expecting him because he had an appointment! Wow, novel concept here I thought.

Next I had my wallet out, ready to be accosted for money before I could even get a quick question in. Before I could eject my credit card, the side door opened and a smiling “nurse” asked Hamlin to come this way. (I assumed they were smiling because they were going to make a fortune out of me). Guarding my wallet, I followed our escort down the hall. I was still dazed from the fact they were expecting us and recognized Hamlin.

As we entered our exam room, I was perplexed to see a shiny new notebook computer on display. Before I could gasp in shock, the vet walked up behind me, introduced himself to Hamlin (the patient) first, then to me. Casually, he turned toward his shiny new laptop and within two key strokes had Hamlin’s medical record on the screen. My dog’s entire record. Looking like the complete geek that I am, I jumped at the vet asking to see everything on the system.

Eyeing me as though I might be in need of medical help myself, he leaned back to show me Hamlin’s electronic medical record. His life history, his owners, where he was born, any past medications he had, everything. Even his lab results were in there. The polite but guarded vet then showed me three other exam rooms, all equipped with shiny new laptops, all with Hamlin’s record available on them.

After a quick and thorough exam, the vet punched a few more keystrokes. He electronically ordered various lab tests — right then and there! I asked him about the firm that performs the tests and he told me the lab he uses provides great service and is top notch. He said the lab results will be sent back electronically and into Hamlin’s file directly! (In a moment of serendipity, I later discovered it was my company’s software providing the lab with the tools to accomplish this small miracle).

As I left the room and approached the front counter, a nurse had a prescription waiting for me along with three cans of super special dog food. Now I was really confused — is it not the patient’s job to walk the prescription and files to the front counter? Did my paper shuffling job just get outsourced to a computer? Adding to staff’s perception of my total geekiness, I asked how she did that. With a slight chuckle, she showed me the computer screen where the doctor requested it from the exam room. It just angered me to see such efficiency. I know my kids feel Hamlin deserves only the best, but better healthcare service than me? Adding injury to insult, I paid only $55 for the visit.

Hamlin’s enlightening experience really made me think of my own recent medical episode. A few weeks earlier, I went to my annual check-up. I scheduled the appointment and diligently showed up on time. As I checked in to see my doctor, one hand shoved a clipboard in my face, while a second hand went for my wallet. No verbal communication yet. Even though Hamlin theoretically can’t speak, he was treated to verbal communication and a custom greeting. I then proceeded to brush up on pop culture in a six-month-old People Magazine (I did not know Britney had a second baby and broke up with K-Fed?) while waiting 27 minutes for my appointment. If only someone told me how long my wait would be — but hey, that would take the fun out of guessing when I would be home.

I finally entered my exam room to be greeted by a nurse,a sheet of blank paper and a $.25 pen. She took my vitals. Later, my doctor sashayed in with that same high tech paper but a more expensive pen (with a drug company’s name on it) to drill me further. As all checked out fine, he indicated he needed some lab work to complete the exam. Amongst some forms floating on a table (uncomfortably near my half-clothed rear end) he found an order sheet. He checked a few things here and a couple things there then gave me the nod to transport the paper across the hall; then my lab orders and I waited some 18 minutes more.

A couple of weeks after my exam, I received my lab results “in the mail.” Next to each test result, the doc was kind enough to scribble an “OK.” Then a nice hand-written note claiming, “All looks OK, see you next year.” I put that report in a sophisticated manila folder and filed it. Why did I have to have this manual, impersonal, medical experience right before my vet visit?

Dazed and confused after leaving the vet, I wandered back to our house. Upon opening the door, my three kids showered Hamlin with love. They rubbed his back, gave him endless kisses and asked him easy softball questions. “Have you been a good boy?” My wife brought over doggie treats and “king” Hamlin relaxed on his back as the kids indulged him full of treats. My life quickly went to the store to find him “the best food money can buy.”

I was left standing at the door waiting to even be recognized. I sure did not get any kisses, let alone a back rub. I put myself on the couch and wondered if anyone was going to fetch me a treat. I would have been happy if one of my three kids just pushed the remote closer. As I stared at a blank TV screen, it dawned on me … I really need to be treated more like a dog.

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Currently there are "18 comments" on this Article:

  1. There is a funny video used for customer service in healthcare training – called “It’s a dog’s world”.
    Visually protrays a similar comparison of dog vs human care. Always a good reminder to us all – maybe we, tho ol’dog in healthcare, could learn some new tricks?

  2. Love your story! I have marveled over similar experiences with my dogs as well – never that inexpensive but I have to agree, I would rather be treated like my dogs – the efficiency, technology and humanity merging to form a pleasant experience unlike anything I experience from our human healthcare system. Conversely, there are places were people receive “care” that I would not take my dog. We also have an equine vet – she pulls up in an SUV complete with a laptop in the front seat, lab supplies, medications, even x-ray equipment in the back. She delivers a smile and greeting to the horse as well as his owners, taking time to understand his issues, and before she leaves we have his record from the day …and a bill! These home visits are not cheap but how nice it would be to have similar service from our physicians. We have physicians providing this kind of care outside of the insurance payment system, but I hope that in our lifetime we can all enjoy the kind of healthcare system our pets enjoy.

  3. Very funny approach to a sad story about our healthcare system.

    Did you ask the Vet, the IT Company and pharmaceutical companies how much they pay for insurance and what they spend each year to prevent senseless lawsuits and to comply with useless regulations? Not the total problem but I bet we could save a significant amount of dollars and maybe get better service. Of course the lawyers would lose out but I am sure Congress will fight for us – oops, I forgot, most are lawyers – next topic?

  4. My wife has always said she would rather go to the vet when she is sick then to a people doctor. We used to breed Airdales and later Dobermans.
    Never had to wait more than a few minutes if I had an appointment for my dog.
    I always have an appointment to see my doctor and always endup waiting 30 to 40 minutes minimum often. One physician I was going to I would call before I left home to find out how far behind the doctor was. A very enlighting experience going to the vet.

  5. Not that Dog doesn’t deserve just as much as Human but could some of this expertise be channel to poorest of the poor in the world I.e Africa where they would appreciate an EMR for a change? Thanks for sharing the reality of the Western World compared to East.

  6. My children’s pediatricians office is similar to your vet (except for the credit card/wallet part – that is up front). Rarely wait more than a few minutes, even for a sick visit scheduled only an hour earlier. The lab and Rad depts are steps away, the order is there before I can dress my child and walk there. Child is in the testing room within minutes. Same with prescriptions – order is there before us. It is possible. But probably for a price – they use Epic and are part of a large health system.

    Like Tuscon Willy state – humans sue and have high expectations, insurance to cover that is costly.

  7. Peter,

    Good to hear from you and great story. Good to see the animal health market get highlighted related to technology and patient care – agree that I too would rather be treated like a dog. I was the gm/vp of the leading animal healthcare software company for 3 years and experienced this type of innovation firsthand. Only if the broader markets could collaborate as well as the vet space

    Cheers

    John

  8. As part of a presentation ( I am an EHR consultant) I give to physicians I show my cats’ electronic medical records and my car’s. Both of which email me when the cat’s need a check up or shots or my car when it needs service. Then a show a picture of my kids’ messy paper records and how if I don’t initiate their care nobody would. Funny isn’t it that my cats and my car have a better health record than my kids.

  9. Nice story. I think this is what we would have had 30 years ago if we had todays technology. The difference is that vets are able to see the majority of the problems with the dogs. If our system had more Primary Care Physician’s and they were able to take care of more of our problems without sending us to specialists, then this might be possible. The problem is that our system has become extremely complex. This results in it being extremely difficult to create a nice streamlined functioning system.
    Still, there are some nice takeaways from this story, thanks for sharing.
    Eugene Y

  10. Daisy Mae is at the vet today getting her tooth extracted… same experience, PLUS, I get a personal call from the vet when she’s done so that I can answer any questions, etc… plus she’s accessible via email… which all logs into Daisy Mae’s medical record… MAGIC!

  11. Great story and so sadly true. One comment, the vet is cash and carry. No messy admin, no medicare/medicaid, no hundreds of different rules for payment, no CPT codes ( I think?), pharmaceuticals on site. So alas we humans sit at the seventh circle of hell. Wish we could divorce that from the science and art of caring for people.

  12. And to add an even more “humane” aspect to this story, when Hamlin’s gets really sick, they will simply end his life in a painless process, where as you will be rushed to the hospital, have tubes and needles inserted in nearly every orifice and subjected to a long drawn out, and I might add, very expensive death.

    Oh to live and die a dog’s life!

  13. Peter,

    Great story with a sad truth! Vets are using the latest in technology, have the most efficient processes, and are still able to charge a mere fraction of the price charged for the treatment of humans. Perhaps this indicates their willingness to look at technology as a means of improving their business’ capabilities, whereas other medical professions view it as an inconvenience because it requires CHANGE. And “We The People” always suffer from fear of change, our own and others’.

  14. What? No national information netowrk, no HIPAA, no bribing the vets to use systems they don’t want? Holding for President Obama …

    It goes to show you how simple and customer friendly the medical system could be if it weren’t for insurance, including that biggest and most bureaucratic insurer of all, the federal government.

  15. “A young healthy [dog] well nursed, is, at a year old, a most delicious nourishing and wholesome food, whether stewed, roasted, baked, or boiled; and I make no doubt that it will equally serve in a fricassee or a ragout.”

    As a part time contrarian, I couldn’t help but be struck by how Mr. Longo’s article and the following commentary could be extrapolated to be a 2009 version of Jonathan Swift’s 1729 satire, “A Modest Proposal: For Preventing the Children of Poor People in Ireland from Being a Burden to Their Parents or Country, and for Making Them Beneficial to the Public.

    This Readers Write note is well written, amusing, and tugs at personal experience; but if we were to be granted this wish of ‘being treated like a dog’ we would be breaking one of the cardinal rules of any good analysis, which is to “follow the money”.

    There is a simple reason the veterinary experience is so commercially wonderful and successful. They don’t treat the really sick patients. They kill them.

    It the pet world, 6M-8M animals are euthanized every year, which is roughly 10% of the household pet population. These poor creatures are a combination of unwanted pets (i.e. indigent care) and pets too old/expensive to treat (i.e. chronic care). In the human world, AHRQ data says that “Half of the population spends little or nothing on health care, while 5 percent of the population spends almost half of the total amount. Also:
    • Five percent of the population accounts for almost half (49 percent) of total health care expenses.
    • The 15 most expensive health conditions account for 44 percent of total health care expenses.
    • Patients with multiple chronic conditions cost up to seven times as much as patients with only one chronic condition.“

    I’m sure Mr Longo’s article did not intend to suggest this, but in order to achieve his state of healthcare & EHR bliss, all we have to do is eliminate those 5% of people who take up 50% of our healthcare costs. If we were to set public policy to follow the pet healthcare delivery model and simply euthanize the all human patients who could not be treated with a $55 doctors visit; we could quite easily fix every economic and IT problem that has ever reared its ugly head in our current 16% GDP healthcare delivery model. We could put an Epic system in every MD’s pot and pay friendly greeters to welcome the surviving patients at every door.

  16. Yes, Jerry Padavano and Jon Manis are still collecting paychecks from the almighty Sutter budget. Randy Davis, the CFO, is also comfortably sitting in his Mather office with stacks of inaccurate reports and forecasts. I understand that they enjoy golf.







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