The Meatball Sandwich Syndrome

It started with a take-out meatball sandwich for dinner. It continued several hours later with a trip to the emergency service with what I was certain was a bad case of heartburn but the pressure on my chest raised concern about a possible serious cardiac problem.

Before I hit the beach, I had heard many cautionary stories from physicians and nurses about not taking any chances when you have chest discomfort. I summoned my inner wuss and asked my wife to drive me to the hospital.

I have been through this clinical protocol before so I knew I would be in the emergency service for at least six hours as various tests were done and repeated. When the final tests were completed, I was told that my results were “perfect”. I asked my wife whether she heard what the doctor had said—I was perfect! Knowing better, she just rolled her eyes. Some support system she is!

This was the first emergency service visit for me since I hit the beach. I have recently accompanied other family members on emergency visits at three other hospitals. There are common threads to all the visits. The staff–doctors, nurses, aides and others–work often under stressful conditions yet in all cases made the patient feel like he or she was the most important person present. These front line staff can make or break a patient’s experience.

Another common thread which I had more time to observe on my visit was the incredible additional demands which are put on emergency service staff. I noticed on my visit that there were several people sleeping on beds in an alcove. They were homeless people who knew that if they presented themselves at a hospital they would have to be evaluated and monitored. That’s the California way. The next morning if they had not left, they were entitled to a social worker visit. Most left.

Hospital emergency services have become the refuge of last resort for the homeless due to feckless politicians requiring hospitals to become a provider of social services as well as medical services. This is yet another unfunded mandate foisted on hospitals.

Homeless people need help, to the extent they desire such assistance, but a busy hospital emergency service is not the place to provide it. It is, though, a place where elected leaders can dump their responsibility for a more comprehensive solution. They are good at that.

Elected leaders would not think of having cots set up at a local fire station or, even better, at the state capitol building. Too messy and far too visible. Better to dump the homeless elsewhere where they are out of sight and out of mind. That way the politicians can work on restoring power to the state.

Hospitals and other healthcare providers are the victims of mission creep mandated by irresponsible elected leaders. Mission creep without conscious purpose can be deadly to any organization. This mandated mission creep comes with a cost that other patients and their health plans have to cover. This cost adds to the total cost of health care in a significant way. It is a different kind of “perfect”–a perfect example of how difficult it will be to reduce the growth rate of health care costs.

Perhaps my meatball sandwich made me too dyspeptic about things. As I write this though, we are once again under the threat of losing power. It is enough to make me want to make another trip to the emergency service to, like the homeless, seek respite. Call it the meatball sandwich syndrome.

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