Demystifying Medicine One Month at a Time

Is it Health Care or Beyond?

This story from the radio program Marketplace caught my attention (you can listen to it at the bottom of this post).

_MG_6278It details the travails of Mariano Garcia, 45, who was at a medical visit to have bandages changed on an open leg wound.

In a bit of graphic detail, we learn that Garcia is not having his bandages changed daily, as he’s instructed to do, but rather once a week. By the end of each week, the healing flesh is matted onto the bandages and each dressing change is subsequently much harder because of the constant sloughing off of tissue. The healing process is thereby greatly slowed.

Garcia is in Camden, N.J., the locale of MacArthur genius grant winner Jeffrey Brenner, he of “hot spotting” fame. [Hot spotting involves targeting people that use the “most” healthcare: things like frequent ambulance rides, ER visits, CT scans, etc., which result in excessive cost to the “system;” and designing care plans around such high users to improve their health and save health care dollars.]

The story quotes Rebecca Onie, founder and CEO of Health Leads (herself a MacArthur genius grant recipient):

Onie says now that hospitals either must drive down costs, or face what could be crippling financial penalties. Healthcare executives must leave the medical map behind and head out for the uncharted territory.

“They are going to have to begin paying for a set of things that have historically [been] considered outside the scope of traditional healthcare,” she says.

And so we are beginning to see healthcare’s first, hesitant steps, where doctors and hospitals wade into the world of social services.

Having worked in several hospitals, I find this daunting but welcome. Too often we see chronically ill patients that are deprived of necessary (and lower cost) follow up care return to the hospital to “put out fires” when a bit of maintenance could have kept things running.

Could you imagine your local hospital offering services outside its doors, in community-wide fashion? Or does this seem beyond the scope of the hospital’s job?


  1. Ros Elder

    Dr. Schumann,

    The medical profession must widen its scope when dealing with people. If the effects of untreated, but related issues sabotage the doctor’s treatment, we are being both realistic & smart to form a treatment team just as Dr. Clancy outlined in his speech.

  2. Eric Zuniga

    A similar dilemma is reached when a patient is prescribed a needed medication that is financially out of their reach. Coordinated care where social work is integrated with medicine does not make too much sense at the hospital level because at that point it is too late. It should start at the community level in a primary care physicians office.

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