July 28, 2018

I have written before about the similarities between health care and higher ed.  See Stress Competency Testing and The Doctor Will See You . . . Next Semester.  Well, to the concern of anyone who still gets a tad nervous when I go to the hospital, yesterday I was reminded of yet another comparison.  Each system, health care and higher education, relies upon the complexity of the inter-related pieces that make up each.

Allow me to explain.  For several years, I have had a ventral hernia in my abdomen. It never particularly hurt, but it was a pronounced bulge on my gut; as I lost weight post cardiac arrest recovery last year, its presence was more and more noticeable. My family doctor/general practitioner and I decided last fall to wait until this summer to potentially address it.  That would give us a full year to see how well I recovered from the cardiac arrest,  This June comes around, and with my cardiologist, endocrinologist, and the general practitioner all elated with my progress, my GP agrees to refer me to a general/vascular surgeon.

Let's start our comparison:

Imagine I am a student in a college program, let's say Business Administration.  I have my advisor (general practitioner) who oversees my general educational "health" toward degree completion; my specific "issue" faculty (someone who teaches Business Administration--for the sake of argument, we will give me just one such faculty member); and other faculty members who oversee my progress in elements of degree completion (for instance, a math faculty equates to the endocrinologist).

I, after getting through my first year with mostly A's, am certainly getting a fairly clean record of health from my faculty.  I go to my advisor, who knows I have an artistic side and want to add some art classes to my curriculum; in fact, last year she had convinced me to get through my first year of required classes first.  Now I want to take a watercolor class as an elective (as I write this, I worry that the insurance company could consider my hernia repair as "elective surgery," because the condition wasn't particularly hurting or threatening my health). My advisor refers me to the watercolor faculty member to see about me taking the class (after all, maybe there are some challenges with me taking it without taking anything else first.)

Back to me as Patient X, or maybe Patient Zero, in the reality of my current health. My surgeon looks at my medical history, assesses the belly bulge, and agrees that this can be handled rather simply as outpatient surgery. He notices the cardiac arrest and asks if my cardiologist gave the o.k. for the surgery.

"Well, I never really asked him," I admit. "I have been working through my family doctor. My cardiologist has had no concerns and put no restrictions on my activities though."

"That's o.k.," responds my surgeon.  "I will check with him to make sure he is o.k. with it."

And with that, I am scheduled for surgery.

Or, I head to a meeting with the art faculty member, who reviews my transcript so far, my grades, and asks me to talk a little about art.  He thinks I have the basic aptitude to take the class and get caught up to speed with the others in the class.  He notices my chosen major and asks if my Business Administration faculty has given me the go ahead to take the class.

"Gee, I never thought to ask her," I admit.  "I have been working through my advisor.  My business admin faculty member says I am an excellent student and will do well with whatever I take."

"It's probably o.k.," responds my art teacher.  "I will check with her and see."

Yesterday, I headed to the hospital optimistic about getting in and out of there rather quickly and finally getting rid of this hernia.  All the pre-surgery checks are going well, and then the anesthesiologist comes in.

"Wow, you've had quite a ride, my friend.  So, you had a major cardiac arrest?"

I proceed to tell him everything that I assume would be on the freaking medical chart.

"And your cardiologist told you he is o.k. with this procedure and going under anesthesia?"

"Well, I haven't actually talked to him about it, you see. I talked to my family doctor and the surgeon, who said he would make sure the cardiologist would approve.  I haven't seen him since February since he basically gave me a clean bill of health and set up twice-a-year appointments."

To make a boring story less boring, the cardiologist had given cardiac clearance for the surgery with IV sedation. However, everyone standing in front of me 3 minutes before the scheduled surgery were working on the assumption that I would go under general anesthesia.  Everything came to a screeching halt while people tried to track down my cardiologist (at 2:00 on a Friday afternoon, mind you!).

Turns out my surgeon had seen the "cardiac clearance" part of the note, not noting the specific circumstances of IV sedation. Needless to say the anesthesiologist preferred knowing more specifically if that was the only acceptable condition for delivering anesthesia.

It was at that point, I could so clearly see this playing out an any college or university across the country:

"Yeah, I am here to sign up for watercolor. It starts next week and I want to add it to my schedule."

"Sure, let me pull up your account."  Staff in various advising and registration offices are pleased to move me along through the process.

"Uh, wait," I am told, as I get ready to sign the registration form.  "This course does not fall within your program.  It may not be covered by financial aid. Do you have your business admin faculty's approval?"

"Well, not directly, but I have my advisor's and the art instructor's."

"Well, we need to make sure.  We're going to track down your business admin instructor to get her approval."

I look at my watch: 2:00 on a Friday.  'Good luck with that one,' I think.

I believe what happened yesterday at the hospital -- and by the way they got my cardiologist's full approval and were able to perform the surgery -- is indicative of the worst's bureaucracies: health care and higher education.  The communication between silos is complicated, not helped by everyone running like hamsters on a treadmill to keep things going to meet demands.  Questions are not asked clearly; answers are not given cleanly.  People facing the patient/student at the moment want to do the right thing and quickly, leading to more ineffective communication.  No time is available to haul all relevant parties into a room to discuss everything.  I know my doctors all know each other, because they work in the same system, but the system's record keeping might as well negate that.

At one point my anesthesiologist asked me if I had been given a stress test by the cardiologist.  "Oh, yes," I answered.

"Where at?" he asked. "The clinic?" he finished before I responded.  When I confirmed, his response said it all, "well, that's why I can't find the record."  The average patient record system is as screwed up as the average student record system.

Such inefficiencies have always existed in higher education and probably also in health care.  I got "mis-advised" between WVU and IU as I transitioned from my master's to my doctorate.  I groaned, half-grinned and bore it.  If I had been sent home because they couldn't perform the surgery without more information from the cardiologist, it wouldn't have been the end of the world. Life isn't smooth.  Generally, higher ed and health care try to find a way forward in such scenarios.

It's that last point that has stopped me from including the third biggest, and ultimately worst, bureaucracy as a comparison: the government. I'm not so sure they would want to try and find a solution, even one not ideal. I am sure a comparison with the government will be more applicable when I have my next prostate exam.