January 02, 2014

Library director encounters clinical quality first-hand
Scott Plutchak's diagnosis of transverse myelitis exposed him to a quality of medical communication not often encountered.

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As you woke up this morning, you probably got dressed for work as if on autopilot. But for patients like Scott Plutchak, director of UAB’s Lister Hill Library of Health Sciences, it requires more thought and effort. Plutchak has transverse myelitis, a swelling of the spinal cord that affects motor control.

scott-plutchak-inside“Getting into a dress shirt in the morning is a lot of work,” Plutchak says. “I use a button hook to try to get the small buttons, but managing buttons is really tough.”

The morning routine that once took him 20 minutes now takes an hour. Though he can still drive, his walking is limited to a block or two, so when traveling for work he relies on the wheelchair assist at airports. His condition causes numbness and tingling in his arms, legs and feet, as well as a variety of twitches and tremors that come and go.

Plutchak’s battle with transverse myelitis began in December 2012 when he suffered sudden paralysis in his home. He remembers collapsing on his couch and calling for his wife to summon emergency medical services before passing out.

“For several months before I had some tingling in my fingers that I didn’t take as seriously as I should have,” Plutchak admits. “I figured it would go away or eventually I would get around to going to the doctor, that it was probably pinched nerves.”

During the ride from his home to UAB’s Emergency Department, emergency medical specialists tried to determine if he had suffered a stroke or was in need of immediate surgery. An MRI revealed swelling along his spinal cord, which can be caused by illnesses including multiple sclerosis. Brain scans, a spinal tap and visual tests of his optic nerve ruled out other conditions. Over the next two days, Plutchak underwent additional MRI scans and a variety of other tests as physicians searched for an underlying cause for the swelling. “It's really a matter of continuing therapeutic interventions in the hope that they will bring the inflammation down and give me some relief of the symptoms, and perhaps find something that indicates what has caused this,” Plutchak says.

From the moment he regained consciousness, Plutchak says he had the sense that he was being given a lot of information by the physician in charge. They gave very clear descriptions of what the doctors saw in the scans, and what they felt was the most advisable course of treatment.

“From the nurses, patient care technicians and residents coming into my room, everyone seemed really aware of what my condition was,” he says. “So it wasn’t that they were just sharing information with me, but I had a real sense they were sharing with each other.”

He says he was most impressed with the number of people involved in his care, and he always felt he could ask questions and get clear answers.

“It struck me as an incredibly complicated process of making sure that everybody is in the loop and that the patient really feels included in the process of their care,” Plutchak says.

Plutchak says that he felt like some of the very best people in the world were working together to try to figure out what was wrong with him while coming up with the best options. He says they really listened to each other but also included him in the decision-making process.

Over the last year Plutchak has had three hospital stays, including the one that resulted in his initial diagnosis. In April 2013 he was admitted for two days after his symptoms worsened. His doctors decided to be safe and do another MRI for further evaluation. In August, Plutchak was admitted for 10 days for plasmapheresis treatments to help relieve symptoms of transverse myelitis.

Plutchak notes his stay in August made him really notice how the staff at UAB truly focuses on patient care and experience; everyone considered connecting with patients his or her responsibility.

Plutchak says he really began to notice how different UAB is in its approach to the patient experience when he attended a joint board meeting for the Editorial Board for the British Medical Journal in London. At the meeting, he listened as others on the board described cases they had researched where physicians order too many tests and over treat patients in American health care. They said it is also common for patients to not be involved to the degree they should in their own treatment.

“As they were talking about the kinds of things that they study, it made me aware that my experience was quite different from what is unfortunately often times the normal health care experience,” Plutchak says.

Plutchak says that he has spent his entire professional career in academic medical centers and is very comfortable in that setting: “It's not scary to me.”

However, he says that so many of those coming to UAB are coming from rural areas, and are here because something really terrible is happening to their family or loved ones. “I think about what a difference it must make for those people to get the kind of connection like I had with my teams at a time when the family is going through terrible things,” Plutchak says.

“This type of patient feedback is further evidence that our Reaching for Excellence culture change methodology is working," says Rodney Tucker, M.D., director of the Center for Palliative and Supportive Care and associate professor in the Department of Medicine’s Division of Gerontology, Geriatrics and Palliative Care.

Tucker explains that the collective goals across all of UAB Medicine center on efforts to continue enhancing quality, safety and patient satisfaction. “All together this constitutes the patient experience, so we appreciate this feedback from our patients and families as part of our validation.”

Plutchak was in an elevator at The Kirklin Clinic for blood work recently when he noticed the posters for UAB Health System’s Core Values: Always Care, Own It, Work Together, and Do Right. He says he couldn't help thinking that everyone at UAB truly takes these values seriously – and how thankful he is that they do.

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