PACS won't solve healthcare's problems

Reaction - Understaffed emergency rooms, underpaid nurses, and miles of bureaucratic red tape compound the problems of today's hospitals, which go way beyond problems in communications.

I read the article by Fran Taylor (PACS & IT supplement, February 2002) with dismay, sympathy, and astonishment that more such public condemnations of the system are not seen. Those of us who work daily taking care of patients see these problems on a regular basis, often several times per day.

As the system responds more to the demands of the marketplace and the "documentation bureaucrats," the distance between a physician who cares about a patient and each individual patient grows ever larger. Unless a patient and family are fortunate enough to find someone who cares and has the time to act on that sense of caring, they are left to fend for themselves in a complex system that responds clumsily and slowly.

The discrepancy between the care that the modern healthcare systems tout in their fancy brochures and the care that takes place in their hallways on a day-to-day basis has become overwhelming. Patients in the hospital are taken care of by "teams" and not doctors. Many patients actually do not know who their "primary physician" is and frequently do not remember having met her or him. Underpaid and undertrained station secretaries have no idea who the team members are or how to contact them, particularly during off-hours, when the service may be covered by someone who doesn't even work at that hospital on a regular basis. Even physicians are often frustrated in trying to contact the appropriate "specialist on call" through layers of automated phone triage systems, answering services, and hassled hospital phone operators using outdated call lists.

Nurses who should be the best patient advocates are understaffed, underpaid, and forced to rotate so that they rarely take care of the same patients for more than a few days. They are forced to do more documentation than patient care and frequently do not have time to notice a patient's deteriorating condition. The hospital system, when challenged by instances that point up these realities, usually responds by referring the problem to a committee that produces yet another set of recommendations that compel providers to do more documentation and less care - but never with concrete answers like paying people more or staffing adequately to meet patient needs.

Ms. Taylor seemed to imply that PACS and the associated electronic medical record could eliminate these problems, and they may help the problem somewhat. But I doubt seriously that anything short of automating all medical care through artificial intelligence systems, or somehow eliminating the "profit motive" and tying medical care first and foremost to the concept of care, will bring an end to the litany of unfortunate stories similar to her own. In my experience, which is limited to only a few hospitals, it is only because so many physicians and nurses still operate with care and compassion on a daily basis that difficulties like the ones she experienced are not more common.