EDWARD HARRIS
President of the medical staff
Our place, it's special
Edward Harris Big things are happening, and many of the changes in our macro world are described using "big-ticket" phrases that cause most of us to pause and stand in awe. Conversations take on new importance as soon as we are told we are looking at the "the merger," "combined programs," "cost savings of $20 million," or we are dealing with such headline-generating issues as "HMOs battle for patients," "Bill of Rights for Patients," "Will President Clinton enforce ... whatever."

But amid these big-ticket items, whether local or national, we would do well to stop to realize what a special place Stanford University Hospital has been and is.

Admittedly, high quality might have been uneven in the past. But I believe that from the time seven years ago when Ken Bloem, our former president, began the plan to upgrade the quality of service at SUH, this place has reflected its true brilliance, as the recent high evaluations from contractors of managed care have shown.

There are many things here that we can point to with pride. The graciously tasteful art work selected and donated by long-time benefactor Helen Bing makes this place a little warmer and more comfortable to work in. We really appreciate the big-ticket technology that our physician/scientists have convinced companies to donate to Stanford, but this isn't what makes us special, either.

Our services are top quality - from food to the managers who keep our budgets on target. But again, that's not the bottom line - even when financially that's exactly what it is.

So, now that I've said the right - and I might add, accurate - things, I'll raise a somewhat controversial concept. Forgive the arrogance, but I submit that it's the skill, expertise and caring of our physicians and nurses that have for years been the sustaining strength of our hospital. These qualities have nourished the reputation of SUH through "down times" when perhaps the amenities of care were, shall we say, undeveloped.

Amid the flurry and scurry about being "big" - joining UCSF, capturing markets, securing contracts - let's not forget that the successes of our hospital are measured as one-on-one, the patient and his or her encounter with the hospital.

For one such encounter, let's look at Jose Roybal, not his real name, and his illness. He is 72 years old, a retired maintenance man at a Silicon Valley software company. Eight months ago he noticed that his ankles were swelling and that he was short of breath when he climbed stairs. His legs, scrotum and abdomen swelled progressively, without pain. He was admitted to an outside hospital. The physicians there used very bit of technology available to them to sort this out: cardiac ECHO, CT scans, MRI, all the various screens of laboratory tests were performed during a two-week period by the best of technicians.

Cytologies were negative. His belly continued to enlarge, as did the cost of his diagnostic tests. His dyspnea increased, but he was sent home without a diagnosis.

Unable to eat or lie down, Mr. Roybal came to Stanford. Within three days a cardiologist from the Palo Alto Medical Clinic and a Stanford medical intern and resident had a diagnosis. A precise interpretation of the cardiac echo detected cardiorestrictive physiology. He had pericardial tamponade.

A pericardiocentesis was performed. Six hundred milliliters of fluid was taken off. A pig-tail catheter was left in place to provide drainage; it yielded about 900 milliliters of fluid each day. A pericardial window was placed by one of our thoracic surgeons, and nodules of adenocarcinoma of the lung were found studding the pericardium.

Gradually the excess fluid has resolved. Mr. Roybal is comfortable. His life expectancy is not a long one, but a diagnosis was made at a fraction of the cost of "testing" by those at outside hospitals who did not know what they were looking for, nor how to find it.

This is just one case, and I don't deny that there are superb physicians at outlying hospitals. I do say, however, that we must recognize that our hospital, the physicians and nurses and support staff, are across-the-board among the best. We must be aggressively proud of this, promote and nurture our quality, and - above all - retain the excellence and character of this place as a university/ community hospital amid the "big" scheme evolving around us.

COLUMNS
Chief of Staff

President of the medical staff

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