Category: Healthcare

What a Comatose Patient Taught Me About Healthcare

“Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.” – Susan Sontag

Some years ago, I chased the dream of becoming a doctor. Part of that pursuit involved weekly volunteering from 8 to 11 p.m. in a hospital burn unit. Most nights, that meant answering phones, restocking supply carts, and peppering nurses with questions about diseases and treatments. Occasionally, I was called into patient rooms to assist with bandage changes.

One night, I learned a valuable lesson.

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I was sitting at the reception desk when a nurse called me into a room to “turn” a patient—a routine procedure where we roll a patient in a medically induced coma to one side to change dressings and bedding, then turn them to the other to finish. I put on the requisite gown and gloves, and asked the nurse why the patient was sedated.

“She has TEN, which is short for Toxic Epidermal Necrolysis,” the nurse explained. “The body is attacking the skin as if it’s a foreign substance. She’s sedated because the pain would be unbearable. Our job is to stop the immune response and act as a second skin, layering bandages to protect her while she heals. That’ll take a few weeks, if things go well.”

As I helped roll the patient to one side, I was absorbed in the science at play in the room. I had never heard of TEN. I wanted to know the cellular and chemical mechanisms of the body’s immune response, the treatment protocols, and the stages of healing. I wanted to know the history of innovations that had made diagnosis and treatment possible. I was in awe of the human body, this marvelous machine, and the life-saving power of modern medicine. 

As we turned her to the other side, something on her right hand caught my eye – her thumbnail was painted a brilliant, glittery blue, sparkling under the sterile hospital light. 

In that instant, my perspective shifted. I wasn’t looking at a case of TEN; I was looking at a person. She was a daughter, a sibling, a student. She had likely painted her nails for a school dance or a Friday night out with friends. Her routines, her relationships, and her dreams had all been interrupted by a terrifying disease. 

I wasn’t just assisting with bandages. I was helping a person get back to her life outside the hospital. 

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That quiet moment changed how I think about healthcare. It’s not just about medicine – it’s about people.

Healthcare is a complex, $5.3 trillion industry. It brings together some of the most advanced science, powerful technology, and sophisticated business models in the world. What modern medicine can do today is nothing short of miraculous. We can replace failing organs, rewire hearts, and decode strands of DNA. 

But if these tools and innovations aren’t designed and delivered with people at the center, something essential is lost. Excellence in business, science, and technology is necessary, but it’s not enough. True success means building systems where every interaction is human-centered, seamless, and supportive.

Because most of us will find ourselves in the hospital at some point, whether for a checkup, a surgery, or something far more serious. As Sontag wrote, we all hold dual citizenship in the kingdoms of the well and the sick. And when we’re called to present that second passport, what matters most isn’t just the care we receive, but how we experience the journey through that unfamiliar land.

That flash of glittering blue nail polish stays with me. It reminds me that behind every chart, treatment plan, and policy is a person, hoping to return to their life. Every strategic initiative, technology rollout, budget conversation, and operational redesign should begin and end with that person in mind.

Why?

Because people are the heart of healthcare.

Image generated with ChatGPT

Achieving Flight: Discerning Between Correlation And Causality in American Healthcare

In the opening chapters of How Will You Measure Your Life, Clayton Christensen illustrates why hundreds of years of attempts to fly were unsuccessful and what changed that got the Wright Brothers off of the ground.

“Early researchers observed strong correlations between being able to fly and having feathers and wings. Stories of men attempting to fly by strapping on wings date back hundreds of years. They were replicating what they believed allowed birds to soar: wings and feathers.

“Possessing these attributes had a high correlation—a connection between two things—with the ability to fly, but when humans attempted to follow what they believed were “best practices” of the most successful fliers by strapping on wings, then jumping off cathedrals and flapping hard … they failed. The mistake was that although feathers and wings were correlated with flying, the would-be aviators did not understand the fundamental causal mechanism—what actually causes something to happen—that enabled certain creatures to fly.”

“The real breakthrough in human flight didn’t come from crafting better wings or using more feathers. It was brought about by Dutch-Swiss mathematician Daniel Bernoulli and his book Hydrodynamica, a study of fluid mechanics. In 1738, he outlined what was to become known as Bernoulli’s principle, a theory that, when applied to flight, explained the concept of lift. We had gone from correlation (wings and feathers) to causality (lift).”

Reading through the passage, I immediately connected this principle with the US’s attempts to implement a national healthcare system.

Now, currently, no policy makers are making moves on Medicare for All. The country is nine weeks into a pandemic. Some states are slowly and cautiously reopening, and it seems we’re going to be in The Dance for another six to eighteen months. Oh, and in case you’ve forgotten, we’re six months away from a presidential election. Medicare for All isn’t at the top of our list of problems.

But once the political and healthcare dust has settled, the debate (or online rage-fest) of a national healthcare system will startup again. I wouldn’t be surprised to see both sides using the pandemic to support their position.

After reading the above passage from Christensen, I wondered. Would mimicking what other countries have done be like strapping wings on American healthcare system? Or would it be like applying the principles of lift? Will doing what other countries have done solve our problems?

What exactly are the problems the US system faces?

For one, value (measured in quality over cost) is low. Costs are higher than anywhere else in the OECD countries. And for all that extra money, outcomes seem about the same or worse. Second, roughly 27.5 million Americans (about 8.5%) are uninsured, which distributes costs to the rest of the system. Third, the incentives between who payers, patients, and providersmeans that consumers and providers often make decisions free of the monetary consequences of their choices, decreasing the power of free market tactics to cutting costs or improving quality.

In addition to our system’s issues, the US is unlike other OECD countries in its geographic and medical makeup. At 327.2 million citizens, we’re fifty times larger than the UK (6.5 million), and sixty times larger than Norway (5.5 million). About sixty million Americans (19.3%) live in rural areas where expensive healthcare services are harder to efficiently distribute. Add to the population issues a host of medical problems the country struggles with. For example, we’re close to the top of the list of most obese countries, with 36.2% of the population at a Body Mass Index of 30 or higher. Compare that to Canada (29.2%), Mexico (28.9%), and the UK (27.8%).

The unique problems and characteristics of the United States are significant. The ideal US healthcare system will need to be different from those of other countries that don’t share similar challenges. In other words, policy makers will need to craft incentives and systems to suit our unique situation in order to achieve flight, and not just mimick the surface characteristic of the healthcare systems of the OECD countries.