Case Study Mr. R. Smith, a 74-year-old Caucasian male was admitted to a community hospital for the surgical removal of a bulging disc in the lumbar region of his back. Medically, with the exception of being overweight, Mr. Smith was determined to be a good candidate for neurosurgery using a minimally invasive procedure. Mr. Smith selected his neurosurgeon based on positive comments from friends. The surgery was performed without any recognizable complications and Dr. Jones left on vacation for the next ten days. Neither Mr. Smith nor his family members were aware that Dr. Jones would be on vacation following his surgery. A second neurosurgeon in the area has been available in the past. Following the surgery, Mr. Smith experienced no complications with the exception of pain from the surgery. He remained in the hospital overnight and was discharged the following day. During the next day he experienced increasing pain in his lower back and was readmitted to the hospital the following day.The pain medication and several other medications were tried but did not relieve his constant complaint of pain. Attempts to reach the neurosurgeon were unsuccessful during the course of 10 days as the hospitalist attempted to manage Mr. Smith’s back pain. The surgical notes and post-op care were not in the EHR. Follow-up X-rays showed no visual reason for the increasing pain. Upon Dr. Jones’s return from vacation, Mr. Smith was returned to surgery. Visualization of Mr. Smith’s original surgical site indicated that bulging tissue was still present in the lumbar region with other tissue fragments visible. A second, more invasive surgery was performed by Dr. Jones, and within a few days Mr. Smith was transferred to a rehabilitation center and eventually was able to return home. Case Study Questions What are the critical issues in this case description? Consider the six aims (STEEP) to better ensure quality care. How might they apply to this patient? Is this patient-centered care? Why or why not? Which of the core health care competencies could have impacted this case? How?