Wednesday, March 27, 2013

Follow the bouncing DVT

This is about the fragmentation of our health care system
This is about accountability.
This is about a man, with limited transportation and a bad set of knees.

Mr. Pinball (name changed) is 80+ years old. A wonderful guy who unfortunately was diagnosed with an unnamed cancer . Fortunately, it was surgically resectable, and his surgeon did an incredible job of removing it, with no complication. I couldn't be happier for him.

Several days after surgery, while recuperating at home, he noticed worsening leg swelling. Because of his history of congestive heart failure, Mr. Pinball was worried he was retaining fluid (especially since his water pills were held around the time of surgery.) He called his cardiologist, who didn't think this was related to his heart. Instead he was advised  to contact the surgeon to be evaluated for a potential post operative complication like a DVT (deep vein thrombosis) i.e. a blood clot in the leg.

Dutifully, Mr. Pinball called his surgeon who also reiterated a similar concern for a DVT. He was advised by his surgeon to contact his primary care physician (me) to get evaluated for a DVT by getting an ultra sound.

 Mr. Pinball called us and I advised him to immediately come in for a look. He was able to come in to our office, thanks to a caring neighbor. Mr. Pinball, no longer drives.

Our suspicion for a DVT was high, so we quickly obtained the  necessary imaging, and he had what everyone expected. On a side note, he had to take a taxi home from the radiology office that night, because his neighbor left. For an elderly gentleman on a fixed income, a 30 dollar cab ride hits hard.

From his initial concern to our office visit, 5 days had elapsed. 5 days of bouncing around without anyone informing him of the potential seriousness of a DVT. Between doctors giving him the run around, and social circumstances limiting his ability to access healthcare, something bad could have happened.

Fortunately, nothing bad happened. Mr. Pinball is doing fine. But how many Mr. Pinball's are out there, victims of a fragmented healthcare system that has misaligned incentives and poor accountability?

How many Mr. Pinball's aren't being saved by the safety net of primary care that is stretched to its limits?


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