Life & Limb: Our Annual Flu ‘Emergency’ Shows Fragility of Medical System
We know it’s coming every single year, yet flu season can strain hospitals to the breaking point. What if something truly unexpected happens?
It was a beast of a flu season, wasn’t it? It seemed like everyone was sick with either Influenza A or Influenza B, or something that wasn’t flu but acted exactly like it. Around the country, we coughed, wheezed, sneezed, shook, chilled, froze, ached, vomited and tried to make the best of it.
Not only was the flu itself typically unpleasant, it seemed to result in a lot of hospitalizations (of young and old alike) for pneumonia. It seemed to be a more dangerous strain with an above-normal number of deaths. Now I say “seemed” because we really won’t know for a while. It may be that when the dust (or phlegm) finally settles, it wasn’t really statistically worse than any other average year. Maybe this year’s flu just had a better PR firm. Let’s wait and see.
I thought a lot about the flu this year. I thought about vaccinations (that don’t help if you don’t get them); about Tamiflu (that probably doesn’t help much if you do get it). I thought about how head colds aren’t the same as flu and probably shouldn’t be treated in the hospital but by experienced parents and grandparents. I contemplated how the reportage of the flu always makes it seem closer to bubonic plague than the regularly scheduled event it is.
But what I thought the most about was the daily struggles of healthcare workers and the all-too-fragile nature of our medical system. Thanks to the flu, small hospitals, urban and rural, were overwhelmed daily. And large hospitals were putting up tents to treat the flood of flu patients. Emergency rooms all around the country were holding dozens, even hundreds of patients who needed to be admitted but couldn’t be because all of the inpatient beds were already full.
Not all of those were influenza, of course. Flu season also coincides with the time of year when there are many other infectious diseases, especially afflicting those who already have health problems and who are very young or very old.
The year-round crisis of mental health adds to the problems of the season. The mentally ill who are homeless, and sick, sometimes have no warm place to be in winter except the emergency room. Where they, too, may wait days or weeks for evaluation and placement.
In the end, paramedics, physicians, nurses and others on staff end up being completely over-run and overwhelmed. This results in a widespread feeling of hopeless despair. And for months it doesn’t abate. The waiting rooms are always full, the ICU is always full, the parking lot is full…the tent is full. I can only imagine what our patients endure – stuck in loud, scary hallways, waiting hours or days to be admitted. Feeling sick, feeling miserable and feeling powerless.
This is all made far worse by the unique torments of modern healthcare. Everyone who works in the hospital (or office for that matter) is measured by patient satisfaction scores and by a customer service model that (by the way) sometimes worsens care. It appears that every clinician has oversight by an army of administrators and data-collectors.
Healthcare is further complicated by difficult, time-intensive computer systems that demonstrably take physicians away from the bedside, and leave patients feeling much less important than the keyboard. Systems which leave the doctors and nurses angry at being data entry clerks rather than medical professionals.
Of course, it’s all made even harder by the fact that people in the U.S. now live longer, with more complicated problems, than ever before. Which is great! But not great when there aren’t enough specialists or beds on a normal day, much less during flu season.
And in rural America, where hospitals already fight to stay open and practitioners work overtime to give their best care, flu season is one more in a long list of daily, yearly battles.
Flu season suggests to me that medicine is practiced on the razor’s edge. And that if society wants continued excellence, continued ground-breaking therapies and life-saving technologies, that we need more (or bigger) hospitals, more physicians and more reasonable workplaces. We also need better plans that allow “surge capacity” when we have greater medical needs.
As such, flu season reminds me that regionally, or nationally, our hospitals are already strained to the breaking point. Only one major disaster, one pandemic, one weapon of mass destruction and I honestly don’t know what we would do.
The people who do the heavy lifting in medicine are dedicated and fearless. But they don’t want to feel despair, day after day, year after year. They just want the tools, the space, and the help needed to do the right thing.
I think we have work to do.
Edwin Leap, M.D., is medical director of the emergency department in a small North Georgia hospital. He lives in a log home in a remote part of Upstate South Carolina. Originally from West Virginia, Dr. Leap is married and has four children. Follow him on Twitter @edwinleap.