Standard(s) of care

March 9, 2007

After open-heart surgery, what kind of follow-up would you expect after leaving the hospital? What level of instruction and support would you expect to receive?

Stanford, not surprisingly, has this perfected. Not only was I sent home with a bulging folder full of papers, but I received a copy of Stanford’s nicely-produced booklet, After Your Heart Surgery. This fatter sibling to the ever-popular Before Your Heart Surgery (which I’d read several months ahead of the event) is full of well-written, expertly organized and helpful information, not to mention some really good illustrations. It contains nearly everything I needed to know to start my recovery. This booklet alone might have been sufficient, but they didn’t stop there. Before I was released from the hospital I had spoken to a long procession of doctors, nurses, PAs, nutritionists and physical therapists who basically covered all the key parts of the booklet verbally. One of these helpful professionals even took the time to go through After Your Heart Surgery and highlight in yellow everything I should pay special attention to. Jeepers.

Okay, but this is Stanford, after all. We’d expect nothing less of them. What about other hospitals, too numerous to count, that also do heart surgery in this country? Do they have their own After Your Heart Surgery bestsellers?

One clue bubbled up a day or so after I returned home. The phone rang and the caller announced herself as Susan, a nurse working for Aetna (my health insurance company). Would I be willing to speak to her for a few minutes?

Being a skeptical and perhaps slightly paranoid fellow, I immediate jumped to the most extreme conclusion: Aetna must be checking up on me to confirm that I actually went though the surgery they’re being charged for. After all, we’re talking about a lot of money.

A few minutes on the phone with Susan, however, changed my mind. Yes, Susan’s job is to help Aetna check up on every heart surgery patient once they return home. But the reason is not because they doubt the procedure took place. They’re calling because they’ve noticed that some hospitals’ post-surgery care sucks.

Susan and I spoke for about 35 minutes, during which she carefully went through just about every major area covered by Stanford: caring for the wound, avoiding stress on the sternum, my walking program, my breathing exercises, which drugs I’m on. It was a bit tedious for me, seeing as I had covered these topics with the hospital staff and had just read over the written instructions. But Susan was careful and patient and needed to cover a rather long list of items, so I decided to forebear. Partway into the call, I asked her something about Aetna’s decision to start this program, and I wondered aloud that they must see it as a net cost savings.

“Oh yes,” said Susan. “Stanford is of course a world-class center, but you wouldn’t believe some hospitals. I’ve spoken to heart surgery patients who received no written instructions whatsoever.”

No written instructions? At all? After open heart surgery?

Maybe this comes as no surprise to anyone. Maybe I shouldn’t be shocked. But when a health insurance company decides it’s in their interest to assign an RN to every single heart surgery patient, I’m forced to conclude that something is very wrong. Yes, the U.S. has top-notch health care. Except. Except that statement is followed by about 15 different asterisks, and the fine print runs on for pages. Aetna (and presumably other health insurers) are doing the right thing to fill in the most egregious gaps. But let’s face it: the house still appears to have termites.

Susan said she’s follow-up with me in about a week. She’s a day or two late, and my hope is that she realized her time is better spent with other patients. I won’t be dismayed to speak to her again, but in the back of my mind I’ll be thinking about the others who need Susan a great deal more than myself.


One Response to “Standard(s) of care”

  1. Alisa Says:

    Well, you are well and I am relieved. I just read about your coming home from the hospital and not wanting to feel “old.” Me either! I’m going to call you now.
    Love, Alisa

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