Software is making hospitals worse — a funny story

(written by lawrence krubner, however indented passages are often quotes). You can contact lawrence at: lawrence@krubner.com, or follow me on Twitter.

(I wrote this as an email for my friends, but then I decided to also share this with the public.)

Okay, I already mentioned that my mom was at the hospital for a week, with an infected foot, and she got lots of antibiotics, and they sent her home on Monday?

Every day I went over there for 6 hours and tried to entertain her a bit. It’s easy to go crazy in a hospital, as it is so very boring. My mom was in a room with 2 other patients and she didn’t have anywhere to go, and nothing to see, nor did the nurses allow her out into the hallway, except when I was with her, so I went there each day and then we’d go for a long walk down the hallways.

A funny fact is that hospitals are more and more dependent on software, yet the bureaucratic confusion never seems to end. I actually think software makes things worse, in that the rigidity of software accentuates the rough edges of bureaucracy, as opposed to the old days, when bureaucracies were overseen by an army of secretaries, who could informally adjust a given process when the process was in danger of producing a result that was obviously stupid.

I wish hospitals were the kind of market where innovative software startups could bring cool new ideas to improve processes overall, but sadly the opposite is true. Over the last 10 years, more and more every year, Epic Software has become a monopoly that has taken over the internal workings of every hospital. And, like with any monopoly, they’ve become less and less innovative, because they no longer need to compete. They charge tens of millions of dollars, yet they leave hospitals with an inflexible system that’s much worse than what the hospital had before.

I think I ran into this on Monday night, my mom’s final night at the hospital. I was worried about my mom getting dinner. Every previous night she had been skipped over — I couldn’t figure out why. But I was there, and so I felt I could fix the situation.

In the hallway I saw the food delivery woman, a very thin, almost frail, black woman who was probably about 60 years old. She was pushing her giant metal cart, that held about 40 meals, for all the people in that section. I went over to her and asked for food for my mom.

“Who’s your mom?” she asked.

“Blanche Krubner.”

A thick stack of papers, stapled together, sat atop the cart, with information on each patient. She flipped through this till she found my mom.

“Oh, okay,” she said. “Mrs Krubner, right? Okay, she is listed as ‘Restricted Carbohydrates.’ Alright, alright, alright. I can give you this.”

Then she gave me a plate that had on it fried chicken, some mashed potatoes, and some stewed carrots. I took this to my mom, who sat down and ate it. For hospital food, said my mom, this was not bad.

When my mom was done eating I took her plate and tray and walked out into the hallway, where I found a dolly where the trays seemed to collect, so I set mom’s tray there and then went back to her room.

A long while passed, almost an hour, and then the food lady came into the room, bringing food to the two other patients who were sharing the room with my mom. I didn’t realize it at first, but the food lady was puzzled about my mom’s situation. Distracted, I didn’t realize that the food lady was trying to figure out my mom’s food situation.

My mom was sitting in her chair and reading a book (a murder mystery). The food lady had an iPad with her with some information about each patient, and after a few moments, she seemed to make a big discovery.

“Oh, okay, I see,” said the food lady. “Your mom is NPO. That’s why I cannot give her any food.”

“What?” I asked, confused.

“She is not allowed any food.” The food lady held up the iPad so I could see the screen. “She’s NPO, that means the doctors don’t want her to eat.”

“Why?” I asked.

“Maybe she is going for surgery in the morning?” suggested the food lady.

“I’m fairly sure I would know if my mom was going for surgery in the morning,” I said.

“Who knows why?” The food lady shrugged. “But she must go 24 hours without food, before it happens.”

“But she had breakfast,” I said. “And they fed her lunch.”

“Oh, that’s bad,” said the food lady. “They shouldn’t have done that. Someone’s going to get in trouble.”

“But she just ate dinner,” I said.

“What?” The food lady was shocked. “Where did she get dinner?”

“You gave it to me,” I said.

“When?” she asked.

“About an hour ago,” I said. “I walked up to you and asked for food for my mom and you gave me a meal.”

“I did that?” She seemed nervous. “Why would I do that? This lady is NPO! She cannot have any food before her surgery!”

“She isn’t going for surgery!” I insisted. “She is being discharged in the morning. And then we are going to go to her favorite restaurant and she is going to order the salmon, which is her favorite meal.”

“Wait, wait, wait,” the food lady was on the ege of panic. “Something is wrong. She is NPO. She should not eat! Why didn’t you tell me she was NPO?”

“I have no idea what that means,” I said. “And also, I didn’t know she was NPO. I thought she was ‘Restricted Carbohydrates’.”

“What are you talking about?” asked the food lady.

“On that paper print out that you read from earlier,” I explained. “It said my mom was ‘Restricted Carbohydrates.'”

“No, that’s impossible,” she said, “They always say the same thing. They have to.”

But she went to the food cart and she got the thick stack of papers. I followed her. We looked at them together, and sure enough, the paper stack said that my mom was ‘Restricted Carbohydrates.'”

“Wait, now, wait, I mean, wait, I mean, what is this?” she asked. And she checked the iPad again, where it said my mom was NPO. “Well why does it say she’s NPO here, if it says she’s ‘Restricted Carbohydrates’ over here?”

“Um?” I was baffled. “I have no idea? I don’t know anything about your hospital? I don’t know anything about the paper printout, or the software? I don’t know what NPO means and I don’t even really know what ‘Restricted Carbohydrate’ means? But also, Epic is a money grubbing monopoly that sucks $100 million out of any hospital chain in exchange for bad software that has many problems?”

“You say what now?” she asked, looking at me funny, or rather, looking at me as if I was kind of funny, but not in a good way.

“I don’t know the answer to your question,” I said simply.

“It’s supposed to say the same thing!” she said angrily. “If Epic says she’s NPO, then the paper should say she’s NPO!”

“Software sucks?” I offered, which is the shortest way I can summarize my 22 year career.

“Well,” she shrugged. “Now I ain’t got any idea what she should eat!”

“It’s okay,” I said. “She leaves tomorrow.”

“Good!” she shouted, but not in the happy ‘I hope you feel better’ kind of way that most of the nurses often say. More like, “Good riddance, you fake NPO woman!”

The food lady left. My mom missed all the drama and was still sitting in the chair reading her murder mystery. I sat down next to her and she looked up at me.

“Did you get enough to eat?” I asked.

“Yes, thank you,” she said. “For hospital food, the dinner was fairly good.”

“I’m glad you liked it,” I said. “And I’m really glad you won’t be here tomorrow.”

“Oh, me too honey!” she said. “I’ll be so pleased to get out of here!”

“Yes, especially since this hospital will never give you any food again.”

“What?” she asked.

“I mean, I’ll be so happy to take you to your favorite restaurant!” I said.

“Me too!” she said.

Of course, the next day we ran into the slow bureaucracy that seems to haunt every hospital. I was told the doctor would check her in the morning and I should come by at 10 AM and take her home, so I got there at 10 AM and then they told me the doctor was running late and would arrive at 1:30 PM. But the doctor didn’t arrive till 3:30 PM. They only needed a few minutes to look at mom and approve her release. We finally got out of there a bit after 4 PM.

But thankfully, we did get out of there, and we did go to mom’s favorite restaurant, where there was no confusion about whether my mom was NPO or Restricted Carbohydrates or whether she was going for surgery. And mom ordered the salmon and she was very happy.

— Lawrence Krubner

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