Ascending and Descending

So the cover of JAMA this past week showed a picture based on M.C. Escher's Ascending and Descending drawing (which made me super happy because I really like Escher's work!).  More importantly, however, the topic of the journal this week was about hospital readmissions.

This isn't really a topic that I had really thought about before, but I have to say that the people in Escher's drawing, traveling either up or down (or simultaneously both), seem to capture the paradoxes of hospital admissions/readmissions.  It seems like hospitals are always playing a numbers game: cutting down on ER wait times, increasing admissions numbers, increasing discharges, and decreasing the number of days in the hospital.  If all of these factors were satisfied at the same time, I'm assuming there would be some sort of math error (like when zero is in the denominator).  It seems highly unlikely that hospitals could simultaneously shorten hospital stays while then reducing readmissions.  In fact, shortening hospital stays may be the reason that more and more readmissions are occurring.  Sometimes the disease process needs longer than a few days to enfold, and sometimes people need to come back to the hospital for treatment.

The bottom line of most of these articles is how to make medicine more efficient.  Granted, this is a very important goal, but sometimes I wonder if we need to change our expectations about health care outcomes so that we don't end up going in circles like the people in Escher's drawing.