Same-Day Surgery Manager

At the end of the day . . .what really matters

By Stephen W. Earnhart, MS
Earnhart & Associates
Austin, TX

Everything seems to be about health care these days. Everyone has an agenda on what is best, for whom, and how much it will cost whom.

I am in a unique position this month to share my views with you from several aspects. But before I do, I want to remind all who read this, that at the end of the day, we provide care and comfort to those who need it the most: our patients. They are the only reason why we are here. More on that later.

As a consultant, I have the opportunity to provide hospitals, surgery centers, recovery centers, and other health care facilities to other countries that currently have "socialized medicine." The systems we set up are for those of means who can afford the luxury of seeing a quality physician of their choosing and have their surgery done or aliments treated quickly and professionally. The centers we establish are all "cash up front," and the word "insurance" is never spoken. There is no need for insurance when you pay out of pocket. Interestingly enough, we are setting up these facilities in the United States for the same reasons.

The question I am always asked is, "Is the service and treatment better in these cash-only facilities." The answer is obvious: unquestionably! There is virtually no comparison between the "socialized" programs and the "cash programs." This is not a political statement on my part. It is simply the fact. What we do in these new centers is simply eliminate the insurance company who —- by the way — contributes no care whatsoever in the system. In this two-class health system, the money goes straight from the patient's wallet to the surgeon's wallet. Ultimately, it is cheaper because there is no middle person involved to muck it up. There will always be those who can afford it and sadly, there will always be those who cannot. No one ever said life is fair.

So with all this being said, what can we do? Nothing. Absolutely nothing, except to do the job for which we are all paid, in one way or another. There is too much money at stake, too much special interest, too much greed, and not enough desire to make it happen. So, let it work itself out, and let's do our job and take care of the patient.

About four weeks ago, I developed a pain in my arms and shoulders following a minor bicycle accident. I ignored it and lived with the pain. However, it soon got worse, and my left arm started getting "heavy" and "clumsy." The right side of my body was tingling. Cold water felt hot, and hot felt cold. Within a couple of days, I couldn't sign my name, and I noticed that I was keeping my hand in my pocket so it wouldn't stray. About nine days ago, everything started going from bad to worse. I couldn't type, and I couldn't use e-mail except with one finger. The pain was now intolerable and untreatable. My left arm was numb and essentially useless, the right side of my body was living its life without me, and I was walking with a decided canter.

Ever the business owner, I continued to work and travel. A little over a week ago, I was having dinner in Los Angeles with — as luck would have it — an orthopedic surgeon and a spine surgeon. And after dropping everything in sight, one of the surgeons asked me if I was OK. (I'm sure he thought I was drunk.) I spilled it all out. Early the next morning, I was inside an MRI tube. An hour later, I heard the words that no one ever wants to hear, "I have never seen a compressed spinal cord as bad as yours."

I wanted to have the emergency cervical surgery in Texas for family reasons. That trip back home was harrowing. I feared every bit of turbulence even though I was wearing a protective neck brace. Thanks to my referral from California, I was seen immediately upon arrival in Texas and underwent a C6-C7 cervical fusion with donor graft and a plate and screws in my spinal cord. I was released in two days, and suddenly everything works again. I take my first plane trip in the morning and cannot wait to see how interesting getting through security is going to be.

But again, with all that is happening in health care right now, I had great surgeons, outstanding nurses, great anesthesia care, and a new sense of appreciation for what all of you do that makes a difference. Here's a sincere and grateful thank-you to every nurse, surgeon, tech, front office staff, nurse's aides, med nurse, aftercare specialist, surgical fellow, and all the other people who made a difference to another human being.

For what it is worth, not a single politician was involved in my care.

(Earnhart & Associates is a consulting firm specializing in all aspects of outpatient surgery development and management. Contact Earnhart at 1000 Westbank Drive, Suite 5B, Austin, TX 78750-2254. E-mail: Web: