It appalled me this morning to read the headlining story on the Huffington Post regarding medical doctors who basically participated in the tortureof detainees at Gittmo. As I read the story, I spotted a link to another story regarding medical double billingand managed to gulp that down without regergitating all over myself what the medical profession has become in this country. Then I reflected over my current job and the way some people in my organization act towards their "choosen profession" and I wonder if we will ever see health care reform. Let me tell you something, it goes alot deeper then price fixing.
This is one nurse's view as the diary progresses.
I started out working to help people after graduating with a BS in Psychology. I got a job initially with a state Department of Corrections administering psychological tests and educational achievement tests and was promoted to Counselor, and after completing my Masters I was promoted to psychologist and eventually was promoted to an Administrator's position. For several of those years I worked with inmates in segregation and fought to ensure those inmates placed in segregation because of mental health problems got mental health treatment and eventually placement at a correctional facility designed to handle prisoners with mental health issues. After fourteen years I left Corrections after the ongoing battles between treatment and security became such a distraction, we all had lost sight of our goals.
I worked for a short time in Community Mental Health, but sadly I think my years in Corrections had clouded my clinical impressions of some patients I saw and I was not truly pleased with my work. During this time I had for many years volunteered with my local rescue squad and loved dealing with more immediate problems, many of which you saw corrected in a matter of days rather than months or years. During this time I was one of the first pancreas/kidney transplants while it was still considered an experimental procedure and from a patient's perspective saw a great deal of the health care system at work. A side note here, my transplant was done at the University of Virginia and I was their first such transplant. Folks I have not been back in a while but I will tell you the nurses were great as well as the docs and entire staff. This is the way health care was supposed to be. People truly caring for people. I've tried ever since to keep that experience in mind as I treat patients today.
I became interested in nursing, and a short time later changed careers at the ripe ole age of thirty nine. Before I went into nursing I took some science refresher courses and due to my grades the doctors at U. Va. promised me a slot in medical school if I wanted it. I thought about it and thanked them and continued on to become a Registered Nurse. The first three and a half years after graduating I did my mandated medical experience work, including becoming certified as a Cardiac Critical Care Nurse. Despite all that I somehow ended up doing psychiatric nursing, which I did for a number of years. It was here I noticed the change in health care, as well as a change in how my colleagues viewed their role in patient care.
Medical care has become a cost containment practice, no matter what the patient's needs. Any time something that is designed for human welfare becomes something you can turn a quick buck for then the financial benefits always seem to outweigh the humanistic cause (yes I understand that health care staff must eat as well, you'd at least think they would get us something better then hospital food though). I went to a Catholic University for my Nursing degree. I was told my first semester there that "nurses eat their young", that sadly is true. If you want to see how bad it is go to your local real estate office and ask how many of the realtors’ are former nurses, bet you it's high. Certain patient populations are also considered a bane to your existence. Watch the next time you are stuck in your local ER and if they have psych patients. Then watch to see how well ED staff avoid them and raise hell to get them transferred out of the ED.
The old and elderly who may have cognitive impairments are given sweet assurances and a pat on the hand, but they too are shuttled out as quickly as possible because their needs can overwhelm and already over burdened ED staff (Code browns are no fun). I have worked in a nationally known hospital where despite all the fine medical training, doctors and nurses overlook a simple fact. Because a patient has a mental illness, it does not mean the patient doesn't have a concurrent medical issue. Take for example a patient brought up right before my shift started. The admitting nurse did not have time to start the admission assessment but told me the patient on arrival did not "look right". The patient was brought in by a local rescue unit after he had been found mumbling and crying in an apartment hallway. He claimed that his landlord was with the mafia and sent "his goons to beat him up for some information he had". After being beaten, the patient told the ED staff some aliens had shot him with "invisible bullets" and his chest hurt. The patient was medically cleared for psychiatry and sent up to us. I went in to assess him and immediately notice the rise and fall of his chest was wrong and his breathing was labored. His right jaw was completely swollen. Upon listening to his right chest sounds I noted there were none. I called the hospitalist and got him transferred immediately out only later to find he had 3 fractured ribs, one of which had pierce his right lung and it had collapsed. Upon doing and X-ray of the patient's jaw (just because it looked bad) they found his mandible was completely fracture in two pieces. At another hospital it was worse. A patient was cleared medically in the ED to be admitted to psychiatry and the patient transporter who brought the patient up remarked to the admitting nurse the patient did not look to good. The nurse checked the patient and remarked "your right, he's dead".
I have worked in a nursing home as a supervisor and have a nurse go on lunch break in the middle of the night after having respiratory therapy confirmed a newly admitted patient was not breathing. Needless to say this nurse never called a code or said anything to anyone, though she had remarked earlier the woman was so old and frail her family should have made her a DNR (Do Not Resuscitate). I have seen hospital facilities go over census on a unit just so they didn't have to turn away a patient and the dollars that patient brought in. What bothers me the most though is hospital staff who forget their job is to care no matter how difficult. To work with colleagues and help new colleagues learn their way about. I have seen hospitals hire new Administrators and staff an expensive PR department while laying off nurses. All over JACHO, a voluntary commission supposedly designed to develop standards to improve patient care go so far overboard that yearly they come up with new ways for staff to treat a patient's chart but screw the patient because their requirements steals the time you have for your patients. Health care in this country has become a bureaucratic nightmare that no longer allows sensitivity to the patient and addressing their needs because it is now an impersonal "business model".
Health care professionals have lost in many ways their ability to care for a patient. The latest example of that is the article I first referenced in my opening. According to a report from the International Red Cross physicians stood by and and in some cases actually facilitated the torture of prisoners. This is a complete violation of the Hippocratic oath and these doctors should be tried and banished from the medical field. The practice of this type of medicine died with Dr. Joseph Mengele after WWII. Why did these people even consider health care as a profession? The problem is endemic in many ways. I have been told by my supervisor at work "you get into trouble here because you try to help others". No kidding, what should I do? I have seen older nurses rip to shreds young graduate nurses who were inexperianced rather then teach them to avoid mistakes. I have seen hospital units overload and go above census to cram that extra paying patient onto a unit rather then ship them else where. As a result everyone suffers.
I studied nursing in a Catholic nursing school, and there I was taught my primary role was patient advocate. Having been both a patient and nurse trust me I can advocate. Because the current medical model is so dysfunctional and profit driven it is designed to eat away at a health care professional's sense of caring. This will not get better until we reform system and go to universal health care. a pay as you go model such as ours results in teaching all health care workers there are different classes of patients who get a different level of care. This too is a violation of our oath to do no harm. I am proud of my work and will be doing it until I can no longer push my wheel chair to give out medications (no I am not in one yet). I am also a voice for my patients and do smile and laugh with them. I smile for a different reason as well, a more pragmatic reason. It's to make those bastards who enable this sick model continue wonder what the hell is he up to? Change I hope, and hope it's soon.