December 1, 2011
Outpatient Care – The Good and Bad
On 15 November, I experienced what I consider to be both sides of outpatient care, the good and bad. I was pleasantly surprised to be told when scheduled for my surgery that I must bring my own sleep apnea equipment. In my blogs before this, I had warned people that they may need to get prior approval from the hospital to use their own equipment. At least in my case this is no longer necessary.
I had to think about this for some time, but I think I can answer this now. With the new health care laws and the fact that Medicare is clamping down on expenses, it makes good sense for hospitals to have people bring their own sleep apnea equipment. First, because they are familiar with the equipment and know how to use it, and second, the hospitals can avoid using expensive equipment and maintaining it, having people knowledgeable in setting the equipment requirements for different patients. This means cost savings. It also means cost savings because people generally do better and leave the hospital sooner when they use their own equipment.
This is a positive for the hospital and the patient. Did I need the equipment with me? Turns out, I did not, but this is now a standard for outpatient surgeries to have the equipment present in the event that you are admitted to the hospital or have troubles in the recovery area. A few years ago, this was seldom considered and is good procedure saving the patient problems and requiring someone to make an extra trip to locate and bring the equipment back.
Now the not so positive side. The reception area for the incoming outpatients was almost too friendly, like they were trying to put you at ease so you would forget and not keep your wits about you. Yes, indeed and in the following hours, I could see why. Talk about like being treated like cattle and the impersonal nature in which you were treated. I have been a patient for very few hospital stays or even outpatient surgeries not counting colonoscopies, but this was one experience I do not want to repeat unless there are some changes in the way I am treated as a patient.
From the patient in processing room to the recovery room, I felt like the more they could keep from me, the better off for them. Why? That probably will never be answered. I do know I made some statements that I did not want an intern or new resident doing the procedure. I also asked that the IV not contain any dextrose because I was a diabetic. Can I say with any certainty that these requests were followed? Maybe and definitely no.
The anesthesiologist was around and said he would be the one administering it, but did I see him in the surgery – again no. There were several people in the surgery room, but no one wanted to introduce themselves and explain what they would be doing. I forced the issue, but never was allowed to complete it as they opened the spigot on the IV tube and put me under very quickly. I remember six people in the room and could not identify any of them other than the first person who would only admit that he was a nurse. My doctor was there, but other than this, I felt like I was being ignored.
Then when things went blank, I do not remember anything until I was seeing several nurses around the cart I was on. Next thing I was wheeled into the room where my wife was waiting and a nurse rapidly asking questions and giving me a pain pill and saying I could get dressed. Dismissed and that was it. Sort of had the feeling of being on a belt moving me through the system.
Now comes the part where I became very angry. I was assured that the IV was dextrose free and that I would receive a minimum of two doses. Well from the meter test results after being shuttled out and in the vehicle, my blood glucose reading was over 300 mg/dl. Therefore, from a reading of 106 mg/dl at entry to 309 mg/dl after leaving, I would conclude that one or both IV's had dextrose in them. Not a comforting thought about how they are concerned about patient safety. I would rate them a flunking grade for several reasons.
The previous time I had the surgery, I was introduced to all people in the room and made to feel like they were interested in the outcome that would be best for me. This time was very impersonal and like they were herding cattle through the vaccination chute and could care less about the outcome. True, the first time for this surgery was before diabetes, but even when I have had colonoscopies since diabetes, I still knew who was in the room, their names, and given reassurances. There will be some changes made before I will willingly submit to surgery in the future.