How We Organize, Pay For, and Integrate Medicine in This Country is a Mess.
The Actual Practice of Medicine, However, Can Be Pretty Impressive.
This is Not Your Parents Surgery
My wife went through a major surgical procedure replacing a hip a few days ago. We are both fortunate to have good health, so this sojourn into the medical culture is a new experience for us. It has been educational and, in many ways, encouraging. We learned some things that might be of interest to anyone facing major medical engagements.
A few years ago, hip replacement involved very substantial cutting by a surgeon. The procedure took hours. With a bit of luck, the replacement hip could last 7-10 years.
Fast forward to today. The operation takes an average of only one hour and forty-five minutes. My wife’s procedure was complete by about 11 AM on the day of surgery. By 6 PM, physical therapists had her walking with her new hip. That hip is likely good for a couple of decades. Remarkable. When I saw her surgeon about 6:30 PM that night, he had done three more hip replacements since I had seen him that morning.
Less than two days later, my soul mate was out of the hospital and on the way home. It is amazing how streamlined, efficient, and effective these procedures are today. Again, remarkable. We know several people with similar hip or knee experiences.
A Few Reflections on All This
– Physical therapists are like any other profession. There is a bell curve of competence and talent. The best ones are remarkably effective. They cause patients to stretch themselves (no pun intended). They seem to have the right balance of coercion and encouragement. We found one of those and hung on to her to make the most of the healing process. PT is as important as the surgery to reach full health for such operations.
– Medicine, especially with surgery, is one of the most integrated disciplines on earth. Do it wrong, and people die – it’s that simple. In only two days in the hospital, we interacted with surgeons, anesthetists, and general practitioners. We worked with nurses, therapists, and chaplains. Support came from administrators, book keepers, orderlies, and schedulers. Pharmacists, food service, transports, transition facilities, and more I don’t even know helped. In most cases, they were all well-coordinated and synchronized to a remarkable degree. That level of coordination is important for patient well-being. It cannot be easy to establish or maintain.
– When one experiences something like this, the meaning of community comes out. Our community has been encouraging and helpful beyond anything we might have imagined. People who had been through the same process were especially informative and helpful. This really has felt like one of those “it takes a village” moments. We are grateful to have experienced this. We look forward to the opportunity to pay it forward.
And A Few More Reflections
– There is a lot of very sophisticated equipment and technology in such operations. But there are surprisingly basic tools as well. The surgeon taps the new hip joint firmlyinto place with a mallet that looks like it came from ACE Hardware. And the suture is often sealed with staples that look like they were purchased at Office Depot. Not everything is lasers and biochemical materials.
– There are all sorts of tips and techniques around healing from a process like this. Advice on how best to get into a car during healing, how to sleep comfortably, etc. is out there. What was surprising to us was a source of so much of this. YouTube! NOTE: THIS IS NOT/NOT a recommendation to go onto YouTube for medical advice. Don’t do anything your doctor or therapist has not cleared.
With that caveat, we were impressed to find everything from detailed descriptions of the surgery to tips on how best to move around with a cane, etc. There is a very interesting culture of sharing and demonstrating on YouTube. One can find tips for almost anything imaginable. There is a good blog in that phenomena one of these days.
– The conversation about pain medication has changed a bit. Years ago, doctors were generally pilloried for not looking closely enough at palliative care, for not helping patients deal with pain. They certainly corrected for that. With the help of some Big Pharma firms, opioids became a dominant concern in America. Although we thought the cautions could have been stronger, we noted that in the patient briefings, people were advised they could expect serious pain the first day or so after surgery and they should avail themselves of prescribed opioids as needed. And they should stop using them as soon as possible. My wife had one dose administered to her as she came out of surgery; that was her last dose. Tough lady, but the right call in my view. This is powerful stuff, helpful but also dangerous.
There are a lot of talented, dedicated people serving in the medical fields. We are lucky to have them. Now on to getting a policy and delivery system that ensures everyone has access to such care. You know – like a modern, civilized country.
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