Dr. Arnold Relman, former editor of the New England Journal of Medicine, has long played a rare role in the health care sphere: He's an exceedingly senior and authoritative Harvard figure willing to speak out about what's wrong in American medicine, from financial conflicts to the need for health care reform.
Now, unfortunately, Dr. Relman has new, first-person lessons to share. In a powerful and compelling piece in The New York Review of Books — On Breaking One's Neck -- he describes the stairway fall that nearly killed him at age 90, and offers his assessment of the care he received at Massachusetts General Hospital and Spaulding Rehabilitation Hospital in Cambridge during his time as a desperately ill patient. Among the lessons he shares:
What did this experience teach me about the current state of medical care in the US? Quite a lot, as it turns out. I always knew that the treatment of the critically ill in our best teaching hospitals was excellent. That was certainly confirmed by the life-saving treatment I received in the Massachusetts General emergency room. Physicians there simply refused to let me die (try as hard as I might). But what I hadn’t appreciated was the extent to which, when there is no emergency, new technologies and electronic record-keeping affect how doctors do their work. Attention to the masses of data generated by laboratory and imaging studies has shifted their focus away from the patient. Doctors now spend more time with their computers than at the bedside. That seemed true at both the ICU and Spaulding. Reading the physicians’ notes in the MGH and Spaulding records, I found only a few brief descriptions of how I felt or looked, but there were copious reports of the data from tests and monitoring devices. Conversations with my physicians were infrequent, brief, and hardly ever reported.
What personal care hospitalized patients now get is mostly from nurses. In the MGH ICU the nursing care was superb; at Spaulding it was inconsistent. I had never before understood how much good nursing care contributes to patients’ safety and comfort, especially when they are very sick or disabled. This is a lesson all physicians and hospital administrators should learn. When nursing is not optimal, patient care is never good.
Read Dr. Relman's full piece here. One personal reaction: I felt a bit defensive for Spaulding; my late mother received excellent care at their Boston facility. But then I thought: If every patient — particularly patients with as much authority as Dr. Relman — routinely reported publicly on where the nursing care was great and where it was inconsistent, that could help lead to constructive change at the places where it's needed. We often talk about care that falls short in personal chats, but hospitals need that feedback — and perhaps some of it should be public — to help them improve.
Readers, thoughts, reactions?