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    Close to Change 2nd edition: Perspectives on Change and Healthcare for a doctor, a town, and a country
    Close to Change 2nd edition: Perspectives on Change and Healthcare for a doctor, a town, and a country
    Close to Change 2nd edition: Perspectives on Change and Healthcare for a doctor, a town, and a country
    Ebook120 pages1 hour

    Close to Change 2nd edition: Perspectives on Change and Healthcare for a doctor, a town, and a country

    By Matt Lambert, M.D.

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    About this ebook

    On August 7, 2012 Camden Clark Medical Center announced the impending closure of the St. Joseph’s Hospital campus in Parkersburg, WV. Among the reasons provided for closure of the hospital were upcoming changes established by the Patient Protection and Affordable Care Act. Being a person who was born at St Joseph’s and raised in Parkersburg, I was moved by the news of the upcoming closure. Being a physician and a healthcare consultant whose life and career have been greatly impacted by the same legislation, I was moved even more. So moved in fact, that I decided to write a book.
    LanguageEnglish
    PublisherBookBaby
    Release dateOct 28, 2013
    ISBN9781619276611
    Close to Change 2nd edition: Perspectives on Change and Healthcare for a doctor, a town, and a country

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      Close to Change 2nd edition - Matt Lambert, M.D.

      Endnotes

      Timeline of Events

      1785 – Parkersburg, Virginia settled

      1861- The Civil War begins on April 12th

      1863- West Virginia separates from Virginia on June 20th

      1898- Camden-Clark Medical Center established

      1900- St. Joseph’s Hospital established

      1971- Author born in St. Joseph’s Hospital on April 13th

      1997- Author graduates medical school

      2000- Author completes emergency medicine and begins clinical career

      2009- Barrack Obama inaugurated President of the United States

      2010-President Obama signs Patient Protection and Affordable Care Act into law on March 23

      2011- Camden Clark and St. Joe’s consolidate under WV United Healthcare on March 1

      2011- Author changes career to healthcare consulting in April

      2012- Supreme Court upholds Patient Protection and Affordable Care Act on June 28th

      2012- Plans announced to close St. Joe’s hospital on August 7th

      2012- President Obama re-elected on November 6th

      History and Physical

      According to my medical record, I was born Matt Wade Lambert at 6:08 a.m. on the morning of April 13, 1971. I was born in room 550, Bed-1 of Saint Joseph’s Hospital in Parkersburg, WV and delivered by Dr. Cruikshank. It was a low forceps assisted, vaginal delivery and I weighed 8 pounds, 10 ounces and was 21 inches long. I was born to Mrs. Robert Lambert and Robert Lambert who were ages 25 and 29 years, respectively. Kay was my mother’s actual name, and she listed her occupation as housewife and my father was a loan officer at Parkersburg National Bank. This was Kay’s third pregnancy; she had delivered my older sister, Robin, in December 1968 in Charleston, WV and had a miscarriage in November 1964. Family folklore had always claimed that I was born with a black eye and that mom’s lifelong intolerance of strong smells came from the ether soaked rag that was placed over her nose for anesthesia during the delivery, but none of that is reflected in the medical record. Incredibly, the application for my birth certificate includes a question of whether or not I was born under legitimate circumstances to married parents. I can plainly read the word yes, in mom’s handwriting, thus removing all doubt about my personal legitimacy (at least in my mother’s eyes). There is not however, an official explanation for why my given name is Matt, and not Matthew, nor any mention of mom being on bed rest during her pregnancy. I was always told that mom was on physician ordered bed rest during her pregnancy and passed the time watching a lot of television. Because of this, I was named not after the apostle Matthew, but Marshall Matt Dillon from the TV show Gunsmoke. Apparently, mom didn’t appreciate the nasal draw of Festus, the only character who consistently addresses Marshall Dillon by the biblical form of the name and likewise to this day, only a few selected friends are granted permission to address me in similar fashion.

      The nursing documentation in my chart is quite good, even by today’s standards, yet concise enough to all be included on one page and I can read that I was fussy that first night but did breast feed twice. It continues over the uneventful four days of our postpartum stay, although I was surprised that mother tried to breastfeed as long as she did given her nature and attitudes towards breastfeeding in the early seventies. I know that I was switched to formula for a while and then eventually my paternal grandmother convinced her to feed me a combination of Karo syrup and Carnation milk, making me quite an obese toddler and something that I can’t recommend as a physician. Being a physician does allow me to comment on the doctor’s notes, which are unacceptably brief by today’s standards for billing and nearly illegible. My pediatrician, Dr. Bailey, wrote the newborn nursery note for Baby Boy Lambert that reads in its entirety, WD, WN, WM infant with no abnormalities apparent. It’s good to know that I was once a well developed, well nourished, white male with all of my abnormalities, apparent or not, ahead of me. I am envious, as a practitioner in 2013, of the brevity of the documentation compared to what is required today. Everything that is medically necessary is there, just documented in a less laborious fashion than required by the government or insurance companies. My medical record also reflects that protocols had become a part of care as early as 1971. I received my vitamin K shot, had my bilirubin tested, and my blood typed all without a phyisican's order as part of a public health protocol. I was circumcised on the second day of life but unlike today, there is no note documenting the details of the procedure, only a consent form signed by my father. I wasn’t aware that the informed consent process, which is driven by our medical-legal climate, had been part of care delivery for over four decades.

      Overall, it is humbling and nostalgic to see your beginnings in 9 pages and it’s not lost on me how simple things can be when it all goes well. It seems impossible that my parents were ever that young and I laugh to myself trying to imagine what was going through their minds. It is documentation of one of the most common human experiences, by third party observers who were just doing their job. So many occurrences, good and bad, were yet to come for all of us and I allow myself soak in the reflections of a moment that I am sure was not as pure as I make it now. What antiquates it the most, in my observation, is referring to mother as Mrs. Robert Lambert and the aforementioned legitimacy declaration. Medically, most of the treatment is very similar to today for an uncomplicated vaginal delivery, other than the current average length of stay for mother and child is just over 2 days as opposed to our four-day stay.

      Included with the nine pages of my medical record obtained from the hospital is a letter from the Health Information Management Department describing their purged medical records policy. It states that they are unable to provide the remainder of my records, including the emergency department records that I also requested, as their retention period for charts is approximately ten years. Even birth records have to be retrieved from microfilm, housed at an off-site location. When it occurred to me to write this book, I envisioned that it would begin with a chart review on myself and I wanted to tell not just the story of my birth, but also my upbringing, through occurrences in my the record. As it turns out, the length of time a healthcare provider has to maintain your records varies from state to state, and the law in West Virginia is only five years. So the only record of an emergency department visit following a dirt bike crash when I was about 12 years old is the scar on my knee and the only record for a concussion I received playing high school football is in the same post-concussed mind. It is most likely that if my record was more active, it would have been maintained and available, but its odd to think that there is no record of those events ever occurring. It is especially odd, and ironic, given the work that I currently do with electronic health records and will be discussed later in the book.

      We were discharged to our home to Vienna, a suburb of ten thousand people, adjacent to Parkersburg. Even though my hometown is technically in Appalachia, it is more like a mid-western river town in its geography and sensibilities. The Ohio River, and thus the state of Ohio, is immediately to the west and the town is bisected into north and south by the Little Kanawha River. It’s position on the confluence has maintained it as a center for commerce since it was settled in 1785, by Captain James Neal and named for Andrew Parker, a revolutionary war captain. Prior to that, it was visited often by many of the eastern native populations and 1770 brought one of the first harbingers of manifest destiny, a young colonel named George Washington. Washington Bottom, southeast of town, is the land along the Ohio that Washington claimed for himself and his associates, as compensation for service in the French and Indian War. On this same expedition, Washington observed many of the local oil and gas springs that would spawn the eventual settlement of Parkersburg and by the 1830s would be developed into the beginnings of the global gas and oil industry.¹ Just downriver from downtown, and not far from Washington Bottom, is Blennerhasset Island. It is named for Harman Blennerhasset, an Irish aristocrat who settled there in 1798 after being ostracized from his homeland for marrying his niece, Margaret. The couple used their wealth to construct an opulent mansion and grounds on what at that time was the western frontier. Harman dabbled in medicine and music while investing in the growing region and they entertained their affluent guests by spending even more money than they could afford. Trouble arrived to the island in 1805 in the form of Aaron Burr and his considerable charisma and political baggage. Burr was looking for a new start after not being retained by Thomas Jefferson on the 1804 ticket after killing Alexander Hamilton in a duel while sitting as the Vice President of the United States. He wandered westward looking to for a new venture and Blennerhasset bankrolled his alleged conspiracy to obtain land west of the Ohio for the formation of a new nation. Blennerhassett purchased boats and supplies and helped recruit local settlers for

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