My third year of medical school has been nothing short of transformative.
While my classmates and I have grown tremendously in translating our theoretical
knowledge into clinical skills, what has also grown is an increasing awareness
of the plight of our patients. Many of our patients are already in a vulnerable
position given their medical conditions. What does the health care system do to
help them regain their health? We force them to navigate the rough seas of a
fragmented health care system.
Out of frustration for one of my patient's experiences while on my Family
Medicine clerkship, I wrote this welcome message that satirizes the typical
patient experience in our current system:
Welcome aboard the US Health Care Cruise Line! Please take your
time to explore all of the great features we have to offer on our entertainment
Decks to take care of all of your medical needs, whether you need them or not!
Here, our motto is “more is better,” so take this opportunity now to indulge
First, a brief message to our VIP guests: As the group of people with
multiple health and social needs that are the true drivers of high health care
costs, welcome! As you navigate this beautiful vessel outfitted with the latest
most expensive technology and drugs, please keep the following in mind:
Primary care services are conveniently located on Decks 1 and 5. Deck
1 is only accessible via our exclusive Jet Ski coverage program. If you are not
a Jet Ski member, we recommend you seek services at Deck 5. Deck 5 is only open
three days a week in the afternoons. Both Decks have the friendliest of staff,
but are only trained to address clinical questions.
Housing, childcare, utilities, legal, financial assistance and food
services are available. With constantly evolving entertaining activities
being offered through these agencies, we unfortunately do not have updated
directions to reach them. But, if you wander around the ship long enough, you
will surely find your way! These are some of our busiest services with the
greatest demand, so please don’t be discouraged if we cannot address your needs.
None of our passengers have suffered too greatly due to inaccessibility to these
24 Hr Care is available on Deck 9. You can access Deck 9 by any
means. But, in exchange for this convenience, you will likely need to wait
several hours before being seen. A 24 Hr All-You-Can-Eat Pizza Bar is also
located on the same Deck to make waiting more tolerable.
Getting around the ship is most efficiently completed on foot as there are
long staircases that connect most Decks. However, if this is difficult for you,
please call the main office to arrange for transportation. We have a
limited number of staff who can carry you to your desired destination. But, your
height and weight may prevent you from taking advantage of this great
Specialty care services for diabetes, cancer, asthma, mental health,
and hypertension are located in a gilded section of the ship. We are practicing
cutting edge techniques that are so advanced that there is little literature
available about them! Please don’t hesitate to let us know if you are having
difficulties finding our specialty services. We would be happy to escort you
there. Just be sure to bring your boarding passes, credit card statement that
documents the purchase of this cruise, and any records of all of the experiences
you have had here onboard. We do not have an electronic system connecting all of
Lastly, drug and nutritional supplements must be purchased off of the
ship, so you are encouraged to step off and explore our various stops. These
islands are not very well-equipped, so please be flexible with the
inconsistencies of what they have to offer.
Only the Captain is completely familiar with the ship and its services, but
given how busy he is, he is unlikely to be able to help you navigate your stay.
We are confident that you all are capable of coordinating your own cruise
With these simple rules, I can guarantee that you will feel so overwhelmed by
our top notch services that you will be wondering, “was it all really worth it?”
Again, welcome aboard and enjoy your stay!
Despite sporadic episodes of safe, effective, patient-centered, efficient,
timely, and equal care throughout my third year, our inconsistent ability to
deliver high quality care has left me almost hopeless for the future of health
care. But, what has reenergized my spirits was reading the book Why Hospitals Should Fly
written by John Nance, a professional pilot and lawyer with a distinguished career in
leading the patient safety movement. The book is a fictional narrative that
follows a former CEO of a hospital, Dr. Will Jenkins, as he travels to a suburb
of Denver, CO to visit the fictional St. Michael's Memorial Hospital. St.
Michael's is THE ideal hospital that exudes quality not only in its basic
processes and operations, but also in its culture. As Dr. Jenkins visits various
departments in the hospital, the reader not only learns about the effectiveness
of specific interventions to improve safety (i.e. multidisciplinary rounds, team
huddles, checklists, etc.), but also indirectly gains insight to the process of
implementation (probably the most difficult part of patient safety work).
When I finished reading the book, I felt like my head had been lifted up from
the chaos of our current broken system. My head is now 10,000ft above sea level,
the same elevation where aircraft passengers can safely use their electronic
devices. While I'm forced to drink liters of water a day to ward off acute
mountain sickness, perhaps it is necessary for me to be at the level where
airplanes fly in order to better understand how to redesign our health care
system to achieve high quality care. That is probably the reason why we are all
here at Telluride, CO.
Stay tuned throughout this week as we dissect some of our health care
system's greatest challenges. You can follow our thoughts here and on Twitter
(#TPSER8). You can also take a look at Paul Levy's experience here at Telluride
on his blog. Here's to a
strong take-off tomorrow!
- Eva Luo, MD/MBA Student at University of Michigan
Originally posted on June 18, 2012