My dad ended up in the hospital a couple of days ago, after a catscan found two emboli on his lungs. The good news is that he’s going to be fine, and instead of being stuck in the hospital for four or five days, he was released after just one. The bad news is that he’ll have to take anti-coagulants every day for the rest of his life.
Evidently, there are four major anti-coagulants, each with their own issues. Heparin is given through an IV, so that was out. Coumadin can be taken in pill form, but is very hard to regulate – if you sneeze, if you sit down, if you eat a PB&J, you need to change the dosage – so that was out. Of the other two possibilities (I don’t know the names – perhaps Wilson can comment), one required one shot a day, the other required two shots a day. The one shot version is more expensive, but my dad’s health insurance covers it, so price wasn’t really relevant.
So, given the choice, you would choose one shot a day over two, right? I mean, I don’t know about you, but sticking myself with a sharp object on a regular basis is something I try to minimize. Which is why it was strange that the doctors prescribed the drug that required two shots a day. Now, my father (who is a doctor), thought about this, and thought back to his interactions with the medical team. For the most part, he’d seen the medical student. He’d seen the resident less, the fellow less still, and the attending physician only once or twice. And furthermore, the attending had admitted that he didn’t really know that much about anti-coagulants.
How had they come to the conclusion that the two-shot drug was better for him than the one-shot drug? And how important was this difference? So my father said, p0litely but assertively, that he was OK taking the two-shot instead of the one-, but first he wanted to talk to the individual who had made the decision, and get an explanation as to why that choice had been made. He had been very happy with the treatment, he felt that things had gone very well, and he was happy doing what they said he should… BUT, he first wanted to talk to the one person who had made the decision, so he could understand why.
So, they went away, and (presumably) conferred, then switched him to the other medication, no explanation provided. Which is fine, as that’s what he wanted, and clearly they didn’t have an objection. What happened? His interpretation was that in a collaborative setting like that hospital, the group gets together to discuss a case, and different ideas are tossed around. Clearly wrong ideas are flatly rejected, but if a reasonable suggestion is made and goes unchallenged, it’s adopted by the group without anyone taking responsibility for it. Asking for one person to take responsibility forced them to reevaluate the decision, and since either option was fine and no one thought of him or herself as the responsible party, no one was going to defend the position.
p.s. It must be said at this point that my dad is very happy with the treatment he got, and has no quarrel with the hospital or the staff. But he’s also very happy to only be taking one shot a day.
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