Monday, April 14, 2008

Healthcare is Broken

As behavioral researchers, we are trained to talk and listen. To ask questions and really understand the end users. My current situation, thankfully temporary, has once again magnified for me how broken our healthcare system is. I have talked with and listened to elders, people with a disability, and people who are chronically ill. We listen, we sympathize, we might even empathize, but at the end of the interview or project we walk away, thankful for our health, our mobility, our cognitive ability and use these abilities to work to help others. The key is, normally, we can walk away, go back to our lives.

At the moment, my life is healthcare. Healing a broken ankle. Tragic? No. Inconvenient? Hell yes. In the dark? Hell yes.

I think first about the work being done in Ireland with the Digital Health group. They have done some investigation about ride sharing. Getting seniors to the doctor, on an errand, food shopping. There is a small system there to help with this. There are also some systems here. None too great. As a middle-class, non-elderly American, the services are almost non-existent. There is one rideshare in my town for people not on public assistance. You need to call 4 days ahead of your appointment and then you find out only 1-2 days ahead of time if you can have a ride. I have friends who can help, but am working at not wearing out my welcome. It's my right ankle and I can't drive. Public transit is a bit of a walk from here on my crutches. I'm unstable and can't stand for long periods waiting for a bus. The options are somewhat dismal. I can pay for a cab, but it's expensive and I'm now self-employed, waiting for 30-90 day payables from February and March. I also live in a purportedly green city. We should have a daily ride share board. "hey, I'm going this way, anyone need a lift?" Or leap even further ahead and have a device where you can log where you want to go and have it alert you when someone in your neighborhood is headed that way.

If I had interviewed someone about this I'd think, wow, we need to do something about this transportation issue. Let's spend 6 months researching, getting info and a few years implementing. That's realistically how these things happen. It is amazing what is still broken. I believe being in the circumstance is why people like Lance Armstrong start their own foundations. Only when you have the experience or sit next to it, do you really realize the work that needs to be done and the money that needs to be put behind it.

The other astounding finding is the lack of information, good information, shared by the doctors. I have a broken ankle. I never had a broken ankle (though I have spent time on crutches from sprained ankles). They hand you crutches and a brace and send you on your way. No conversations on how to make yourself comfortable, how to sit/sleep/work. How to get food for yourself when you can stand only on 1 leg and both hands are grasping your crutches. How do you carry things? What's the best way to bathe or shower? What should I expect over the coming weeks?

The hospital handed me paperwork encouraging me to "ask questions" and ask "have you washed your hands?" Really, that's my slightest concern. What I really want to know how my life is changing for the next 4-6 weeks and how I can manage. My doctor sees broken bones, every day, but this is my first experience. I don't think he realizes that. I've read research papers on what happens when you leave the doctor's office. How confusing and scary it can be. How many questions you forget to ask or don't even know to ask. Mine wasn't a heart attack or diabetes, a chronic or life changing event, yet the confusion and scariness is likely to be more profound with chronic illness. Health education is extremely behind the times and as designers and researchers it's our job to get this information to the patients, into the hands of the sick, the worried, the scared and empower them/us, make us feel safe and that somebody in healthcare actually might care.

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