Friday, July 29, 2011

GREAT HARDWARE, TERRIBLE SOFTWARE

A friend recently took a bad bicycle spill. Along with assorted other injuries, she broke her jaw and hand. A helicopter flew her to a major trauma center, where she was promptly triaged and her jaw laceration stitched. She learned that her injuries were relatively minor compared with people who were brought in with missing limbs and lacerated livers. Naturally, those in more serious condition were attended to before she was. During the next fourteen hours she lay on a gurney, requesting repeatedly that she be seen, but no one even came to put ice on her broken hand.

The contrast between the light and dark sides of American healthcare is ever more visible. Our medical technology, our hardware, especially in regard to treatment of trauma and infectious disease, can be truly wondrous. Where we are scandalously lacking is in our low-tech software, our ability to communicate.

However we're encouraged to pretend otherwise, healthcare isn't simply another commercial transaction. Deep personal issues, often questions of life and death, are involved, so it's an EMOTIONAL process. This makes communication absolutely central to the medical encounter.

We commonly think of optimal communication as clear speech, but those of us who labor in these fields know than nine-tenths of communication is sensory reception--listening, observing, sniffing, empathizing. Thus one of the most important people in the private medical office is the receptionist: he or she sets the emotional tone of the visit.

Every WalMart store features a greeter. "Hi, how are you? Welcome!" Smart medical operations like the Mayo Clinic do likewise, and even assign employees or volunteers to accompany patients throughout their visit. They don't just advertise that they "care." They demonstrate it. If my friend's trauma center wasn't simply a repair factory but actually a caring place, she would not have had to endure fourteen hours of a fractured hand without even a little ice on it.

More about this soon, as her trauma center visit exemplifies much about what's right and wrong in our healthcare system.

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