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Let’s Admit a Few Things About Readmission

April 27, 2018

When I was a practicing physician I always strived to treat patients equally, but sometimes for whatever reason certain patients just require more attention. It might be age, a particular health condition or complication, a personal relationship — or sometimes the patient just might be responsible for overseeing health care in the entire country.

Doctors in Indianapolis experienced the latter firsthand when HHS Secretary Alex Azar checked into the hospital not once, but twice in his home state in recent days. Diagnosed with diverticulitis, a condition that causes inflammation in the intestines, Azar’s readmission to the hospital does point out some health care issues worth considering. It also gave the peanut gallery ammunition for cheap shots.

Some alleged that Azar’s readmission is “embarrassing” as well as costly. The reasoning of some went along the lines that if we can’t even keep the HHS Secretary out of the hospital, then what chance does the average American have?

This point of view makes the mistake of looking at medicine in stark, black and white terms. In this view, the presumption is that adequate initial treatment in a hospital means that no one should ever have to return to the hospital. This is good in theory, but what it doesn’t account for is that medicine is sometimes more art than science and can be complex and, dare I say complicated.

Having to readmit patients is never a good thing, and people are right to note the cost and risk to the patient associated with readmission. It is also right that hospitals bear a large share of the responsibility for ensuring that patients are adequately treated the first time. What is not right is to brand any readmission as an outright failure.

Not only is medicine a tricky business, when you add in health care providers, differing health insurance policies, and sometimes even the patients themselves, you get a complex mosaic. Hospitals must manage this complexity every day, and by and large they do a good job. Tackling this Gordian Knot of complexity is Azar’s number one mission.

Readmissions are a problem and they can have costly and even deadly effects. But instead of piling on hospitals, we should be working with them to find solutions. And as for Secretary Azar, I am glad to hear he has returned to Washington and send him best wishes on his recovery. I am hopeful that for the duration of his tenure the only time he will spend in the hospital going forward is for collaboration and education, not treatment.