A few years ago, Krumholz would describe this paradox to medical groups and get blank stares. But these days, it's "starting to be met with universal head-nodding," he says. "People embrace the idea as if a light has gone off, and they sort of recognize what they've been seeing in front of them all this time, but haven't been able to describe well."
That's because doctors' clinical perception has been clouded by the patient's history, and the focus has been on what led the patient to the initial hospitalization, and trying to get the acute symptoms resolved. Providers forget about this other thing that's been hovering right there in front of them. The elephant in the room—the "hospitalization toxic."
"When I call this the 'hospitalization toxic,' I don't mean that we're purposefully harming people or exposing people to anything, of course," he says.
"It's just that when we're in the process of trying to provide life-saving therapies, we're indifferent to the aggregate of what we cause the patient, which we consider minor inconveniences: Dehydration, malnutrition, deconditioning, information overload, dislocation, and chaotic scheduling." Then there are the medications and their cumulative effects.
"The aggregate of all that," he says, "is what causes patients to lose their equilibrium."
And that leads to patients getting readmitted. And of course hospitals and the physicians who treat their patients are increasingly concerned about preventing those.