My Journey Into the Fragmented Healthcare Twilight Zone

One challenging guardrail of a healthcare marketing career is knowing just enough to be dangerous in the delivery of services to consumers.

I've been away from this blog for a while dealing with the chronic curse of a more mature man. It's called Benign Prostatic Hyperplasia (BPH). In layman's terms, BPH is a large prostate that causes all sorts of unpleasant issues. It's no fun at all.

This will get personal, and I debated whether to be this vulnerable. Yet, if it sheds more light on a deteriorating care delivery model needing a makeover, why not? It's fresh, current, and likely being experienced by many others.

The reason to share some of this is to show how challenging a disjointed and fragmented healthcare delivery system is for patients across the spectrum. The words 'seamless patient journey' don't exist in this dictionary.

And, when you add current workforce shortages, the incredible demand on our fragile system of care, burnout, etc., the process is unrecognizable to any routine product or service buying experience consumers face today.

A recap of this experience is not to disparage any caregiver (or organization). To a person, the staff were all terrific, knowledgeable, and as caring as humanly possible.

The Prologue:

My situation reached a critical point back in mid-February. After managing annoying symptoms for more than two years, I just couldn't pee one day. And that was after a great round of golf in the afternoon.

If you've ever had a plumbing problem, you know any backup is not good. Address it quickly.

Over the course of the next week (not quickly), after many sleepless nights, a trip to the ER, several visits and many calls to the 'doctor's' office - where they somehow lost an initial urine culture - I never did see a physician in that time. A nurse practitioner provided necessary bladder scans, and treatment options to manage the backup. (details too invasive to describe here).

At those visits, I noticed the new gatekeeper in assembly-line care is now the PAC who is mostly invisible to the patient and verifies the treatment protocol delivered by the nursing staff. Three nurses I now know by their first names were exceptional, putting up with my questions, my anxiety, loss of any remaining dignity, and the behind-the-scenes knowledge from my work experiences.

In due course, the only time I would see my physicians would be for the actual procedures. Yet, I was always able to communicate through MyChart portal messages to any caregiver.

Act 1:

Stuck in urine retention, the main, temporary remedy is a Foley catheter and a bag that becomes your attached companion. Even though the prostate is acting up, the bladder is equally important and must be protected from further harm. Bladder spasms occur frequently while you manage a new wardrobe accessory.

Besides the physical and mental stress of your life being turned sideways, the worst part is the care schedule journey. You are thrown into a patient 'queue' for scheduling a fix to the problem. Not enough time, not enough staff, and not enough hours in the day to meet growing chronic demand. The office is full of guys just like me.

The second issue is that Foley catheters inevitably cause CAUTI bacteria infections despite my daily cleanliness ritual and loads of alcohol swabs. I don't like antibiotics, either, yet I had to absorb 3x use of 'Cipro' over the course of what eventually would be seven weeks wearing the catheter.

In my case, a cystoscopy (performed by a physician) was the first procedure to determine what surgical procedure would be appropriate for my medical issue. The cystoscopy - which takes less than five minutes - was scheduled more than two weeks after agreeing to the test, and I'm told I was lucky. It's usually longer!

Every day of waiting is an anxious eternity. You begin to think about mortality in a different way. When I attempted to navigate the situation more efficiently, I was told I would have to 'wait my turn.'

Fundamentally, this becomes the main patient care disconnect in the process. And nothing - not tech, no personal connections, nor fancy marketing jargon - can change the journey experience.

Fortunately, the cystoscopy confirmed that I was a good candidate for the HoLEP Laser Prostate Enucleation. It's considered one of the gold standards for fixing BPH in men. A surgeon cores the 'orange,' lasers away the pulp, and re-opens the channel that should stay open for the rest of my life. There are, of course, some side effects which I won't mention here. A good long-term tradeoff, for sure.

Act 2:

The decision was made on the HoLEP on February 29. Since Urology specialists skilled in HoLEP don't grow on trees (only two in my region), the next available timeslot was April 23!

Wait! What? Are you f'ing kidding me?!

Here's where the system also gets stuck in regulatory CYA protection and the status quo of a fee-for-service delivery model. For surgery patients, requirements include additional appointments and insurance charges for the following: (Note: even if you see an NP or PAC for routine appts., surgery clearance requires a physician signoff. So you're in the schedule queue again. It's weeks, not days.)

• Pre-op lab work
• Pre-op primary care clearance
• Pre-op cardiac clearance

Then, the eternal sitting and waiting your turn with a foley becomes a mental killer. Investigation into procedure options in other locations, and with the competition showed no favor. It was actually a longer wait.

Knowing how to navigate and learning to maneuver is a good hack. Because I was diligent in pre-testing, a young mature man, and a relatively small risk compared to others, I was fortunate to have my procedure moved up eight days to April 15. Bless you, surgery scheduler.

Act 3:

Here's where the dichotomy of healthcare delivery plays out. Operational orchestration was seamless on the actual day of the procedure. In my case, everyone was special. As an observant patient, you see it in action. I was cared for in the expected way.

However, a flawed systemic process rooted in red tape, regs, and the staging required by insurance and others disrupts caregivers from doing what they do best - caring for people.

Staff frustration is palpable.

The good news...the procedure went very well, even though I thankfully don't remember a thing.

The road to recovery has begun and I'm resting up for the next month as I heal.

That includes NO golf! :(

Curtain Call:

Overall, despite the cumbersome process, I can pee again. And, as I continue to recover, my gratitude rests mostly with the nursing and support staff who got me through this ordeal. They are the angels in care delivery and as many others opine here on LinkedIn, are woefully overworked and underappreciated.

I'm also indebted to my surgeon who was responsive and willing to answer my crazy questions pre and post-surgery. He explained everything to me in comfortable, and personal terms.

Finally, the experience exposed me to the challenges faced in our industry. Access, convenience, seamless patient journey, and patient experience are buzz words talked about incessantly, but rarely able to be delivered consistently.

Operational efficiency and technology have yet to solve the problem. Now, shortages for caregiving, misaligned financial incentives to treat chronic disease, and the growing demand for this type of care are all piling on an already overburdened model.

Do the ends always justify the means? I'll let you be the judge.

For me, to prevent an industry implosion, it's imperative that we find a better way and it must emerge quickly.