It was the sixteenth hour of call. I sat down in a chair in the ED and dozed off.
I awakened with a sharp pain in my abdomen. The pain kept getting worse, so I called my doctor and heard the following recording: “If this is an emergency, go to the nearest emergency room. If you would like a consultation with your doctor, please visit our Web site, as office visits are no longer covered by your HMO.”
I logged onto the Web site and answered questions there. The computer gave me the differential diagnosis. Taking advantage of UPS same-day service for blood and urine kits, I shipped out a drop of blood and all results transferred to my profile. When the computer expressed concern about gallstones and kidney stones, I walked to the pharmacy and used the scanner booth. Within minutes my scan was transmitted to my profile. Symptomatic cholelithiasis, diagnosed my doctor and the radiologist in teleconsultation.
My HMO posted my profile on Surgerybay.com and selected the surgeon with the lowest bid. The Web site extended a warm welcome and explained the procedure by video. I clicked onto my surgeon’s weekly schedule and scheduled a robotic cholecystectomy for the next day.
On arriving at 8:00 AM, I read a brochure that stated, “You are the best. You deserve the best.” I felt lucky to be treated at this excellent teaching hospital with a patient satisfaction rate of 95%, a Quality Assurance Index of 0.9, and a customer retaining capacity of 92%. I swiped my credit card through a machine at the admissions office and followed directions to my slot in the holding area. There the hospital lawyer, via video, took my consent—all 50 pages.
Following voice commands, I changed into a hospital gown and climbed onto a stretcher. A remote-controlled robot wheeled me into the operating room. A cornea scanner quickly checked my identity.
On the operating table, conscious inhalation gener-al anesthesia, which required no tubes or lines, was administered. I was invited to watch my operation on the monitor while enjoying my favorite CD.
Automatic machines like those in a 20th-century car wash prepped and draped my body. Then the robot, under stereotactic vision, placed ports in my abdomen and, with perfect precision, removed my gallbladder with its robotic arms. A third-year surgery resident sat at a nearby console, supervising 5 operations. I saw his image in the lower left-hand corner of the monitor. Using the intercom in the monitor, I asked why he did so many at once. He replied that HMOs had been pressing the hospital to increase cost-effectiveness and productivity.
The operation was successful. A few hours later I was excited to see a group of residents starting evening rounds. It’s time to speak to a human being, I thought. The surgical residents entered the room like raging bulls. One checked lab results on his Palm Aviator. Another ordered my meal from McClown’s. The intern dictated progress notes into the mouthpiece of his headset. The team beamed my discharge instructions and medications to the computer and exited.
I called the hospital operator. “I want to speak to a doctor,” I said. An image of the hospital risk manager appeared on the screen. “Please consult your attorney to make arrangements for a meeting with our hospital attorney,” she said. Disappointed, I left the place with the home care cab driver who was part of the nice package deal offered by my HMO.
When night fell, my desire to speak with a doctor had not left me. I telephoned. The hospital’s Caller ID system recognized my voice and offered the following choices: “If you are in pain, press 1. If you are bleeding, press 2. If you have fever, press 3.”
For lack of a better choice, I pressed 1. A recorded voice stated, “If you are in mild pain, press 1. If you are in severe pain, press 2. If you think you are going to die—finally I would hear a human voice—enter your 16-digit credit card number and an ambulance will pick you up.”
I woke up screaming, “I want to talk to my doctor! Can anyone tell me what’s going on?”
Looking around, I discovered that I was not alone in the ED. A couple of other patients were screaming the same thing.