It gets personal

A couple of weekends ago, my son headed back to college in southern California and my husband went with him. They planned to test-drive a used car, check out a street festival in Silver Lake, run last-minute errands, and move boxes to the dorm.

They arrived Friday night and checked into their motel, an online bargain near the freeway. It was already late and the burger place next door was Yelp-recommended, so they ducked in for the special, which came with fries and slaw. But the boy doesn’t like slaw, so my husband got an extra side.

He got something else, too. Early Saturday morning, I was surprised to hear my son’s ringtone. He is not an early riser and of course it was even earlier in California. He reported that his Dad had been up all night with vomiting and diarrhea and was lying in bed exhausted. He’d asked for some Gatorade—any color but red, which can confuse the clinical picture.

My husband is a pediatrician and a kidney transplant recipient. He is an expert on vomiting and diarrhea, clear liquids, and signs that point to the emergency room. So when I heard in late afternoon that he hadn’t drunk much Gatorade or even gotten out of bed, I asked “Do you need to go to the ER?” When he answered, “I don’t know,” I told our son to take him there.

He arrived with a fever of 103 and got an EKG, which was normal. The doctor on call patted his belly and someone else cultured his nose—not for diagnosis (wrong site!) but for hospital infection control. Five hours later, as the ER overflowed with patients, he was admitted to the hospital’s telemetry unit on IV fluids and antibiotics. Nearly 24 hours after getting sick, he hadn’t had any of the many medications that he takes daily, including Prednisone.

I worried about him, his kidney, and his compromised immune system. I worried about the teeming microbiota of the country’s second-largest metropolis. I worried about the increased risk of hemolytic-uremic syndrome (HUS) in people with Shiga-toxic E. coli (STEC) infection who take steroids. (Earlier this year, STEC sickened thousands of people in an outbreak blamed on vegetable sprouts; hundreds developed HUS, which often leads to renal failure.) My worries knew no bounds.

On Sunday morning, after nervously checking airline schedules for flights to L.A., I went to the Los Angeles County Health Department’s website. It wasn’t hard to find the page to report a case of foodborne illness (the “FBI_Report”). Filling out the form online made me feel a bit better. It said, “All reports received after hours or on the weekend will be responded to on the following business day.” Really?

It was already Sunday afternoon and my husband had a return airline ticket for Monday. I hadn’t heard from the doctor, although I’d asked the nurse to have him call when he made rounds. As it turned out, he hadn’t actually been at the hospital at all—but he had called to tell my husband that he might be discharged later that day. Late Sunday evening, about 24 hours after admission, my husband got a handshake from the doctor and was sent on his way. Our son took him back to the motel, where he spent the night before flying out Monday morning.

Back in Atlanta Monday evening, he had a voice message from an investigator at the L.A. County Health Department, requesting a telephone interview. On Thursday, he heard from the inspector who had been out to the implicated restaurant, near the edge of L.A. County. He’d found that the slaw was at the correct temperature on the day of his visit but the tuna salad in another refrigerator wasn’t. Other findings that led to citations included using the same rags to clean tables and food preparation surfaces and failing to display the restaurant’s health rating in a place visible to customers.

My husband also requested a copy of his hospital chart to add to his records here. He was surprised to discover that it noted “a history of coronary artery disease,” which is one condition he doesn’t have. It also included extensive and detailed descriptions of physical examinations (from chest percussion to Romberg’s sign) that weren’t done during his hospital stay. How could this be?

Most often, telemetry units admit patients who need continuous cardiac monitoring, such as after a heart attack. My husband was served a “cardiac diet” once he quit vomiting. His roommate, a youngish guy with a drug overdose, also got an EKG before he recovered enough to walk out of the hospital against medical advice (AMA, the medical equivalent of AWOL). Could it be that my husband and the drug addict were managed as cardiac patients because they were admitted to the telemetry unit? Was my husband’s medical record cloned from electronic boilerplate?

Compare the prompt, personal attention my husband’s illness received from the local public health department with the depersonalized treatment he received at a high-tech, private community hospital.

More than 10 years ago, health technology and a skilled surgeon gave my husband a kidney transplant and a new lease on life. Health technology alone, however, does not save lives or money. It must be deployed as part of a system that includes standards and accountability. The adoption of electronic medical record (EMR) systems is an important component of healthcare reform, with the potential to improve healthcare while reducing costs. However, as RAND Corporation scientists wrote in Health Affairs:

“[I]t is increasingly clear that a lengthy, uneven adoption of nonstandardized, noninteroperable EMR systems will only delay the chance to move closer to a transformed health care system. The government and other payers have an important stake in not letting this happen. The time to act is now.”

Their article appeared in September 2005.