This has pretty much nothing to do with public health, but lots to do with the health of our healthcare system. However, watch me loop it around at the end and tie it up with a pretty bow.
I went to the hospital this weekend. I was watching TV on Saturday evening, and got a little discomfort around my chest and neck that felt like a pinched nerve or a muscle pull from sitting awkwardly. It persisted, and I thought, well, I’m 55, and all these little pings, creaks, and groans start to mean something. So, I trundled myself off to the local emergency room and told the admitting nurse I was having a little chest discomfort.
Front of the line for you, sir! The ER doc listened to my chest, did an EKG, did a chest x-ray, and told me everything looked fine, but he was going to admit me for observation because, you know, chest pain.
Three hours later, deep in the middle of the night, we have a room ready for me. The next morning, the cardiologist orders another EKG and a CAT scan. Still nothing, but the cardiologist notices a small filmy place on my lung which might be a little fluid, which might be incipient pneumonia, so the hospitalist overseeing everything orders a pulmonology consult. The pulmonologist sees both the filmy spot and what might be an inflamed lymph node, which could cause the referred chest pain.
For the next 12 hours, the cardiologist doesn’t talk to the hospitalist, who doesn’t talk to the pulmonologist, and nobody talks to the nurses, who are still dutifully administering the nitroglycerin patches ordered by the ER doc, who thought I had a cardiac problem. Since I apparently don’t, the nitroglycerin starts to crater my blood pressure, puzzling everyone, but especially the cardiologist, who is afraid I won’t be able to do a full cardiac stress test because my blood pressure is so low.
I mention the nitroglycerin patch to the hospitalist, he removes it, my blood pressure recovers, I take the cardiac stress test, and once again everything is fine. I leave, 36 hours later, with a follow-up appointment for the pulmonologist in hand.
And, with an elegant flourish, we bring this back around to public health. This not talking to each other thing is epidemic. Researchers don’t want to talk to their stakeholders, the NIH doesn’t want to talk to the CDC, and nobody wants to talk to the Department of Education, which is doing some yeoman work in knowledge translation. It’s inefficient, it’s counter-productive, and it’s dumb.
What’s the solution, dear readers?