Two decades ago I wrote a four-part series for this newspaper on hospitals that operated on the wrong joint or organ — sometimes even the wrong patient — and made other mistakes that shamed the hospital and sickened its patients. It left a journalist like me convinced there must be a way to prevent errors like those.
Three weeks ago the knife cut into me. When the surgeon scribbled his initials on my left shoulder in blue ink to remind him which side was to be repaired, I was reassured. When I was asked to confirm my name and birth date 10 times within 90 minutes, I didn’t complain. But the medical team’s in-hospital meticulousness did not extend to my bedside at home: It took four phone messages, two e-mails, and four days to get a call-back on what I worried was a post-operative infection. (It wasn’t.)
All told, my day surgery convinced me that things have improved dramatically — but not enough — in rooting out hospital miscues and keeping patients from being readmitted.
I know change isn’t easy, not with all the moving parts, human and mechanical, in today’s high-tech hospital. Over my short stay at Brigham and Women’s, I was attended to by legions of administrators and volunteers, nurses, orderlies, doctors, and doctors-in-training. The fact that all were applying the safety lessons medical pioneers had preached to me decades ago — from ensuring they had the right patient and procedure, to taking time in the operating room to check my X-ray and their blood supply — was wondrous. So were the instructions on how to ensure nothing went amiss with my recovery and how to reach my doctor if it did. They even told me, in writing, what exercise to do: “Walking is good for you, and you may also climb stairs.”
I did both, and got back on my exercise bike when my doctor said I could, four days after he operated. That same day I got word that the complex cyst he had removed was benign.
But not all was well. The surgeon’s orders that I didn’t need an overnight stay had gotten tangled; the hospital insisted I would be there three nights and told my insurer, which denied coverage. “Please understand,” the company wrote in a letter that arrived home just as I did, “if you have had this service, your plan will not pay for it.” My mental anguish was nothing next to my physical distress, which had been easing but was back full-strength after my cycling workout. I left my first voicemail at my doctor’s office that morning, asking for a follow-up exam. No reply. Over the weekend I experienced the drainage, swelling, and “pain that does not go away with pain medicine” listed on my instructions for “when should I call my doctor.” As an ex-marathoner I know how to bear pain, but as an ex-medical reporter I know that infection is a common complication of surgery and needs to be addressed urgently.
I called my surgeon’s office again on Monday, in the morning, at noon, and in the afternoon, and in between I shot my doctor two e-mails. Still no response. Just before 5 p.m. I heard back from a scheduler who offered me an appointment with the doctor — in eight days. I could see a physician’s assistant tomorrow, she added, and offered to have the doctor call after his last surgery that evening. He didn’t, but his PA did.
The next day I saw my internist, who confirmed there was swelling and some oozing but no infection. I should be fine, he said, but I shouldn’t get back on the bike or walk more than necessary for two weeks. I also learned, after an hour on the phone, that my insurer will pay.
Is there a lesson in what happened to me? I think so. The attention to in-patient errors will not mean much unless the same care is shown when the patient heads home, which these days is earlier than ever. My able surgeon agrees. “Getting a timely call-back is a problem for a lot of doctor’s offices,” says Dr. Graeme Steele. “It’s not a perfect system, which is why as a patient, you need to be your own advocate or have patient advocate like a family member.”
Larry Tye, a former Globe reporter living in Lexington, now writes books and runs a training program for medical journalists.