The Optimistic Futurist: Avoiding the ‘tow truck’ syndrome in health care

  • Posted: Sunday, May 5, 2013 12:17 a.m.
Francis Koster
Francis Koster

Imagine your car broke and was towed to the shop. The mechanics listened, poked, prodded and explained what your choices were, and the costs. You choose one, and agree to leave the car for repair.

In a day or so, you go get the car and are assured everything is fine now. After handing over your credit card (ouch — that much?), you get the keys and drive off.


Several days later, the car breaks again — in roughly the same place under the hood. Call the tow truck, and wind up back in the shop again. “Sorry”, they say, “these things happen. Wasn’t exactly the same problem, just close to the one we fixed — can we have your credit card please?”

How does that feel?

Now let us mentally get out of your car and get into an ambulance as you hold the hand of your son or daughter or parent whose health is broken. Your loved one is about to become a member of a new club, made up of the 30 million Americans (one out of every 10 citizens) treated by America’s hospitals every year.

As the emergency medical technicians bustle about connecting tubes and wires, remember that our current health-care system costs — about $8,600 per American per year — about twice as much per capita as the other developed nations — and most of those nations get higher scores for health-care quality.

In the world of hospitals, one out of every eight hospital patients has to be towed back (“readmitted,” in health-care speak) because of failure to fix the original problem, or to fix something accidentally broken while fixing the original problem. For Medicare alone, this costs around $17 billion.

Unplanned readmissions are one of the reasons our health-care system is so expensive. They are also an indicator of quality of the health-care “non-system.”

Back in the day, the family doctor took care of you in the hospital. Family doctors knew what drugs you were on, your medical history and your personal circumstance. Those days are gone; because of the invention of hospital-based new tools and medicines, hospitals now have full-time doctors to care for you, and your family doctor often does not know a lot about your hospital care. The non-system has changed.

Information sharing has broken down in many cases.

Research shows that many re-admissions can be avoided. The three leading causes are: (a) hospital issued drugs that fight with other drugs the patient is already on; (b) failure of the family to follow instructions for patient home care; and (c) lack of a visit by the patient to the family doctor after discharge from the hospital to keep an eye on the patient’s overall condition.

The bottom line is that once the patient leaves the hospital, it falls to the family to keep all the various parts of the “system” working together. This may include the pharmacy, nursing home, primary care doctor, school nurse, other specialists, the VA and on and on. This often overwhelms the patient’s family. The patient’s health declines, and the tow truck is called, and off to the hospital they are carted again. Out comes the credit card.

It does not need to be this way.

Cox Medical Center Branson, in Missouri, put in place an information sharing system designed to notify all members of the patient’s family and health-care treatment team of what was being done to the patient in the hospital, and what needed to be done after discharge. Readmission rates dropped almost one-third!

Other hospitals started what they call “transition planning.” The hospital care team identifies the possible risks to the patient and assigns specially trained people to shore up the system. They make sure the family doctor is fully informed. Prescriptions are cross checked. House calls are made by specially trained caregivers. These steps alone can eliminate about one quarter of all re-admissions!

We can help control health-care costs, prolong life and lower taxes, as these hospitals have done. When people you know enter the hospital, you can make a big difference by being present to offer support, log temperatures and generally keep a loving eye on stressed patients and family members. Make a list of their medications and enter them into a website that checks for harmful interactions (like http://reference.medscape.com/drug-interactionchecker). If their health seems to be getting worse once they’re home, head off that ambulance run by a timely trip to the family doctor.

Your efforts to help a loved one will also make America healthier, and health-care cheaper, by local action.

Francis P. Koster lives in Kannapolis. His “Optimistic Futurist” column appears every other Sunday. For more information, visit www.TheOptimisticFuturist.org.

Coming up: Koster will be at the Center for the Environment at Catawba College on May 16 to talk about his book “Discovering the New America: Where Local Communities Are Solving National Problems.” The program starts at 6:30 p.m.

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