“Where’s that useless doctor,” my patient grumbled. A nurse had warned me that healthy patients love to complain, but this instance was perhaps justified. For several days the patient had been itching to get discharged. But instead of releasing him, the doctor ordered a scan of his gallbladder. Ironically, this patient’s gallbladder was removed years ago, as was noted in his chart.
Like many of my classmates, I spent time away from Yale during the pandemic. Specifically, I took a medical withdrawal because a family emergency was distracting me from college. During this time, I decided to test my fledgling interest in biotechnology, so I took two jobs in one hospital. One was a cushy internship in biomedical engineering. The other position was an “in-the-trenches” Patient Care Associate (PCA) role on the COVID-19 floor. Performing chest compressions, measuring vitals and cleaning emesis (a euphemism for puke) were regular parts of the job description. But beyond my listed role, hospital circumstances forced me to become an unofficial public relations manager.
Here’s the issue: the hospital was filled with healthy patients, such as our friend with Schrödinger’s gallbladder, who racked up huge bills and took limited resources away from sicker patients. There was an incredibly slow discharge process, which was partly by design since triage entailed focusing resources on the sick and dense bureaucracy assured patients were not discharged prematurely. However, human error and systemic disorganization exacerbated the problem.
For example, a doctor told one of my healthy patients that he would visit them in the morning to explain test results and discharge them. The patient even made dinner reservations to celebrate. When the doctor finally came by the following evening, he informed the patient that he hadn’t yet read the results.
We can’t simply blame the slow service on triage. Staff sometimes ignored the principles of triage to service the needs of the healthy. These healthier patients could advocate for themselves or complain to a manager, while those in critical condition could not. Often, relatively healthy patients complained until they successfully diverted attention away from the sick. Otherwise, they were neglected until they got fed up or walked out against medical advice, (“AMA”).
I am no expert. But even from my entry-level perspective, the problem was glaring. Healthy patients’ aggressive demands for better-tasting coffee competed with my responsibility to care for the non-ambulatory. And these patients seemed to stay in the hospital for days longer than necessary. I often witnessed healthy patients trap doctors with long stories that took time away from their less talkative counterparts in critical conditions.
Doctors and nurses are not at fault, as criticism of the recent RaDonda Vaught verdict highlights. And the patients are certainly not at fault either. Yes, human error exists: the Harvard Gazette reported that “burnout among doctors is costing the U.S. health-care system an estimated $4.6 billion a year.” But human error is merely a symptom of the underlying systemic issue — a flawed bureaucracy that misallocates scarce resources. Put simply, hospital bureaucracies cannot efficiently coordinate the discharge of healthy patients, which increases the workload for staff and decreases the overall quality of care.
There needs to be some intelligent system for organizing these discharges. More generally, hospitals need software that can optimize the allocation of their limited resources. If Amazon can use algorithms in its warehouses to deliver packages at record speeds, why aren’t we using those algorithms to save lives? Indeed, software may be our best tool for handling future pandemics.
This is an issue that the Yale community can address. Developing the technology is the easy part. More challenging is the task of marketing systems in which machines make decisions affecting human lives. Media frenzy over Tesla autopilot crashes suggests society is not yet comfortable entrusting human lives to algorithms. And ethical issues such as AI demographic biases and patient data privacy further complicate the matter. But realistically, hospitals should be making constant calculations to prioritize certain patients, optimize resource allocation and mitigate risk. In the long run, machines are better than humans at this task.
Until then, I strongly recommend that every Yalie spend time working in a hospital. Although it might not pay as well as a typical undergrad internship, you could massively impact understaffed hospitals and develop far more valuable human skills. My experience working on the unit forged an emotional resilience, discipline and sense of duty that I sorely lacked beforehand. For everyone involved, hospitals are arenas of adversity. But they also present unparalleled opportunities for growth and recovery. Most importantly, hospitals need help.
ELLIOTT COOK is a junior in Jonathan Edwards College.