Letters to the Editor is a periodic KHN feature. We welcome all comments and will publish a selection. We will edit for space, and we require full names.
Late in April, the Kaiser Health News’ story, Health Care's 'Dirty Little Secret': No One May Be Coordinating Care
(Rabin, 4/30), drew a number of reader comments. Here’s a sampling:
Carl Welsh, BSN, RN; Phoenix, Ariz.
With all respect due … anyone who has been involved in the delivery of health care, or been on the receiving end of that care, has known this since Florence carried her lamp to light her way as she made rounds. … This is not a secret. Nobody is responsible for coordinating care because, until we started to realize just how much it was actually costing us, there was no real money in it. Assign coordinating care a healthy reimbursement code, and step back, it will be done. This is not a criticism. This is how we designed our health care system to work.
Fred Matthies, Portland, Ore.
When I was a young GP in the 1960s, we rounded twice a day on every hospital patient. We knew the families from visiting their homes [and] making house calls. We engaged the specialists as needed, knew treatment plans and read the nurses' notes. Where are those docs today?
Andrea Herman, Omaha, Neb.
I am one of the few primary care docs in our organization who still does hospital work. It is tough even for me to coordinate care for my patients and I can just imagine how hard it is as a hospitalist. Part of the problem is horrible progress notes -- too many docs write "doing well," or "status post (procedure)" and don't commit to an assessment. When I try to clarify in the chart about when a patient is ready for discharge, I don't get any feedback. I hate to call the specialists … but sometimes I have to do that, if I don't bump into them on rounds, because I can't gain useful information from their notes. Even the resident writes incomplete notes -- I wouldn't have gotten away with that in my residency!
Linda Russo; Boston, Mass.
I am in thorough agreement with the article and feel very strongly about patient advocacy. I have been an RN for 42 years in acute care teaching hospitals in Boston. It is my firm belief that the knowledge we were taught in nursing school -- to be the patient's advocate and guide through the health care maze -- still exists even to a greater degree. The problem is, nurses are now so overloaded with other tasks that there is no time to be a patient advocate … . I have recently experienced this first hand after my husband was diagnosed with advanced prostate cancer. Until insurance companies realize this, the health care system will remain broken.
Regarding the story, California Weighs Expanded Role For Nurse Practitioners (Bartolino, 5/9), a reader wrote:
Louise Kaplan, Saint Martin's University Nursing Program Director; Lacey, Wash.
[This] story … failed to mention that nurse practitioners have completely unrestricted and independent practices in 16 states and the District of Columbia. Many of these laws have been in place since the 1970s. In Washington state … we have collegial relationship with physicians, and work cooperatively to assure access to care. We are a model for California and other states that unnecessarily restrict nurse practitioner care.
The story, Doctors Transform How They Practice Medicine (Rao, 5/15), drew this reader comment:
J. Mark Greene; Waukesha, Wis.
After reading the article "Doctors Transform How They Practice" I am concerned that these approaches will significantly limit access for the Medicaid patients. Are we creating a two-tier system in health care? Will nursing home patients (65 percent Medicaid) be able to receive the same level of quality physician services? Also, I do not see the blending of social program changes needed for the poor as being incorporated into the medical model.
Meanwhile, another reader offered the following comment regarding Patient Satisfaction May Not Be A Good Indicator Of Surgical Quality, Study Finds (Rau, 4/17):
David Costello, Press Ganey Chief Analytics Officer; Boston, Mass.
The conclusions reached by the authors of the JAMA Surgery study reported in Kaiser Health News by Jordan Rau on April 17 demand further scrutiny. The authors did not observe a link between patient satisfaction scores and surgical care quality scores. A number of important limitations in the study design shed light on this conclusion. … That being said, there is a significant amount of research that underscores the positive correlation between patient satisfaction and quality. Patient experience-of-care metrics speak volumes about a hospital's quality of care and are part of a balanced approach for measuring hospital performance on a variety of domains and identifying specific opportunities for improvement. Patient-centered organizations use survey data to determine if they provide a healing environment, to identify areas to minimize patient stress and anxiety, and to uncover areas for improvement. Mandatory reporting programs, while not perfect, do encourage progress toward greater accountability and a commitment to identifying improvement opportunities. The integration of the patient's assessment into these programs will ultimately help the industry achieve true patient-centeredness.