I just turned 69, and after enjoying a lifetime of radiant good health, I underwent five complex surgical episodes in the last 2½ years. In all five encounters, I got superb surgical care. I have fully recovered and returned to my busy life.
What I learned from these five encounters is that the patient's journey does not end at the hospital door.
What used to happen is you'd have a weeklong hospital stay, with a lot of that time focused on recovery, rehabilitation and educating patient and family about post-operative risks. Now with short stays, you may end up standing on the hospital curb in less than 24 hours, hurting, drug-addled, and holding a sheaf of discharge instructions, with family members uncertain how to help you.
The key to a great outcome is not just great care in the hospital, but the willingness of clinicians and the hospital to assume responsibility for your recovery. In my five surgeries, there was huge variation in the degree to which the crucial post-acute phase was scripted and managed effectively.
When I was diagnosed with throat cancer on Christmas Eve 2014, I decided to go to the “best place in the country” for my care, 600 miles from my home in Charlottesville, Va. The preoperative evaluation and technical quality of the surgery at this academic health center were outstanding. However, post-operative pain control issues added five days to the expected three-day hospital stay. I lost 17 pounds and a huge chunk of muscle mass.
I later talked to the surgeon and the hospital CEO, and they pledged to make changes.
On returning home, an avoidable post-operative complication resulted in my losing the use of two fingers on my right hand, necessitating a complex peripheral nerve-grafting procedure. For this I went to another academic center, the “best place in the country” for this specialized type of surgery. Again, I experienced spectacular pre-operative evaluation and surgical care.
But I also experienced an even sharper discontinuity in supervision of my recovery, both in pain control and rehabilitation. I got a sheaf of discharge instructions and four days later I'm flying home. They gave me exercises to do, but it wasn't obvious who I should call if something went wrong.
I eventually self-referred to a local hand-focused occupational therapy team back home in Virginia—as well as seeking help from local orthopedic surgeons—to regain full use of my hand. When issues arose eight months into my recovery, I wrote to my hand surgeon to get guidance about how to proceed.
After these medical tourism experiences, when my left hip failed at the end of 2015, I found a brilliant young orthopedic surgeon in Charlottesville. I chose her because she had scripted the entire hip replacement surgery encounter from diagnosis to successful walking and returning to normal life. She employed a “rapid recovery” protocol, the tightest and most thorough protocol I'd ever seen. And she hovered over the entire process in real time by text and instant message.
I walked on my new hip one hour after waking from anesthesia, and I was out of the hospital within 24 hours. The next morning my doorbell rang and there was a physical therapist to teach me how to exercise and walk on my new hip. That afternoon there was a home nursing visit focusing on wound care, stroke risk and watching for infection. These visits went on for a week.