This month's column details one of my often-failed attempts to be treated as something better than pond scum. I give you fair warning: Much of what you'll read deals with CRM in the face-to-face, interpersonal sense, so if you want info on the technology, there are better choices than this column. When you're ready for a rant, you know where to find me.
For those who remain, here goes: As almost none of you know, much of my time is taken up playing caregiver for my mother. The list of what ails her is pretty much everything you're asked on a doctor's intake form, so I'll skip the details, but I will share that in addition to her myriad issues, she thinks it's wise to not bother me unless she expects catastrophe. So when she woke me up at 7 a.m. one winter day complaining of shortness of breath and chest pains, I knew we had something in the works.
It had snowed several inches the night before, so I had to go out and get the car ready and shovel a path for her. Why no ambulance, you ask? Ambulances take you to the nearest hospital, which in this case is one at which none of her doctors have privileges. So I have to transport an elderly woman on dangerous roads to a hospital several towns away. (Complaint 1: I know that ambulances aren't taxi services, but if a patient has a really good reason for choosing a different hospital, there should be a way around that rule.) We get her into the ER and admitted soon thereafter.
Everything goes more or less smoothly for a few days and things settle. Until the blizzard warning.
While it didn't amount to the historic mess that was predicted, the clipper of January 2015 dumped a whole bunch of snow on our area, and we were confident that no sane hospital administrator would discharge a frail old woman into this. Of course, they proceed to do exactly that, despite protests that stayed just this side of civil. (Complaint 2: Throwing sick old ladies out into a snowstorm is some serious Charles Dickens villain–level BS.) Days later, I'm told by an outside source that there's a MRSA infection (read: patient-killing bug) going around the hospital and that might have had something to do with her quick discharge. (Complaint 3: Honesty is the best policy. Let us know, and let us weigh the risks.)
After hours of hurry-up-and-wait discharge plans (Complaint 4: How hard can it be to let somebody out of your hospital if you want them to go?), I roll into the discharge area in near white-out conditions, wondering what I'll do if she relapses. We'll be snowed in for at least a day, and then there's that ambulance problem again—looks like she'll have to go local if things turn bad. Roads are being closed all over, and pharmacies are either unreachable or suffering from network failure, so the prescriptions the hospital gives her are not going to be available. Yes, that's right. They sent an actively ill person home in a blizzard, without access to transportation or medication.
As of this writing, Mom is slowly improving despite catching a cold (a serious health hazard for her) and going two days without any of the three prescriptions she was sent home with. The point is this: It doesn't matter how good the standard of care is within your four walls. The whole person needs to be considered, and that person has to survive the trip into the hospital and the trip home, not just the stay. In any service-based enterprise, not just healthcare, you've got to remember there's a world outside your door. Even if you can't fix it, you've got to consider it.
Marshall Lager is nursing a cold, a grudge, and his mom, in no particular order, and still watching the CRM world at Third Idea Consulting. Get your second opinion at www.3rd-idea.com, or www.twitter.com/Lager.