After falling down a flight of stairs, breaking his neck and nearly dying, a Massachusetts physician is now speaking out about the stark deficiencies he saw in his own treatment -- and how those shortcomings relate to more general problems he sees plaguing medical care in America.
Writing in the New York Review of Books, Harvard Medical School faculty member Arnold Relman -- who is in his 90s -- documents the course of his treatment from arrival at Massachusetts General Hospital’s emergency room on June 27 to his discharge from Spaulding Rehabilitation Hospital ten excruciating weeks later.
As he says, “Since then, I have made an astonishing recovery, in the course of which I learned how it feels to be a helpless patient close to death. I also learned some things about the U.S. medical care system that I had never fully appreciated, even though this is a subject that I have studied and written about for many years.”
Specifically, Relman says, “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.
“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.
"Given the limited life expectancy of someone my age, is it justified to spend hundreds of thousands of dollars to extend a nonagenarian’s life a little longer?"
- Arnold Relman
"Conversations with my physicians were infrequent, brief and hardly ever reported.”
Within this vacuum of personal care, Relman says the role of nurses has never been greater in ensuring a patient is not only comfortable during their convalescence, but actually ultimately gets well.
“I had never before understood how much good nursing care contributes to patients’ safety and comfort, especially when they are very sick or disabled,” he wrote.
“This is a lesson all physicians and hospital administrators should learn. When nursing is not optimal, patient care is never good.”
Also, Relman draws another conclusion, seemingly rooted in the same problem, about the de-emphasis in American medicine today of primary-care physicians and the resulting shortage of doctors who become one.
“What is important is that someone who knows the patient oversees their care, ensures that the many specialized services work together in the patient’s interest, and that the patient is kept fully involved and informed,” the doctor wrote.
“At Spaulding, that was not the case, and the U.S. health care system suffers from the same deficiency. The growing national shortage of primary care physicians allows for fragmentation, duplication and lack of coordination of medical services.”
Beyond those conclusions, Relman reached a few that may be a bit more obvious regarding medical care and recovery, although they are seemingly no less important for being so salient.
In receipt of a total bill for all medical services exceeding $470,000 before adjustments, Relman proceeds to ask an unthinkable question: "Given the limited life expectancy of someone my age, is it justified to spend hundreds of thousands of dollars to extend a nonagenarian’s life a little longer?"
And while he doesn't supply an answer to that seemingly rhetorical question, he does claim clarity on three other points: The presence of loved ones during one's recovery is essential, the patient's will to live cannot be discounted -- and he's very, very happy to still be alive.