Vol. 100: Health care’s brave new world

Where nothing can go wrong, except….

Like a modern Eiffel Tower, Thomas Jefferson University’s spanking new Honickman Center dominates its Center City Philadelphia landscape, proclaiming its landlord’s status as the ultimate provider of cutting-edge health care. With its 300-plus examination rooms, ten operating rooms, and $762 million construction cost, the Honickman seems a fitting symbol for a medical colossus that has spent the past decade gobbling up eight rival health systems while somehow managing to record an operating loss of $203 million during its past three fiscal years, not to mention an additional $90.5 million lost in the quarter recently concluded on September 30.

That’s a lot more money than the humiliating $107,000 debt that Thomas Jefferson— the insolvent U.S. president, not the health system that bears his name—owed when he died in 1826. But of course, a dollar went much farther back then.

“From the ground up,” the Honickman Center’s` website burbles, “this 19-story advanced technology facility will be home to a wide range of Jefferson Health's nationally ranked specialty programs— from cancer and respiratory care to otolaryngology and gastroenterology— so that you can have one-stop access to care in a stunning space.”

Best of all, the website assures me, the Honickman Center has been built “with you, the patient, in mind…. Every detail—from our sunlit, healing spaces to the convenience of accessing many of our care services in one facility—has been designed to create an exceptional patient experience.” Outpatients will find such special features as pet-friendly areas, sensory-sensitive furniture, and abundant natural light in the waiting spaces.

Ground-level ordeals

When viewed from a distance— like, say, the ninth-floor men’s room window of my office building, four blocks to the west— the glass-and-steel Honickman Center dwarfs its more modest brick-and-mortar neighbors, like Independence Hall (where modern democracy was born) and the Academy of Music (where the Philadelphia Orchestra was born). It’s a sight so inspiring that I sometimes find myself going to the men’s room even when I don’t need to.

As for the Honickman’s actual ground-level outpatient experience …well, based on my three doctor appointments there since the building opened in April, that’s somewhat less uplifting.

The experience begins when you enter the Honickman lobby to be greeted by the backsides of a dozen bewildered patients struggling to check in at one of the Center’s dozen or so computer kiosks. Yes, I know—when you’re tapping into a computer from the familiar security of a swivel chair in your home or office, this task is a piece of cake and sometimes even fun. But if you’re aged and infirm, or ill, or handicapped, or technologically challenged, or you’re dripping with rain or snow, or you’re nervous or apprehensive because, after all, you need to see a doctor, this process can be traumatic, not to mention time-consuming.

Should you survive this initial ordeal, you must next pass through a metal detector, which I suppose is a friendlier process than boarding a cattle car bound for Dachau (although, never having boarded a cattle car, I can’t say for sure). If you make it through, you are next directed to the appropriate elevator for your floor— and since there’s apparently only one elevator dedicated to each floor, you must wait fretful minutes and minutes before boarding an elevator filled with maybe a dozen anxious souls like yourself. When you arrive at your floor, you and your fellow passengers find yourselves disgorged into the end of yet another long line of impatient patients waiting to be checked in by two receptionists who seem overwhelmed, worried, and not exactly overjoyed to see you.

Shades of The Exorcist

As for the Honickman’s 300-plus examining rooms—all of which, I’m told, are identical—first, the good news: Each room is equipped with a comfortable soft patient chair that records your weight automatically while you’re seated, so you don’t need to step onto a scale. Unfortunately, this patient’s chair—not to mention the doctor’s desk and all other furnishings in the room—is bolted to the floor and incapable of moving or swiveling. So, to make eye contact with your examining physician, you must crane your neck 45 degrees. When the doctor taps on his/her computer, those computerized notes are helpfully projected onto a screen on the wall— but to view them requires craning your neck 90 degrees.

When I mentioned this complication to my doctor, he invited me to move to a less comfortable (and also immobile) bench in the corner, where I could view him (albeit from a greater distance) without turning my head but could not view the screen on the wall without craning my neck by 180 degrees. I was beginning to feel like Linda Blair, doing her full 360 in The Exorcist.

When the visit is done, the doctor departs, but the patient remains in the examining room for a virtual checkout. It’s a theoretically simple procedure: A screen message instructs you to press a button marked “Continue,” which will connect you to a live human face somewhere in the Western Hemisphere. Or is it the Eastern Hemisphere? Unfortunately— I’m using this word a lot, yes?— I couldn’t find the “Continue” button. I would probably still be there if my virtual interlocutor hadn’t appeared on his own.

Calling Frank Lloyd Wright

The good news: Had this experience driven me nuts, the Honickman no doubt could have quickly moved me to its psych ward without requiring me to don a coat or step outside or call an Uber or anything. And if I’d twisted my neck from all that craning, some Jefferson surgeon would be available to twist it back, just a short— well, maybe not so short— elevator ride away. One-stop shopping, indeed.

Have you ever been to Fallingwater, the famous house that Frank Lloyd Wright designed in western Pennsylvania? When it opened in 1935, architecture critics praised Fallingwater for its stunning design. Everyone agreed that Fallingwater had uniquely achieved the harmonious union of art and nature. But nobody wanted to live there.

Next question: How come every time I visit the Honickman Center, I find myself thinking of Fallingwater?

What patients need

“You don’t need to be a genius to be a doctor,” my Penn classmate John Owens, later a cardiologist, often advised his medical students. “You just need to know how to listen to your patients.”

I would offer similar advice to Jefferson University’s empire-building geniuses: You don’t need stunning landmarks to create a great health system. You do need to provide a secure and welcoming environment for patients. That requires an institutional understanding that a visit to the doctor— unlike going to the theater or a ball game— isn’t something most people look forward to.

Patients need reassurance. They need friendly faces. They need receptive receptionists. They need angels of mercy. Furnishing these special features requires the sort of humility capable of appreciating that a health care system needs its patients as much as the patients need the system.

I realize that money can’t buy human kindness, empathy, or warmth. And in any case, I’ll continue to utilize the Honickman Center, because my preferred doctors— who, increasingly, are Jefferson employees rather than independent practitioners— have been moved there. I understand the economic requirements of state-of-the-art modern medicine. But surely it doesn’t cost $762 million to teach employees to smile?

Enjoy Dan Rottenberg’s newest book, The Price We Paid: An Oral History of Penn’s Struggle to Join the Ivy League, 1950-55. You can also visit his website at www.danrottenberg.com