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The Tampa Tribune

Published: December 30, 2007

Care And Commitment

Thank you for speaking out about a serious shortcoming in the health care system. Plenty of us have similar experiences.

Please continue to champion this. The medical community knows what is happening and blames the insurers and money, but it is much deeper than that, I believe.

It's about care, commitment and the absolute poor system of shared medical history and data between all the parties assigned to a patient while you are in a hospital's care.

And I dare you to get any of them - doctors or nurses - to speak out against another.

Personally, I would only speak highly of a handful of people in the profession anymore.

PHIL GROW

Brandon

Testimonial is Right On

I've watched two dear friends die not so much from what put them in the hospital but from what happened to them afterwards - like Ms. Goudreau's stepdad, George. One of them was an 80-year-old woman who probably would have made it had her doctors communicated with each other. She had a long history of smoking and a persistent hacking cough. She went into the hospital for removal of a spot on her lung that turned out benign. The night before the surgery she was at Bern's Steakhouse, drinking her beloved Budweiser and just generally kicking up her heels. We did not anticipate that this would be her last supper, so to speak.

After the surgery, she developed pneumonia, which started her on a downhill path. The pneumonia caused her to have breathing problems, which led to a breathing machine, which led to having to be fed by IV that gummed up her insides, which led to kidney dialysis.

All of this then left her too weak to breathe with the machine, so she had to have a breathing tube inserted in a hole in her neck. Eventually the stress wore out her heart. She did not leave the hospital alive.

Here's the kicker: She got pneumonia because during recovery, she was flat on her back, which meant the stuff she would usually cough up couldn't go anywhere and accumulated in a pocket in her lung.

After the pneumonia developed, the doctor overheard (from a visitor) that she had the hacking cough. He said, incredibly, that he'd wished he'd known about that because he would have had her elevated during recovery. Why the heck didn't her primary doctor and the surgeon discuss her condition before she was operated on?

It's been two years, but it feels like yesterday and I'm still stewing. Thanks for the opportunity to finally vent.

CATHY PEEK McEWEN

Tampa

'Hospitalist' Problem

Your story on hospitalists really hit the target with my same experience.

The idea of someone always being at the hospital to take care of your needs is a great idea, but very often they were not there, they were very late in making rounds, they knew very little about the patient, and worst of all, many were foreign doctors who had extreme trouble with the English language.

In searching through the several hospitalist groups, I found that language communications with my patient (my wife, Lee) was the biggest problem. I finally went to top management, but did not get much satisfaction.

Thank you for doing an excellent job.

VIC LEAVENGOOD

Tampa

Problematic Trend Exposed

Witnessing the slow process of elderly death is always painful, but even more so when the death may have been preventable, or delayed.

My heart goes out to Rosemary Goudreau and her family, and I praise her for allowing us to step inside her private life to get a glimpse of a growing and problematic trend in the health care industry.

Perhaps Ms. Goudreau will take heart in knowing that her very sad story alerts her readers to prepare for the same situation, that of "hospitalists" as opposed to attending physicians caring for our loved ones. We will know to be aware, to be attentive to the care being given and to be alert for errors such as she described. For that, we applaud her telling us the story of her father, her stepfather and the manner in which death received each of these two men.

JUDITH DIANE BATSON

Tampa

Communicate Directly

Sadly, this is almost a daily situation - and it seems to be increasing in scope.

Elder Care Advocacy of Florida is confronted with similar commentaries all too often. We find multiple doctors, none of whom are familiar with the family, making decisions and giving orders without having a complete history on the patient. We see replacement physicians covering for vacationing doctors and instant diagnoses being made without checking with the patient's doctor.

Loved ones should not have to go through this disastrous scenario in an already stressful moment. A concerned and knowledgeable family member or close friend should be on hand in these situations. Be assertive and communicate directly with the physicians or hospital staff in knowing what is transpiring.

AUSTIN R. CURRY

Tampa

System Was To Blame

I had the exact same experience with my father this past summer.

Over a four-month period, he was transferred from nursing home, to rehab facility, to the hospital - at least seven times. At each change, I had to spend hours and hours discussing and educating the new treatment team on his issues. Not only did the treatment plans not carry from one facility to the next, even within the same facility there seemed to be a disconnect from the floor nurses to the other specialists.

I am not sure what the final cause of death was. I'm not sure it truly matters. But I do know that it might as well have been "lack of continuity of care." There was no single doctor who followed his care from facility to facility, episode to episode. We would raise issues every day, but just when I was able to get the attention of the staff, he would be transferred to another facility and the saga repeated itself.

When my father died, the family discussed the litany of issues and malpractice that we had witnessed. Everyone agreed that every care-giver we met was a sincere caring person, dedicated to doing their job and helping heal the sick, but that somehow the system of care had grown so defensive and so focused on itself that the simple stuff seemed to slip by them.

If we felt that a lawsuit would save another person and family from what we experienced, we would have pursued it. But in the end it was not any one individual, but more like system malpractice and that would not change.

RICH MANNERS

Tampa

Cooperation Needed

To improve the patient experience when the hospitalist care model is employed, it is imperative that hospitals and physicians work together to:

•Clearly define the role of the hospitalist as a specialty.

• Educate the patient prior to admission regarding the role of the hospitalist. Primary-care physicians defer the care of patients to hospitalists in order to focus on their office practice and avoid taking emergency room call. However, patients often do not know what to expect or understand why it is happening.

• Assure there is a defined communication mechanism between the hospitalist and the primary-care physician throughout the hospital stay and upon discharge to the next level of care. Appropriate hand-offs in the delivery of care are critical to assure that all care-givers are on the same page.

Fortunately or unfortunately, depending on your perspective, this care model is likely here to stay for the foreseeable future. We must continually strive to improve upon our ability to provide the highest quality of care to our patients.

KEVAN METCALFE

Zephyrhills

Try The VA Model

I'm a retired physician who spent his career practicing, teaching and researching how we in the medical profession handle information and how easily it can be mishandled, as was pointed out.

I became a strong advocate for the EMR (Electronic Medical Record) as I realized that the good old family doctor and his 24/7 availability was going by the wayside - and along with him, the continuity of medical information. I started looking for what could replace the continuity of care, or at least the continuity of information, and realized it would have to be via easily accessible medical records.

Unfortunately, the medical profession has been the slowest to embrace electronic information systems, and the results are as Ms. Goudreau so clearly demonstrated.

There is one glimmer of hope and worth following at - of all places - the Veteran's Administration. They have the best electronic medical records system in the country because it's used at all VA hospitals and clinics. And patient satisfaction with the VA has grown by leaps and bounds in spite of their under funding and staffing since Iraq.

H.E. "PAT" CROW

Sun City Center

The author is executive director of Elder Care Advocacy of Florida. The writer is chief administrative officer of Florida Hospital Zephyrhills

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