heart disease and the chinese health system

Today I had my first encounter with the Chinese healthcare system. In order to get my visa extended, and in order for China to exert its endless bureaucracy and make a quick buck, I had to get a medical examination at this international health center. I was pretty annoyed about the distraction from my work (namely, watching a bootleg version of some f-ed up Spanish film…rough life, I know). However, since I’ve quickly learned that everything in China needs between 1-100 red stamps, off I went.

First of all, according to the center’s giant map of the world, China is apparently free from all infectious disease, including malaria, yellow fever, SARs, dengue, the works! Funny, that’s not what the CDC says.

Secondly, this medical exam was strangely more thorough than any US medical visit I’ve had in years. As I passed from room to room, I got the works: urine test, blood draw, eye exam, ultrasound (?), x-ray (?!), EKG (?!?!). The place was bizarre: entirely deserted, with a white-clad nurse silently sitting in each room. Each one would perform her procedure wordlessly, stamp a big red stamp on my form, and then point to the next door. It felt a little Alice and Wonderland-esque. Because my imagination tends towards the twisted, each time I passed through a door, I wondered what kind of bizarre, macabre scene lay within: jars of pickled brains, shrunken skulls, bloody carcasses?

Oh wait, no…that’s just the local grocery.

Actually, the blood draw was actually quite upsetting. Much to my parent’s chagrin, I’ve had a vasovagal reaction to getting blood drawn since I was about twelve. Namely, I sweat and pant and pass out. Not a pretty sight. I tried to warn the nurse what she was about to witness, but of course the meaning was lost in translation. Since we were both panicking, she called in a well-meaning “English-speaking” doctor. He held my hand as I lay there, reassuring me that “It is not a problem! We only use the needles once! One time use!” In my mind I was screaming: THIS IS NOT HELPING!

After surviving that debacle, it was time for the ECG.

“Expose your heart,” the nurse told me solemnly.
Um, I just met you- let’s not be hasty, I thought.
“OK,” I said.

And as I was lying in this tiny room in this deserted hospital, with a dozen electrodes clamped to my chest, I started thinking about all the things I’ve done since I’ve been in China that could possibly get me in trouble. Taking photos of the Mao statue? VPN-ing into YouTube and Facebook on a semi-regular basis? Googling the crap out of everything? Why am I such an idiot?! I started to sweat as I waited for the electricity to surge through my veins. I was sure I was going to die. Good-bye world, I thought, melodramatically—and what a way to die, half-naked on a lumpy bed in a Chinese exam room waiting---

“Your heart…,” the nurse said, pulling off the electrodes.
“What?” I asked incredulously. “Is it bad?”
“No. It’s slow. Your heart is slow.”

Amen sister. Tell me something I don't know.

grievances

[Unfortunately, my formerly objective healthcare experiences have taken a turn towards the personal, so from now on I'll also be blogging about my own experiences in & out of the doc's]

So how’s this for irony? The last few weeks, I’ve been working on conducting patient focus groups at all of our hospitals to get patients’ responses to the following question:

Have you ever left a visit with your medical oncologist or other care provider wishing you had more information?

What kinds of questions do you wish you would have asked?

Based on the results of this survey, we’re creating visual aids and notepads for patients so they can keep track of all the questions they want to ask during their appointments. Oftentimes, new (and returning) patients feel overwhelmed with information…and because the doctor is the “authority figure,” it’s so easy to nod your head and accept what they tell you…and forget to ask the questions nearest and dearest to your heart!

Last week, I was diagnosed with a relatively common, yet serious, women’s health condition that puts me at risk for a whole host of potentially serious health issues (infertility, diabetes, and cardiovascular disease being the heavy hitters) as well as more superficial problems (hair loss, weight gain, acne…you know, every woman’s worst nightmare!). Obviously, I was pretty upset about this information. I did my research online, checked out a bunch of useful forums, and was prepped to go with all my questions for my follow-up visit whereupon the doc would confirm my lab results.

Except that visit never came! The doc called me on Sat. morning to confirm that I might have this “kind of syndrome thing” (her words!) and then told me to call the office on Monday to get a prescription. No time for important questions like: Why this drug and not another? How do I prevent myself from getting diabetes? What kind of lifestyle changes can I make to help decrease my risk of health complications? Where can I get more information?

All things I need to know so that I can help myself prevent future painful and costly issues, placing more burden on me and our healthcare system. Instead, she just wanted to talk about how the office’s adjacent spa was running specials on facials. Then today, she wasn’t even in the office, so I got the message from a nurse from yet another doc that I would be put on one particular kind of med- no questions asked.

And now my only remaining question is:

WTF?!

Every year my (former) roommate and I throw a Seinfeld-esque Festivus party, and this sorry doc and her spa-pandering office definitely deserve a top spot on the Wall of Grievances!


(PS Yes, for all you fellow One Tree Hill fans, that is Haley James Scott at the top of the list- she is way too much of a goody-two-shoes/pancho-wearing has-been for our liking)

(Aren't our dresses fab? Takes ugly sweater parties to a whole new level)

rockin out

This is what I feel like today:


Work and life have been kind of stressful the last few days: got in a minor fender bender over lunch hour the other day when I was rushing to get to the pond to read my book in the sun. The man I bumped was the ideal person to run into, however- he just kept saying, "No worries, it's just plastic and metal." If only everyone could be that easy-going! But of course, my cell phone broke and my rearview mirror fell off on the commute home last night, so it's been a one-two (and three) punch.

Not to mention, I'm currently working on a project at work that is stirring up a political s*storm. It's fascinating from an objective point of view: business administrators attempting to drive physician behavior change. Not an easy task. Honestly, I doubt it will be effective. Everyone's heart is in the right place, but that doesn't make this less messy. Physicians learn best from other physicians, and although marketing is attempting to construct a facade that shows otherwise, it is my unsettling suspicion that all this effort will be for nought when the docs perceive this educational effort as an attept by marketing to increase patient acquisition. Hopefully my pessimism is unfounded, but who knows!

I'm trying to be patient, though. Like all businesses, be they hospitals, universities, or othewrise, this is a flawed organization, made up of flawed individuals. After two years, I do believe that everyone is trying to do their best by the patients. In spite of financial and business constraints (and honestly, a smidge of avarice for some) most people deeply care about patients and each other. I have to remember that when it feels like everything is crashing down around me. It may not be the pretty picture I once envisioned it, but after you wipe away the grime, the beauty of the effort still shines through.


And so, the rock-out picture. This is what I do on my way to and from work every day: my battle cry of sorts. I cruise in after my commute, sun streaming through the open window, crank up the jams, and play a little air guitar. It makes me feel more alive- and so much more me- before I enter the storm.

wild wild west

As of Wednesday, I am temporarily living in Phoenix, AZ (well, technically Goodyear, AZ) for the next 6 months in order to help open our newest hospital here. I'm excited for multiple reasons, not least of which is the much warmer weather--I've set my iGoogle to show me the temps in Chicago and in Phoenix, and delight several times a day when I notice that the Phoenix temperature is 2x or3x as much as Chicago's.

The hospital opens at the end of December, which will make this holiday season even crazier than usual, as we will have only a few days to prepare for and pass state inspections, train the entire staff, and tie up all the loose ends required to get the place up and running. As for me, my "unofficial, official" task is to help get the Lean/Six Sigma department up and running. Lean and Six Sigma are two process improvement methodologies we use to eliminate waste (waiting time, etc), reduce defects (increase pt. safety), save money, and improve service delivery/quality of care. My responsibilities, besides setting up the various processes, programs, and training all employees, will include the implementation of several tools required to staff nurses based on patient acuity. For non-HC people, this essentially means understanding how much RN work is associated with a given patient condition, and then structuring staffing around assigned acuity levels so that patients get the best care and nurses are utilized most efficiently. Patient-based nurse staffing is mandated by Arizona state law and will require a tremendous amount of clinical knowledge and IT skill that I simply do not have....yet. I love the challenge of working on something that is completely foreign to me, and will help acquaint me with all the order sets, documentation, etc. that an electronic health record requires. Plus I'll get to hang out on the inpatient/ICU unit, and there's not much more I like than being around patients (as opposed to spreadsheets!)

Even more appealing to my creatively-inclined brain is the start-up atmosphere: the feeling of actually envisioning something and then creating it...as opposed to most of what I've experienced in the corporate world, when implementing anything feels like a battle. It's an opportunity to help establish a culture that embraces process improvement and equips employees with the tools they need to create change, rather than just providing lipservice to the notion of employee empowerment. After spending years studying culture as a concept and the last year observing organizational culture in particular, I still have no clue...but I'm excited to find out!

a little bit of medicine....

In terms of grad school, there are a few more applications I have yet to complete. I've been a bit distracted lately (as evidenced by my lack of attention to this blog), by schoolwork, the election, a cold, wrapping up my finance stint in Philly, and getting ready to "move" to Phoenix (more on that later...)

My cold was minor: a little cough and a slight sore throat, accompanied by the requisite whining to my mother via throaty, whispered cell phone calls. I couldn't sleep a couple of nights, when it felt like there were several dozen hyperactive Boy Scouts attempting to build fires in my throat, and as I writhed in agony, I quickly lost my grip on reality and plunged into the depths of self-despair.

That is, until the next morning when I was traipsing around the hospital affixing asset tags to capital equipment (read: the most mind-numbing job ever), I stopped to chat with a kindly-looking elderly man wearing an Ohio State cap. As we chatted enthusiastically about the impending Northwestern vs. Ohio State football game, I noticed him grimace in pain several times, although he wasn't moving in the slightest, and his face blanch as whatever was bothering him grew increasingly worse. We finished our friendly conversation, and as I trotted away he quietly offered me the traditional Ohio parting words of "OH," to which I gleefully replied, "IO," secretly delighted to find a small piece of home in a faraway city.

What struck me more than our easy Midwestern camaraderie, however, was the chronic pain my newfound friend was clearly experiencing that day, and most likely every day. (Assuming, of course, that his pain could not have been in response to my pitiful predictions of an NU victory.) I thought about my cold and how annoying it was, and the gulf between the sick and the healthy opened in my mind. I have always taken my health for granted. Except for minor illnesses and surgeries, I have never experienced protracted or dehibilitating pain. If I ever did encounter such a misfortune, I could go to a number of specialists, get a few scrips, and be done with it by day's end. I think about all those with no or insufficient insurance, who have no choice but to live with the pain, the discomfort, and much worse than the occasional sore throat until it gets better...

or until it forces them into the ER.

After experiencing life from the student and provider's perspective, I understand the implications of this country's paltry emphasis on preventative medicine & primary care from a conceptual (and financial) perspective: predispositions, poor health behaviors, or chronic illnesses left unadressed until more costly, time and labor-intensive acute care is the only available alternative. What I forget--or simply can't imagine-- is what it must feel like to be that individual with high blood pressure who can't buy their medication or to have strep throat without access to antibiotics. I can't imagine living in constant pain, rendered unable to participate in my own life, a helpless bystander watching as my body betrays me. Once again, I am grateful for the opportunity to work with patients who distill the articles, theories, and philosophical pontification in which I so often lose myself, and illimunate real life. I hope that grad school--and especially public health internships--will help expose me further, because I know I must understand before I can help.

And on that note, back to applications!....