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I passed my RN state boards in 1972, and went to work for a large hospital affiliated with the Mayo Clinic,  on the surgical orthopedic unit. I invite you to join me on this trip back to the days when medicine was still considered the healing arts, before it all got sold out to profit making corporations. And lets say you name is Joe, and you are facing surgery to replace a worn out hip.  

You arrived the evening before your surgery, and were immediately assigned to your Primary RN (me).   I would let you get settled in your room, then come in to visit. First I'd explain that for your whole stay, I will be in charge of coordinating all aspects of your care, as your Primary Nurse. If you have any problems of any kind, with anyone, or with any aspect of your care, you could turn to me, and I would facilitate a solution.

I'd probably spend an hour or so taking a complete medical/social history, do an initial physical assessment, and then together we would write your plan of care for your stay with us. This included not only physical/medical needs, but social, emotional and spiritual needs. We'd also discuss preliminary aftercare planning.

This also gave you the chance to talk about your fears and questions regarding the surgery to come. If you were anxious and didn't think you could sleep,medication was willingly dispensed. You see, the whole focus of my training was on insuring optimal care for  well being of my patient, physically, mentally and emotionally.

Before I left my shift that night, your care plan would be written up and placed on the cardex, visible to any other caregiver you would have on my off shifts. No one  including the nurses aids,  took care of any patient without first reading the condensed care plan, and the nurses notes from the preceding shifts. It all worked. Any change in condition or need to deviate from the written care plan was marked with colored flags, which were also communicated nurse to nurse at shift change.  Night shift nurses would go through all the doctors orders from the day just past to make sure every single one was transcribed in all the necessary places.  

By the time I got back on duty the next day, your surgery would be over, and you'd  be back in your room floating in and out of your comforting cloud of good drugs. This was when I'd go over every note since I'd last seen you, and make sure all orders had been followed, and nothing missed. I would also do all of your personal cares, which gives a nurse the best possible opportunity for acute observation of condition.

 We were also well trained in pain control measures, fully aware that it works much better to stay on top of the pain, than wait till it's severe and then try to control it.  I'd coordinate with physical therapy and keep an eye on progress, and we' d also start talking about discharge plans.  It was part of my job to make sure that when you were discharged, whatever help you needed at home was arranged, including special equipment.

Almost always, when that day came, it was like saying goodbye to another new friend.  You went home with a phone number you could call and reach me for a few weeks more. In other words, I was with you or a phone call away,  every step of the way, start to finish.

At the most, in this kind of Primary Nursing, I'd have full responsibility  for the coordination of care for 4 to 5 patients at a time, never any more than that.  It was intensely satisfying work, and as a Primary Care RN, I was a respected member of the Team.

But this was back in the GOOD old days, when the whole circle of health care providers  revolved around the patient, who was always in the center of the circle. I loved my profession then: I was proud of it. It truly was all about healing, first and foremost.

Then it all came apart before my very eyes, over the next 25 years. As we turned away from defining health care as the healing arts, and turned it into a profit making business, the patient, once the center of the circle, was slowly spun off to an outer ring of that circle, and profit took his place in the center. For me, the process of being forced to abandon patient centered principles of care and replace them with cost centered measures,  that took me further and further away from my patients was literally excruciating.  

People who had nothing to do with health care, but everything to do with efficiency and time management and counting beans were calling the shots now. We saw our work loads double and triple, based solely on the minimum amount of time some "expert"  determined it should take us to do Procedure A or Procedure B.  

None of it left any time for listening to a frightened patient, or sitting with a grieving one, or hands on comfort measures. It was soon determined it wasn't cost effective to provide all those services anymore, and when my work load got to the point where I couldn't even provide safe monitoring of post op patients, I left to find a less critical kind of nursing, in psych and long term care.  Both of which were turning into equal nightmares in their own particular ways.

One thing was always the same: it was the patients who suffered the most as this went on. Oh not the wealthy ones: they had very loud voices and wouldn't stand for anything but top level care, and they could afford to buy it.

It was the non wealthy, the  poor, the sickest, the oldest, the weakest ones who had NO voices, that paid the highest cost, as always. And us old school professionals who had to watch this atrocity happen and were unable to do a damned thing to stop it.

I am still surprised I survive it at all. I can't even describe the heart pain of having to walk past suffering people day in and day out,  people you know you could comfort or relieve their pain so easily, but no longer being allowed to do so, at risk of being fired for "poor time management" skills, and yes, my file was full of that kind of accusation.  

My back injury probably saved me from an actual heart attack, and although I held on in part time positions for several years, I had to quit at age 55 and go on disability.  By that time, my on-duty hours in a geriatric setting consisted mainly of pushing pills and shuffling paper. I saw little of my patients unless they were falling down, bleeding or needing CPR. I am glad to be done with all of it.

Those of us who are still around to remember how it was have an obligation, in my eyes, to share this information with those who have no way of knowing.  Once we really did know how to treat the sick and the aged and the vulnerable as valuable human beings, and we really did know how to help people heal.  And we knew how to value the healers, too.  

Originally posted to Old Timer's Journal on Fri Apr 22, 2011 at 03:40 PM PDT.

Also republished by Community Spotlight.

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Comment Preferences

  •  Tip Jar (127+ / 0-)
    •  An interesting question... (15+ / 0-)

      Why is it that back in the old days before the "efficiency experts" did their job and "rationalized" health care to make it more "efficient", we actually spent far less on health care than we do today? How can it possibly be that a procedure that is day surgery today costs more (adjusted for inflation) than it did back in the days when you'd have spent several days in the hospital with the kind of extensive support described so well by the diarist?

      Yes, I know that some of the difference comes from the expensive medical technology that we've developed in the intervening years.  But I can't help but be curious how much of the difference has landed in the pockets of investors and corporate executives?

      Political Compass: -6.75, -3.08

      by TexasTom on Sat Apr 23, 2011 at 08:39:54 AM PDT

      [ Parent ]

      •  Most of it (22+ / 0-)

        Now, every single layer of the  multilayered entire health care delivery system is in it to make as much profit as possible. This is why I could go online and find a walker I wanted for 125.00, but that same walker, if purchased through a Medicare approved medical supply company, ends up costing the taxpayer 395.00. This is in addition to the costs of seeing a physician who will certified the need for one.

        Another example. I once did RN Home visits for a group home company that ran homes for the developmentally disabled. Most of the clients living in these homes were fairly young, healthy adults. Law required monthly RN visits. I'd spend two hours examining four totally healthy adults, for which Medicare/Medicaid was charged for four separate RN  visits at 100.00 each. (400.00. This was some years back.) My wage for this time spent was 50.00. Pretty profitable gig for that company, huh?

      •  Administrative costs because hospitals have to (13+ / 0-)

        keep dozens of different insurance costs on file.  The cost of covering what little care uninsured patients who can't pay their bills receive - that cost gets spread over the hospital to be recouped in different ways. Added insurance costs, because the insurance companies need their profits. Profit - hospitals want to profit, insurance companies want to profit, everyone wants to profit. The only one who loses out in this situation is the dollar sign - oops, I meant the patient.

        "Here's to our last drink of fossil fuels - may we vow to get off of this sauce...shoo away the swarms of commuter planes...and find that train ticket we lost."

        by terra on Sat Apr 23, 2011 at 10:52:18 AM PDT

        [ Parent ]

      •  P-R-O-F-I-T. (2+ / 0-)

        "We the People of the United States...." -U.S. Constitution

        by elwior on Sat Apr 23, 2011 at 11:53:54 AM PDT

        [ Parent ]

      •  High cost of corporate medical care (7+ / 0-)

             Between 1960 and 2008, the cost per individual for health care increased 5% per year.  The salaries of US workers grew at 2% per year during the same period. Obviously health care became more expensive for each of us.  

             If you look at the growth of cost in the same way as growth of compound interest, you can divide 5% into 72 to get a doubling time of 14.4 years.  Now divide 14.4 into 48 years to get about 3.3 doubles. ( I hope this is mathmatically kosher.)  

             That doesn't sound too bad until you look at it like this:

        First 14.4 years  -- cost of medical care x 2  =  2 X cost

        Second 14.4 yrs -- ( 2 x cost)   X 2    =  cost x 4

        Third 14.4 years --4 x cost  doubled   =   cost x 8

        So, maybe we are paying about 10 X the cost of medical care per individual now as we did in 1960.

        What bites is that wages per worker have increased far less rapidly--about 2% per year during that time.  So doing the old compound interest trick with that growth, we divide 2% into 72 to get a 36 year doubling time.  

        Then divide 36 into the 48 year time frame to get about 1.3 doubles in average wages since 1960.  

        If the worker earns a bit more than twice as much, but health care costs ten times as much as in 1960, we have VERY expensive medical care.

        Who gets the money?  Medical professionals have had 5% income growth during that period, rather than the 2% increase in the general economy.  But, I think they work harder, see more patients per day, and they see sicker patients than before.  And because the patients in the hospital are sicker, more staff see each one daily, generating a higher bill.  

        Personally, my income as a physician (not adjusted for inflation) has about doubled since the 70's when I started practice, but that is less growth than the inflation-adjusted income growth of the average worker.  So, I'm losing ground.   I work harder and do more damn paperwork.  The system treats me as if I am a thief, and I have to document document document to be able to prove I'm doing what I bill for.  

        The RN who wrote this diary describes being required to work harder to keep up with the demands of administrators. That's also my experience.  I agree with the diarist.  Good for you!

        Where does the money go?  "Not here", says Doc Z.  Check the insurance companies, big pharma, hospital chains, medical equipment suppliers, and especially those CEO's.

        Bush hijacked the US with lies about 9/11 and crashed it into Iraq, killing over 500,000 human beings. So far, he's avoided arrest and prosecution.

        by Zydekos on Sat Apr 23, 2011 at 04:22:38 PM PDT

        [ Parent ]

        •  The overlords (3+ / 0-)

          ...who own the medical system now will never pay doctors and nurses one thin dime more than they absolutely have to, and that's after they got you doing the work it used to take two people to do.  Here I see many doctors setting up their own group practices, then building their own day surgery centers and testing facilities, and they seem to be making out pretty well in some cases. But more often I see clinics being bought up by hospital and health care conglomerates, and of course, insurance companies. All of whom are apparently competing over who will get to run the ACO's come 2012.

          From listening to my own Doc talk about what she goes through, you couldn't give me HER job either!

  •  spring cleaning, and (34+ / 0-)

    I came across copies of some old medical bills. These are from the early '90s, in a New England college town, so it was a sophisticated medical setup but not big-city:

    Office visit   $32.00
    Several labs and analysis tests,
    as ordinary testing for base numbers   $26-27 each
    Mammogram  $110.00

    Even then, a number of these were rejected by my insurance company, it says, so at least that part hasn't changed.

    And a much earlier one, from the early '70s, when I had to go to an ER because of something in my eye. The initial visit, plus treatment that included antibiotics, plus a follow-up visit, cost $7.50.

    :: sigh ::

    Your diary is spot on, scribe.

    Yesterday's weirdness is tomorrow's reason why. -- Dr. Hunter S. Thompson

    by Mnemosyne on Fri Apr 22, 2011 at 05:30:27 PM PDT

    •  My parents have my mother's birth bill framed on (24+ / 0-)

      the wall.  I think the total for a week or so in hospital was around $16.00.  Now admittedly, that was back in the late '30s.

    •  To me, it's not the prices. It's the money versus (28+ / 0-)

      care feeling.

      As I say elsewhere, I'm having surgery on Monday to remove a tumor on my thyroid. Outpatient if it's a partial removal of the thyroid, with my going home to late in the afternoon, at which point, I'll be on my own.  A night in the hospital if the whole thyroid is removed.

      I haven't seen a doctor in ten years. So I went to a clinic and saw a primary physician, then a specialist, then a surgeon. All nice people, all willing to answer my questions, but always a bit of a sense of "Let's get this done as quickly as possible."  In and out.

      So you're left with an just a wee bit of an uneasy feeling that you're a product on an assembly line.....

      Freedom has two enemies: Those who want to control everyone around them...and those who feel no need to control themselves.

      by Sirenus on Sat Apr 23, 2011 at 04:30:06 AM PDT

      [ Parent ]

      •  I'm 55 (21+ / 0-)

        and grew up just post polio epidemic.   I remember the family doc coming to the house when I had freaking pinkeye when I was 4.  PINKEYE!   I remember quarantine signs on the doors of houses where sick children lived.  That would have been 1960 so I'm not sure what was going around at that time, I would guess measles, but I could be wrong.   Public health is a joke too.   I hope that americans are so repulsed by the GOP that we can get both majorities back, keep the white house and then do some social engineering of our own.  Single payer, schools funded, campaign finance reform......If I believed in god, I'd pray for that.

        How did we go so far backward, so quickly?

        •  I'm 59, but I grew up on air bases. (18+ / 0-)

          So a quick trip to the dispensary, no problem.

          Had pneumonia when I was 14 and ended up getting hospitalized. (I was such a shy kid that no one noticed how badly I was coughing--Mom was in the hospital and Dad was clueless--and I didn't complain about how awful I felt.) Ended up in Tripler Army Medical Center. I LOVED it! No going to school, no beds to make, or meals to cook or laundry to wash....they fed me chocolate milkshakes and I got to watch TV all day and read books brought around on the library cart. Of course, I was feeling no pain....

          But even just ten years ago, I remember being able to spend a few minutes joking with my doctor without that sense of "time is passing"...

          Freedom has two enemies: Those who want to control everyone around them...and those who feel no need to control themselves.

          by Sirenus on Sat Apr 23, 2011 at 07:14:15 AM PDT

          [ Parent ]

      •  The assembly-line feeling (4+ / 0-)
        Recommended by:
        JVolvo, SadieSue, Zydekos, wader

        may come from the fact that this is your first time with this illness, but the professionals you saw do it every day. The surgeon I worked for told me to always remember that. If you saw all those people on the same day, that's really a well-run clinic. Also, if I understand correctly, most cancers are best treated quickly.

        My sympathies for what you're going through. My personal experience with one-day surgery, alone and not alone afterward, pushes me to ask you to consider having a friend or family member spend that night with you. Surgery is a physical trauma to the body, so naturally it leaves most people a bit shaken.

        Those friendly people, willing to answer questions, sound like real allies, however briefly. If you can do a difficult thing in an uncomfortable situation and joke with them a bit, my bet is it would be received with a fountain of warmth. I suspect most of them trained for this because they wanted to care for people, but the assembly-line approach may not share their values.

        Hope you have a speedy, easy recovery!

        I haven't seen a doctor in ten years. So I went to a clinic and saw a primary physician, then a specialist, then a surgeon. All nice people, all willing to answer my questions, but always a bit of a sense of "Let's get this done as quickly as possible."  In and out.
        •  Actually, I saw these people in different offices (3+ / 0-)
          Recommended by:
          JVolvo, cotterperson, Zydekos

          over the course of about a month. And I've tried to joke with them. It tends to fall a bit flat.

          When I had my leg repaired ten years ago, I asked my surgeon if he had been partying the night before.  He said "No." I asked him to hold out his hands and he made them shake like crazy. "Oh, no, I'm doomed!" He just grinned at that.

          Now,  if I tried that kind of joke, I have a feeling they'd start wondering if  I was trying to create a basis for a lawsuit and pitch me out into the parking lot. Hopefully in my clothes, not those little paper outfits. Hiking around in the middle of Fort Worth, TX in a backless paper shift is not my idea of fun.

          Maybe it's just me. The more body parts I have to get repaired, the more depressing it is.

          Freedom has two enemies: Those who want to control everyone around them...and those who feel no need to control themselves.

          by Sirenus on Sat Apr 23, 2011 at 01:21:46 PM PDT

          [ Parent ]

          •  Oh :( (0+ / 0-)

            I'm an oldfart myself, and was thinking about before the MBAs took over "medicine" in the '80s. Calling it "healthcare" broadened the market, doncha know ;)

            Thanks for the giggle from the mental image I got when I read this:

            Hiking around in the middle of Fort Worth, TX in a backless paper shift is not my idea of fun.
            •  Flashback to the scene in "The Right Stuff." (0+ / 0-)

              Except that I'm 59, female and not an astronaut.

              Pleeeeassse give me my clothes back before you kick me out.

              Which they did. I mean, give me my clothes back. Did get to joke a bit with the operating room team too.

              Had the operation yesterday. Home directly after, since it was just a thyroid removal. Sick most of the evening until I threw the damn pain pills away; much better today. Eating fine, no pain.

              Best. Word. Ever.

              Benign.  

              Freedom has two enemies: Those who want to control everyone around them...and those who feel no need to control themselves.

              by Sirenus on Tue Apr 26, 2011 at 04:15:03 PM PDT

              [ Parent ]

  •  This is heartbreaking, scribe. (45+ / 0-)

    The view my grandmother held of hospitals, as dangerous places that you have to watch like a hawk if you're there, a view that was outmoded when I was a girl, is back again. I'm glad she's not seeing this. She came here because she thought this was the greatest country in the world, a country that could do anything. But there's a difference between "can" and "will".

    •  big difference, belinda (27+ / 0-)

      between "can" and "will". Plus, what seemed to have been factored totally out of the mix is the wanting-to-simply-because-it's-the-decent and humane way to treat each other.  This is the inevitable outcome when a societies value system gets all turned inside out, like ours has.

    •  I recommend to everyone I know (41+ / 0-)

      that, if they go in the hospital, have someone there with them as close to 24/7 as possible. A friend or a family member should be the one, but there has to be someone there who has the patient's, and only the patient's, best interests at heart, because nobody in the hospital will any more. For me, that person has had to be Charles. This last time when I was in the hospital (this time for a kidney transplant) I was in there for over a week, a week that he had to take off work under the Family and Medical Leave Act (some of that time without pay) in order to be there for me. He also had to go home at night, an hour to two each way, and feed the dogs, and I made sure to stay awake and alert the whole time he was gone because there wasn't anyone else staying there with me. Each night after the dogs were taken care of, he came back to the hospital to sleep on a cot.

      There have been other times when I've been in the hospital and he's had to either sleep on the floor, or sleep in a chair.

      I would have done the same for him when he was in the hospital overnight a couple of years ago, but he made me go home and do dialysis instead.

      Organ donors save multiple lives! A donor's kidney gave me my life back on 02/18/11; he lives on in me and in others. Please talk with your family about your wish to donate and sign up to give others the gift of life.

      by Kitsap River on Fri Apr 22, 2011 at 10:01:31 PM PDT

      [ Parent ]

      •  Absolutely agree, Kitsap (24+ / 0-)

        Always keep a trusted person with you when hospitalized, if at all possible. So often there is short staffing and/or nurses and aids floated to floors they are not familiar with, or pool nurses, and almost always people are overworked and under stress.

      •  I did that for my mom (22+ / 0-)

        showed up at the hospital or the nursing home every single day.  stayed there most of the hours I was not working.  showed up at different hours so the staff would not know when "the pushy daughter" was showing up.  explained more than once that my being there meant that the patient would be more comfortable without having to ring for the aide everytime she needed a drink of water, or a kleenex, or her pillows adjusted.

        but i was also there when they forgot to leave the call bell within her reach and she was unable to call for help, or when she needed the bedpan and the aide went to get help and "forgot" to come back, when they forgot to leave the phone within her reach and relatives were trying to call her, when it was time for her pain medicine and the aide "forgot" to get the nurse, or when she was just lonely and upset about being in the hospital/nursing home for so long.

        I'm not accusing them of negligence, well not most of them, but they are so overworked and trying to keep track of so many people at once that people who were quiet fell through the cracks.

        My greatest fear is ending up in long term care with no one to look out for me.

        "Politics is like driving. To go backward put it in R. To go forward put it in D."
        I support Bob Massie for MA-Sen

        by TrueBlueMajority on Sat Apr 23, 2011 at 06:52:24 AM PDT

        [ Parent ]

        •  same here--all of it (15+ / 0-)

          I know what you went through and I completely share your greatest fear.

          Hospitals are not safe places any more. You need someone you trust there with you to make sure you're getting the care you need.

          I would always try to be there at breakfast, lunch, and dinner because my Mom, who had had a paralyzing stroke on her right and whose left hand was crippled from a past injury, was unable to feed herself. No one ever seemed to have the time to feed her.

          And I'd try to be there on shift changes, especially if there was something critical that the next nurse needed to know. So often, they came onto the floor blind. You'd think with all the time they have to spend doing paperwork, that someone would note important information that the next shift needed to know. Or perhaps they did and the next shift had to hit the ground running and didn't have time to read the info.

          Anyway, it was a depressing, scary thing to see how poorly run our "best healthcare in the world!" hospitals are these days.

          "'Things would be a lot worse without us,' is not a winning campaign slogan." Barney Frank

          by cassandraX on Sat Apr 23, 2011 at 08:10:21 AM PDT

          [ Parent ]

          •  i have horror stories about meal times (5+ / 0-)

            at one place there was a nurse who used to raise the head of the bed up very high for mealtime.  mom was tall so unless they pulled her up in the bed first so that she bent at the waist, she was not sitting upright but awkwardly contorted just from the shoulder blades up.  then the nurse would shove food into her mouth very fast, not really giving her time to chew.  mom was a slow eater and always afraid of choking, and in that position she could hardly swallow properly!  mom started to cry and say i can't eat this fast and the nurse said "there will be no cry babies on my floor!"

            that nurse had some other problems too, pulling the covers roughly off mom's stump right after she had the amputation.  she made my mom cry changing the sheets (but at least without the snide remark about crybabies) .

            my mom put up with this for a few days without telling me.

            the next time that nurse was scheduled to be her nurse she said something like "oh no, the bad nurse" and I finally got the story out of her.  mom did not want to tell me because she knew I would go off on the lady and she was afraid that would only lead to more retaliation.

            but i handled it gently in spite of the fact that I was insensibly enraged.

            i simply went to the supervisor on the floor and asked her if any other patients had ever complained about this nurse.  of course the supervisor said no.  then I told her what my mother had told me, and that my mother is not a complainer and I thought she was telling the truth.

            the supervisor hemmed and hawed and called the nurse in question over to talk to me.

            I said, in a controlled voice, barely managing to control my anger, "the last two times I came to visit my mother when you were her nurse, she told me that you had made her cry.  do you have anything to say about this?"

            "I treat all my patients the same" was her answer, which I found telling, since it was not a denial.

            Then I dropped my bombshell.  I put a smile on my face and said as sweetly as I could manage: "Do you know what a mandated reporter is?"

            The supervisor's face went white.  The "bad nurse" looked at the supervisor and then at me.

            I continued, very calmly, "If I ever come in here again and hear from my mother that you made her cry, you will wish that I had not."

            "Are you saying that you think I am intentionally hurting your mother?"  she asked indignantly.

            I said, "It does not matter whether you are doing it intentionally or not.  If I hear this kind of information from an elderly person I am obligated to report it and let others decide whether the complaint is genuine or not.  I am going to let this one go because we have had this talk and I know you are going to respond as a professional should."

            I had her then.  She had to be on her best behavior with my mom after that, not even getting close to the line of mistreatment, and she could not retaliate because she knew that any complaint was going to put her in a very bad light.  Fortunately my mom was a woman of integrity and did not take advantage of the fact that I put this woman over a barrel.

            The "bad nurse" started asking the aides to do the feeding (I don't even know why she had been feeding mom in the first place since it was usually the aides' job), and became VERY gentle with the bedding changes.

            That was the only time I had to pull mandated reporter out of my bag, but it worked.

            I weep for all the people who do not have a "pushy daughter" to stand up for them.

            And I do not have a daughter or son, pushy or otherwise, to stand up for me, so I will have to take whatever treatment I get.

            Tears well up in my eyes everytime I think about it!

            "Politics is like driving. To go backward put it in R. To go forward put it in D."
            I support Bob Massie for MA-Sen

            by TrueBlueMajority on Sun Apr 24, 2011 at 06:35:18 AM PDT

            [ Parent ]

            •  I am so sorry (4+ / 0-)

              ..we exist in a world where your Mom, you, or anyone EVER had to experience this kind of cruelty. And I'd give anything to be able to tell you I saw very little of this kind of thing in my years working in those kinds of settings. But I can't.

              There are so many who work with the aged who are kind, compassionate, and totally dedicated to providing the best care they can to their residents. Unfortunately, there are also miserable, mean, and deliberately cruel people like the nurse you turned in. Our frail elderly cannot protect themselves against them, and the supervising nurses of ten have no time left for direct observation of the staff they are charged with supervising.  Plus, the "gathering of the wagons" you witnessed in a common response to complaints. You Mom was blessed to have you there.

              I know there have been other diaries here with suggestions on ways to make as sure as possible an elderly person is not being mistreated in these places...might be time for a refresher.  

              But again, as long as we are running health care on the business model, cost containment will win over hiring and retaining adequate numbers of well qualified, well supervised workers. The stark outcome of profit centered care is the intense suffering of the most vulnerable and sickest and  frailest among us,  

            •  So will I (2+ / 0-)

              So maybe if it comes to it, you and I can watch out for one another?

              Organ donors save multiple lives! A donor's kidney gave me my life back on 02/18/11; he lives on in me and in others. Please talk with your family about your wish to donate and sign up to give others the gift of life.

              by Kitsap River on Sun Apr 24, 2011 at 12:55:39 PM PDT

              [ Parent ]

            •  same here, TrueBlue (2+ / 0-)
              Recommended by:
              TrueBlueMajority, scribe

              I don't have children. I once said to Mom on a day when I needed extra hands that I sometimes thought I should have married and had about six kids because they'd come in handy. Then I told her that I figured I did the right thing by remaining single because I'd have married a no-count man and my six kids would all be so messed up that I'd be looking after them.

              Mom nodded and said, "You did the right thing."

              But I so dread being at the mercy of some "caregivers" in a hospital or nursing home that I really hope I drop dead before it comes to that.

              "'Things would be a lot worse without us,' is not a winning campaign slogan." Barney Frank

              by cassandraX on Mon Apr 25, 2011 at 04:26:57 AM PDT

              [ Parent ]

              •  You are certainly not alone in that wish... (1+ / 0-)
                Recommended by:
                cassandraX
                But I so dread being at the mercy of some "caregivers" in a hospital or nursing home that I really hope I drop dead before it comes to that.

                Yep...or simply go to sleep one night and never wake up. :)
                My Dad had a classy exit. He got his evening paper and a cold beer, settled into his recliner, read the paper, and soon fell asleep like he always did. And that was that. Wasn't till bedtime that we discovered he'd really left for good.

        •  I think that's the fear (12+ / 0-)

          of all us aging boomers, and the reason so many people are seeking alternatives to nursing home care when we reach that point.  

          There is no snooze button on a cat who wants breakfast.

          by puzzled on Sat Apr 23, 2011 at 09:06:22 AM PDT

          [ Parent ]

          •  I've made some decisions (17+ / 0-)

            and will share in a diary soon, about how am approaching the final phase of my life, now that I am 70, and they do NOT include forced imprisonment in any hospital or nursing home.

            •  i'll be waiting to see that diary (4+ / 0-)

              because i too have an idea what to do, if and when i get a diagnosis that means giving up control of my life, etc., being old enough now not to feel i have to live for others' sake

              •  isabelle (3+ / 0-)

                The diary is in process, but it's not an easy one to write.  The whole topic of an Elders right to choose how to live the final stages of life is so loaded and so controversial. I wish it was different. I wish we could be accorded the same kind of love and compassion  and choice we so easily extend to our beloved animal companions, when their quality of life becomes too burdensome to bear.

                 

                •  appreciate the difficulty (3+ / 0-)

                  i don't know if you saw the recommendation i posted in a comment to another diary, about a film from a canadian director, about a man who has cancer, and what his son is able to do for him, so that he has a peaceful, dignified death

                  the film is "The Barbarian Invasions"

                  a source of succor for me, i'd be interested if you know it

                  it's not as organized a solution as an Elders would be, and i'd love to know more about that, even if it's just an ideal

                  •  Thank all the Gods I live in WA (3+ / 0-)

                    where we have a Death with Dignity law and good hospice care. This is one of only two states with a Death With Dignity law; the other one is Oregon, one state to the south, and ours was modeled after theirs. I worked hard to get that voted in, because among other things I will probably have to use it at some point.

                    I've made my peace with death long since; when you have a catastrophic chronic condition like ESRD, it's something that has to come up in conversation and be discussed at length with family. I have done that. Thus, if it comes down to that, Charles knows - and agrees with - what I want to do, with what my plan is.

                    Organ donors save multiple lives! A donor's kidney gave me my life back on 02/18/11; he lives on in me and in others. Please talk with your family about your wish to donate and sign up to give others the gift of life.

                    by Kitsap River on Sun Apr 24, 2011 at 01:01:08 PM PDT

                    [ Parent ]

                  •  It came from a dream I had.. (2+ / 0-)

                    which inspired me to write that diary. And memories from all those years working with the dying...it all came together somehow.

                    Right here in this independent senior housing building, we currently have seven retired RN's, In my dream, it was a group like this that made up the group of Elders, whose chosen work was to help people who have come to the end of life leave it in the manner of their own choosing, whatever that might be.  They would have the power to administer whatever comfort drugs were needed, so as to not have to suffer needlessly on the way out, and/or to facilitate the process, according to the persons choice, as well as to support and comfort family through the whole time.  Best of all, in my dream, this had become the norm for anyone who wanted it, and families came together to plan the whole thing out however they wished, which gave people the blessing of being able to talk about it all, process it all together, and finish up anything that needed finishing, together.

                    It all had more of a sense of celebration about it, like reaching this stage was a authentic  victory attained, which it most certainly is..to have lived fully all the way. Gone was the crippling fear and dread of death, and all of the unnecessary suffering it now holds...and I felt so safe..so very safe...and so loved. Which is what dying should be like, in my mind.

                    •  your dream (2+ / 0-)
                      Recommended by:
                      scribe, TrueBlueMajority

                      was a wonderful, what?, message, perhaps

                      i've had a number of such dreams that have foretold; sometimes it's been as if spoken into my ear as i'm waking from sleep;

                      nurses are the humane face of the medical (profession/art it used to be known as) business, thanks be for them

                      the Elders will happen, it's already established that hospice works in every way, including cost

                      if we're lucky enough that the electorate acts sensibly, we get a true blue house and senate along with a transformative chief executive, and voila! such and all the other humane policies become a birthright

          •  Strongly agree. (6+ / 0-)

            My house is 'way too big, and I'm taking care of my 92 y/o mom in it now. My hope is that if I'm alone, a friend in the same predicament will take the downstairs bedroom. There's even a space the size of a small studio apartment upstairs with a deck of its own and a magnificent view. Maybe someone younger than "us" downstairs would enjoy living their for a reasonable salary. There's a two-year branch of a state university that might add to the temptation. (You can tell I've been thinking about this a while ;)

            There are different things for each of us that we simply cannot do alone at some point. It's a helpless feeling, and I hope not to have it too often.

            I hope that for all of us!

        •  exactly why I like home health care (12+ / 0-)

          so much; both of my parents have that now, my dad still getting skilled nursing while my mom maintains with CNA care. It's cheaper for Medicare and insurance, which is hugely important for my dad; even though he rarely pays for healthcare [except premiums], he feels strongly that "his" Medicare came out of his pocket, and feels responsible for how it's spent. Between he and his nurse, they work out what tests are necessary; he's not ramrodded through the system.

          We made a 'plan' with their primary care physicians years ago where the PRIMARY goal of their health care was to stay the hell out of hospitals. The second goal was to keep life and limb. Heh.

          So now when they've been hospitalized, it's been either ICU, or me fighting to get them released back to home health care. Hospitals seem to prefer to keep patients in a step-down unit even when the danger's over, so we've found it's MUCH easier if a patient has an Adv. Medical Directive agent (patients don't feel like arguing with hospital admins — admins can bully a patient easily, but less so with a healthy, non-hospitalized family member who has the legal power to speak for the patient).

          But it still BLOWS MY MIND that hospital admins make it so hard to get a patient released to home health care [if they're insured up the kazoo]. Not to brag, but for all the times I've been cursed for taking my parents out of the hospital, they're home, happy, and thriving now.

          Home Health Care is where it's at. Much more like "old days" patient-focused care: the nurses seem more content than hospital nurses, and are respected by the doctors and specialists, and they do most of the interaction between patient and doctors so everything seems centralized (fewer mistakes get made).

          The only thing missing is the hospital hierarchy. (YES!)

          "Ridiculous, counter-productive, and stupid." —P.J. Crowley on the treatment of Bradley Manning

          by IndieinVa on Sat Apr 23, 2011 at 09:14:12 AM PDT

          [ Parent ]

          •  Great thinking, great information, IndieinVa. (4+ / 0-)

            Strongly agree about the hospital hierarchy. With my mother's medical power of attorney and only a bit of dissatisfaction in my voice, I was able to get her home after a broken hip without too much trouble. They wanted to keep her three months in an in-patient rehab unit!!

            We need all the knowledge we can get, eh? Thanks for sharing yours!

          •  yes--it was VERY hard to get released with care (3+ / 0-)

            one time I took my mom out of a place over the objections of the staff and the snippy adminstrator said "she won't last 90 days at home".

            you see, after Medicare pays for 100 days of SNF care, you are on your own for the full cost after that.  Many people do not know this.  And if you leave SNF care, you have to be home for 90 days before Medicare will pay for another 100 days of SNF care.

            I decided that for the level of warehouse care she was getting for $335 a day, I could care for her at home with some limited help from a home health aide (she was not eligible for very much care because she lived with me and it was assumed that I could take care of her).

            With her doctor's help, a couple of house calls from the nurse practitioner, and a home health aide three times a week, she stayed at home for 90 days.

            When she reached the 90 day mark we celebrated with a little party.

            And we celebrated every month after that.

            When she reached the one year mark I bought her a big balloon that said ONE YEAR AT HOME!

            When she reached the two year mark I bought her a big balloon that said TWO YEARS AT HOME!

            Just before the two and a half year mark, she went into her final decline... but she did stay home more than two years.

            And we celebrated every month after that.

            "Politics is like driving. To go backward put it in R. To go forward put it in D."
            I support Bob Massie for MA-Sen

            by TrueBlueMajority on Sun Apr 24, 2011 at 11:08:59 AM PDT

            [ Parent ]

        •  Me too! (2+ / 0-)

          And since I have no children, if I outlive my Charles and wind up in long-term care someday, there will literally be no one there for me and I'll probably die of neglect.

          I am only 51, and Charles turns 60 this year. Outliving him is a very real possibility, especially since he doesn't take care of his diabetes or take care of himself in most other ways. I am scared spitless of it.

          Organ donors save multiple lives! A donor's kidney gave me my life back on 02/18/11; he lives on in me and in others. Please talk with your family about your wish to donate and sign up to give others the gift of life.

          by Kitsap River on Sun Apr 24, 2011 at 12:52:51 PM PDT

          [ Parent ]

      •  We did this for my sister, and she was in the (6+ / 0-)

        hospital for months. It was draining, but it certainly brought us closer as a family. And it opened my eyes a great deal to the world of healthcare. Before she went into the hospital, I believed that hospitals were where you go to get better and that you could trust doctors to make the right decision. That seems horribly naive to me now. The whole ordeal was a clusterfuck from start to finish, but my entire family has become an informed consumer of the US healthcare system...and not in a good way.

        "Here's to our last drink of fossil fuels - may we vow to get off of this sauce...shoo away the swarms of commuter planes...and find that train ticket we lost."

        by terra on Sat Apr 23, 2011 at 10:55:31 AM PDT

        [ Parent ]

  •  I am so old I remember when the doctor came to (38+ / 0-)

    your house when you were sick.  He was like a member of the family.  I loved Dr, Cameron's little black bag.  No matter what your ailment he had just what you needed right there in that marvelous satchel.

    Corporate medicine has completely sucked the humanity out of health care.  I am an O. R. nurse and have been one for decades.  The role of the nurse is not to cure but to care.  My current amount of time spent with an awake patient averages less than 15 minutes.  I check them in with a standard assessment, glance at their chart to make sure their consent forms are signed and rush them into the O.R.

    Keep in mind that I am their primary advocate for the period of time that they will be rendered unconscious and their body will be cut open and altered in profound ways frequently. I literally just met them and away we go.  Once the operation is over and they are put on a gurney my responsibility to them ends and I am on to the next case.  Total human contact with that patient and their family 15 minutes and it does't matter if you are getting your tonsils out or a heart transplant.  

    For what it is worth I haven't ever received a raise more than 3% and haven't had a raise in 7 years.  The rising cost of healthcare, as in every other industry is directly related to corporate bigwig salaries.

    When the rose lies withered by the roadside don't try to negotiate the bloom.

    by Atilla the Honey Bunny on Fri Apr 22, 2011 at 06:21:24 PM PDT

  •  The bean counters, sociopaths and greedy (24+ / 0-)

    Took over, and we see what we have now. It's really a horrible thing what has been done to our health care.

    The worship of money that has been pushed to the forefront by the conservatives is downright evil, IMHO.

  •  I'm having surgery Monday. (19+ / 0-)

    Went down to the hospital on Thursday to get all the preliminaries done.

    The time to take my medical history? Ten minutes.

    The time make sure I paid the 60% upfront co-pay, signed a promissory note for the other 40% and signed all the paperwork agreeing that I understood that surgery is inherently dangerous and complications can happen....a half-hour.

    And yes, when you're talking to the medical people, there's just the slightest flavor of "Let's get this done as quickly as possible."

    I'm getting to the point where I almost don't want to live in this country anymore.

    Freedom has two enemies: Those who want to control everyone around them...and those who feel no need to control themselves.

    by Sirenus on Sat Apr 23, 2011 at 04:23:13 AM PDT

  •  that's the nature of the beast (17+ / 0-)

    Funny, but if one substituted the word teacher, and changed the duties somewhat, it would describe to a T my career in education.  As I look back now, back to the dream I started out with, after years of preparation, and how that dream fulfillment  has been ruined by corrupt power and money, I just shake my head.

    This can't be right.  What a waste.  And I speak from somewhere in the pile of discarded servants-by-choice to those who are now servants-by-necessity.  This can't be right.

    What a great diary to begin the day reading!

    Poverty exists in direct proportion to greed.

    by jcrit on Sat Apr 23, 2011 at 05:11:39 AM PDT

  •  Medicine? NO ONE CARES. (15+ / 0-)

    I've been a Medical Technologist in hospital labs for 42 years. We're the people who do your testing and care for you though we are invisible to patients. Coming from someone on the inside, all I can say is Don't Get Sick. No one cares. All decisions are made by some bean-counter at an office, and they have every base covered.

    I was just in a hospital for surgery after blacking out and falling and shattering my cheekbone, sustaining a concussion and a large subdural hematoma from the cranial bleed. Head injuries, with lots of neurological problems from the pressure of the hematoma. In and out of the hospital, no one ever asking if I had help at home. I had 2 surgeons who worked on my face who never even examined me in their follow-up visit, who refused to sign any of my short-term disability forms, who did I think I was asking? Then they tried to send me to 3 different facilities for CT scans, only Cigna-approved, mind you.....3 facilities meant they could soak me for separate "facilities charges" for the different ones. My brain has recovered enough for me to tell them to stuff their final CT scan, especially since I saw that the neurosurgeon couldn't even work his computer to explain it to me, in fact couldn't read it at all.

           Alan Greyson said it right, talking about the rethuglican plan. "Don't get sick, and if you do, die quickly."

  •  scribe, I was so pleased (16+ / 0-)

    to see this diary waiting to go into the CS box when I started my shift last night. I'm overjoyed that you made it onto the Rec list.

    I worked as a Medical Assistant for most of my career. When I first started, the profession was still one that cared. Things were changing even then, but we still put the patient first. I ended my medical career doing billing for the "new-fangled" HMOs. I could see that they were trouble but my warnings went unheeded. I was actually fired for trying to make them pay what they were responsible for. Apparently I made them feel uncomfortable; "like they were lying" they told my Supervisor. Well, the shoe fit but I was out and they gained control. Damn them.

    How can anybody be enlightened? Truth is, after all, so poorly lit.

    by Purple Priestess on Sat Apr 23, 2011 at 06:51:00 AM PDT

    •  I should clarify (6+ / 0-)

      I did the billing for a large clinic. Billing the new HMOs fell into my lap - lucky me.

      How can anybody be enlightened? Truth is, after all, so poorly lit.

      by Purple Priestess on Sat Apr 23, 2011 at 06:52:18 AM PDT

      [ Parent ]

      •  My last attempt (9+ / 0-)

        to stay employed as an RN with a wrecked back was applying for a desk job with a large HMO. The last step in the hiring process was spending a day shadowing another RN whose task was to approve/disaprove claims. I felt like I'd walked through the looking glass.

        It was a warehouse sized room full of cubicles, computers and RN's reading prepared scripts and responses  off computer screens in response to claim requests. These prepared questions and protocols were written by a whole team of physicians hired by the HMO, the nurses were not allowed any deviation at all: it was cut and dried. Unless factor A, Factor B, and Factor C.etc were present, claim denied, period, end of call. All calls were to be timed, no exceptions made.  I sat watching this nurse show absolutely no change of expression emotion, even when the callers were pleading for the very lives of their patients: when I asked her how she did it, she grinned and said "Oh you get used it it. Can't let it bother you."

        It was literally an Orweillian scene from hell.  I couldn't walk away fast enough from that 70K a year position, even knowing it was no doubt my last shot at staying employed.  

  •  I'm not sure how this happened (11+ / 0-)

    but the care you describe is close to exactly what I received last November and December at Virginia Hospital Center, a teaching hospital, in Arlington, VA.  The nursing and physician staff were spectacular, and focused on treating patients.  My moods were not exactly stable (lots of abdominal pain, a major surgery, and dilaudid, with a side of percocet) and I was pretty irrational and cranky a lot of the time but the nursing staff was always professional and tolerant, and willing to accept apologies.  My primary care doc, whom I will not name here because she's not around to approve of me naming her, is beyond wonderful.  I've been with her since she was a resident (I think i was the first patient she brought with her as a private practice attending) and will be with her as long as I can.

    I am lucky in that i have high quality, high priced health insurance through my employer, but I know Medicaid patients who received equally excellent care at this facility.

  •  I was an LPN for 25 years (13+ / 0-)

    And I miss the good old days when you had time for your patients. I moved to home health care so I could have control of the time I spent with people and feel like I could actually care for them.

    "The Church has many that God does not have; God has many the Church does not have" St. Augustine

    by createpeace on Sat Apr 23, 2011 at 07:53:35 AM PDT

    •  I have what I think of as luxury (1+ / 0-)
      Recommended by:
      Book of Hearts

      right now, working as a hospital psych nurse, to spend a heck of a lot of time with my ~5 patients. My main role is as coach and advocate, sometimes as therapist (though therapy is relegated to others on the team, most of the time).

      I had worked in LTC and hated the morass of clerical duties and the very limited role of the RN. I would be pecking away at the computer most of the day with perhaps at most 10 minutes apiece with 10% of my pts. and none with a sizeable  minority of them.  Nursing judgment came in only when someone coded or split their scalp open. I was also the supervisor for the building, the schedule master, the disciplinarian and the receptionist. It totally sucked.

      Looked at home health, and such that it is in this area, it is also paperwork-heavy, and not for me.

      So I feel as though my current role is a lot like that of the diarist's, though of course acuity is higher and the hospitalization time frame has contracted. I feel fortunate.  Perhaps it has something to do with working for Mayo? Or that the interpersonal aspect of psych nursing is preserved?  In any case, I feel blessed.

      Sometimes a .sig is just a .sig.

      by rhubarb on Sat Apr 23, 2011 at 01:48:40 PM PDT

      [ Parent ]

      •  So glad to hear (1+ / 0-)
        Recommended by:
        rhubarb

        that you have a position that allows you to practice as you wish.  The psych unit I transferred to at the Mayo affiliated hospital was a lot like what you describe. But then I relocated, and ended up supervising a State Hospital psych unit, which turned into a living nightmare.  There is definitely a class system in health care delivery: one for those with insurance and money, and one for those without either. I spend most of my years working in places that served the poorer class who had no choice but to take whatever treatment they could get.  

  •  When I trained as a medical technologist (16+ / 0-)

    in the late 1970s we were told how important it was to consider ourselves part of the healthcare team.  

    We were told the reason med techs go out on phlebotomy rounds was not just to insure the integrity of the sample, but so that we would think of patients as real human beings and not just tubes of blood.

    We were told that the comfort and well-being of the patient was paramount when drawing blood.

    Twenty years later, I was expected to use 18 gauge needles (in the ICUs!) because it was faster. I was written up for being 5 minutes late coming back from phlebotomy rounds.  When I explained that I had had a patient going for open-heart surgery (He had come in through the ER during the night after suffering a massive heart attack.  He'd coded and been resucitated.) who was afraid and wanted to talk to someone and I'd spent an extra 5 minutes listening, they told me patient welfare is none of your business.

    I got out.  I went into teaching and I wondered how long it take them to fuck that up, too.

    When is what goes around going to come around? When?

    Every year the monsters get more powerful.  Society becomes more bestial.  Where is it going to end.

    "I wish I loved the human race. I wish I loved its [venal] face." ~ [apologies to] Sir Walter Raleigh

    by houyhnhnm on Sat Apr 23, 2011 at 08:11:16 AM PDT

    •  How well I know (1+ / 0-)
      Recommended by:
      houyhnhnm

      ..I once received a written warning in my permanent file  for sitting on a patients bed to hold and calm an old dying man who was literally terrified and calling out for his dead wife. Inappropriate behavior for a professional, they said.

  •  I think some it has to do with corp (8+ / 0-)

    and a lot has to do with the fact that medicine has changed.  Many of my older colleagues lament about the protocol laden medicine.  Every day Medicare/Medicaid and insurance companies lay down more boxes that must be checked for each patients so they can collect data for pay for performance reimbursement.  Clinics like mine don't have the resources to keep this data collection out of the doctor hand but want the $$ incentives Medicare will pay to get this done.  All this invades interactions with the patient which become more formulated less interaction time.  

  •  You cannot serve God and money (11+ / 0-)

    Which is to say, if you are focused on profit you are not ethical.

    But a corporation is always focused on profit.

    The conclusion is left as an exercise for the reader.

    In theory, there is no difference between theory and practice; but in practice, there always is a difference. - Yogi Berra

    by blue aardvark on Sat Apr 23, 2011 at 08:30:46 AM PDT

  •  I'm sad to say I was born (12+ / 0-)

    (on probation) in 1958. (h/t to Monty Python!) and was blown away when my mother told me that the usual stay in the hospital back then for a mother giving birth was 9 days! And that was for everyone - not just births with complications.

    Part of that included training given to the new parents on do's and don'ts of caring for newborns.

    From what I've heard, today mothers are lucky to spend a day in the hospital. I suspect our infant mortality rates reflect that.

    This ain't no party. This ain't no disco. This ain't no foolin' around!

    by Snud on Sat Apr 23, 2011 at 08:33:35 AM PDT

    •  I've had three kids, and only spent the night (2+ / 0-)
      Recommended by:
      ER Doc, Snud

      after the second one, as he didn't show up til 9 pm, by the time all the shouting was done and I could take a shower it was eleven-thirty, and I was tired and wanted to sleep, and knew I'd better do it now as I wouldn't get to for months when I got home.

      I had the others in the early afternoon and was home by 9pm, having gone into the hospital around 8 am.

      It is what it is. It will be what I make it.

      by Alexandra Lynch on Sat Apr 23, 2011 at 11:05:26 AM PDT

      [ Parent ]

  •  I spent a night in a big regional hospital (9+ / 0-)

    in Atlantic City in February.  Before that, the last time I'd been hospitalized was in 1991.

    In 1991, the nurses gave me the impression that they had time to spend with you explaining and treating and helping, but they were under pressure to move faster, and they didn't like it.  Mostly they ignored it.  They taught me how to get out of bed, how to relax, and got me through my stone bowel in the four days I was in the hospital.  

    In 2011, in the shiny brand new medical center, the nurses were all young, and their training was totally different.  More of a traffic control officer.  "You'll be going for a CAT scan, then to PT, here's your dailiy medication (all of it, in one handful, and I was so out of it I took it all), just ring the bell" and gone.  I waited for bedpans.  I waited for aides who never came to help me clean up.  It was pretty awful.  I was there for about 18 hours.  Plenty long enough.  

    "Republicans are poor losers and worse winners." - My grandmother, sometime in the early 1960s

    by escapee on Sat Apr 23, 2011 at 08:58:55 AM PDT

    •  Todays nursing education (8+ / 0-)

      ..has a markedly different focus than what nurses of my generation were taught.  We had a strong focus on patient teaching and empowerment and preserving wellness, all of which require nurses to spend time with people, which is not considered cost efficient today.

      The other thing is that professional level Nursing care is being replaced by less trained, non professional staff wherever possible. This means that the majority of hands on care is being done by the least trained, lowest paid staff, usually overworked aids, while RN's are tied up with doing skilled treatments and documentation.

      This means we have little chance for hands on nursing assessments of status, or to catch complications early on.

  •  Essential services (8+ / 0-)

    It is as crazy for medical care to be provided in a for profit setting as it would be for any other life affecting service such as education, prisons, energy availability to be a for profit business....wait, they are.   We are lost!

  •  Thank you for this thoughtful diary (9+ / 0-)

    We need to keep alive, a vision of what can be...of the fine, moral, patient, caring nation we could become (and at times once were).

    Because many of our children have no idea that America wasn't always this way.

    It's the cruelest I've ever seen right now. And seems to be in thrall of an unstoppable juggernaut to an even crueler and more vicious place.

    I had hopes this might not happen, but that ended in the last year.

    Skepticism of all the elite institutions, not trust, is what required for successful leadership in this era. Digby

    by coral on Sat Apr 23, 2011 at 09:09:46 AM PDT

  •  Right on! (5+ / 0-)
    Recommended by:
    ladybug53, Stripe, ER Doc, revsue, JVolvo

    My dad (step-dad) was a surgeon. The way things were run back in his day are nothing like now.
    back then, you could eat off the floors, things were kept so clean. The local hospital, of which he was Chief of Surgery, ran like a well-oiled machine, and patients got great care.
    In addition, since they were non-profit, they also had a nursing school on the grounds and had an intern/residency program.
    All that changed, of course. Now they are a for-profit institution and are squeezing every last dime out of it for the CEO and shareholders.
    As you say, the care of a patient, and wellness, are no longer at the core. It is everything to do with how much money they can make in a day and how they can use the patients in that process.
    The halls and rooms are not that clean anymore (during a stay by my elderly mom last summer,  I found feces on the window sill).
    And don't get me started on the food. The hospital once had pretty good food. patients had a menu in their room where they could choose the meals they wanted. It wasn't the best stuff in the world, but then dietitians are pretty much toeing the corporate food-chain line about nutrition. But it was OK stuff.
    of course, the hospital deemed it too expensive and hired a new contractor for the food. It is horrible. When my mom was in for a GI bleed (she was on coumadin and prone to them), the two choices were "seafood salad" which was nothing more than a bowl of surimi (fake crab meat) or a pepperoni pizza - this for a woman who hadn't eaten in 4-5 days. Guess what? The bleeding started again. The rest of the dreck that came, or was ordered, was equally inedible.
    I confronted the "hospitalist" (a fancy name for a Doctor assigned to a patient, since most doctors don't go to hospitals or do rounds to see their own patients) about it. He said "all hospital food sucks". I asked him if he didn't feel that nutrition was part of the healing process." He said "That's not my job".
    I could go on and on.
    It' really sad seeing a once-proud, well-run hospital do such a poor job. of course they get on the "Top Hospitals" list occasionally. But I have a feeling the criteria is not what one would want as a patient.
    But they have a heck of a PR/Marketing department! The can spend lots of money on advertising and promotions. But I ask myself, who needs it? Hospital care is not always a choice. Sometimes you end up where they take you. And word of mouth is about as strong PR as you're going to get.
    Glad you got out of the rat-race.

  •  Scribe, I'm curious (1+ / 0-)
    Recommended by:
    ladybug53

    thanks for the diary and the perspective!

    I'm wondering what you, as a veteran of the medical world, think about the plan to move toward Accountable Care Organizations in the ACA.

    Some medical folks I work with believe that a well-crafted ACO could bring patient care back to the "center" as you described it.  (I know that no one really knows yet what ACOs will look like.)

    What do you think?

    Do the thing you fear most and the death of fear is certain. -- Mark Twain

    by Sarea on Sat Apr 23, 2011 at 09:33:57 AM PDT

    •  I'll need to review this (2+ / 0-)
      Recommended by:
      ladybug53, Sarea

      ..as I'm not that familiar with these. I especially want to know if run by any kind of private profit making entity.

      •  Essentially, the gist (I think) is that (0+ / 0-)

        medical organizations (including hospitals, physicians, etc.) can form an ACO to provide coordinated care.

        The idea is that each patient has a place where care is coordinated.  Any money saved is provided as profit / incentive to the ACO.  So there is impetus to cut down on repeat tests, etc.  I believe it is a way to bundle payments, which the doctors and hospitals don't seem too excited about.

        At least, that's it as I understand it. but no one has started a model yet because it is so new, and so no one really knows what it will look like / how it will function.

        So I'm wondering if those on the ground inside the health care field (doctors nurses etc) agree that it is a good model.

        Do the thing you fear most and the death of fear is certain. -- Mark Twain

        by Sarea on Sat Apr 23, 2011 at 10:27:55 AM PDT

        [ Parent ]

        •  Did some reading.. (3+ / 0-)
          Recommended by:
          tardis10, rhubarb, Sarea

          All of these lofty ideas sound so good, and might well BE good if they actually lived up to them, and could prevent gaming of the systems by those who want to bleed the most profit possible out of them. These sound a lot like the old HMO's with some new trimmings. Right now, it sounds like there are three kinds of groups who are competing to run ACO's: hospitals, doctors and Insurance companies. There's two in operation now, according to one source: Kaiser Permanente and Health Care Partners Medical Group. Lots of risk involved, if it leads to out of control mergers and monopolies forcing out competition, and raising costs: of course they claim they could keep this from happening with anti trust oversight, etc..but I've yet to see much success in this area.

          At the same time, there is a crying need for effective, measurable  coordination of care for Medicare patients with chronic conditions. Right now, it seems like we end up being a cash crop for any profit making medical/pharmaceutical entity who wants a piece of us. I am a skeptic when it comes to ever seeing authentic patient centered care coming out of any system that profits from our vulnerabikities. Greed wins every time.

  •  I just returned from the hospital (11+ / 0-)

    after a hip replacement.  In Canada we worry a lot about our medical system.  It is, like most, under pressure with the wave of baby boomers reaching their 60's, increased testing and treatment costs etc.  I was concerned about the level of care I would receive.
    My surgery was at Welland General Hospital in Welland Ontario.  The care that I received from the preop visits to the surgery and 4 days in hospital to the post hospital care was what you described occuring in the old days.  The surgery was flawless, the nursing care was amazing and rehab started the day after the surgery.  The staff was dedicated professional and caring.  I would have to search to find a criticism.
    I think the difference is obviously the lack of a profit motive and while I have always intellectually understood this, I have now experienced it.  
    We in Canada will continue to worry and obsess about our medical system and there are things that need to be fixed.  Healthcare is a subject in every election and the current one is no different.  But the simple lack of a profit motive and the principle that good healthcare is a right for everyone makes all the difference
    We do this with 35 million people.  Given economies of scale, can you imagine what you could do with 300+ million people.  Don't stop fighting for this.  Americans deserve better than what their getting.
    By the way, my surgeon who is of Libyan origin has just left to take care of the wounded in Libya working for Medecins Sans Frontiere.  He is gone for two weeks but said that could be shortened "if someone slits that bastards throat".  I wished him a safe trip.

  •  My wife quit hospital work for the exact (6+ / 0-)

    reasons you describe. She was in charge of 10-12 patients, doctors were never available, the hospitalist was worthless and supervisors were mostly concerned with avoiding overtime. But there's always a "happy face" painted on "our wonderful nurses" as the admin grind them into the floor.

    I can tell you where some of the money went (besides execs pockets): making hospitals look like hotels, electric adjustable beds, MRI and CAT machines which hospitals had a cut of, electronic monitoring and charting, large labs and testing equipment and drugs, to name a few. All of which costs at least twice what it should because everyone is in the same love boat of money making.

    "The people I distrust the most are those who want to improve our lives but have only one course of action" Frank Herbert

    by the fan man on Sat Apr 23, 2011 at 10:29:09 AM PDT

  •  being 10 years younger than you (5+ / 0-)
    Recommended by:
    Stripe, ER Doc, revsue, JVolvo, rhubarb

    I also remember seniors who had no insurance, whose hospital care bankrupted both them and their families. I remember nurses working well past their "sell by " date cause they had no insurance.  Someone should grab these republicants by the scruff of the neck and shake them.

    "The United States should have a foundation free from the influence of clergy."Thomas Jefferson (also attributed to George Washington and John Adams)

    by regis on Sat Apr 23, 2011 at 10:29:13 AM PDT

  •  I have never trusted the medical profession (0+ / 0-)

    I wrote upthread about my 42 years in this miserable field. Such was my distrust that I had both my kids at home in the mid-70s. After the first one, it took 4 months to find a doctor to certify the baby's birth.

  •  And if anyone hasn't read it... (5+ / 0-)
    Recommended by:
    ER Doc, scribe, tardis10, JVolvo, rhubarb

    Paul Krugman did a piece in the NY Times:

    Patients Are Not Consumers

    Here’s my question: How did it become normal, or for that matter even acceptable, to refer to medical patients as “consumers”? The relationship between patient and doctor used to be considered something special, almost sacred. Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction, like buying a car — and their only complaint is that it isn’t commercial enough.

    What has gone wrong with us?

  •  All I want to see is the OLD family DR (0+ / 0-)

    come back in style...  the one that knew your name AND your medical history without having to look at a chart to even remember who you are...  I want that Dr who would take a call from you in the middle of the night if someone was sick, the one that would COME TO YOUR HOUSE if you couldnt make it to his office and he/she actually HAD an office, one that you went into to discuss stuff before AND after your examination...  not the cold impersonal cubicle you now wait in while you hope your 'number' is next because you have been waiting to see A dr for hours even though you actually had an appointment...   I want my OLD family Dr back.  I want to know that the person who looks after my family's health actually KNOWS my family and our health history.  and I want to first question to be asked of me when I go to the Dr to be HOW ARE YOU not 'have there been any changes to your insurance since your last visit"

    is it really to much to ask for?

    and if we could get that kind of healthcare BACK I bet the cost would be lower and IF we had to I bet no one would complain about paying a little more 'out of pocket' if we got actual health care by a caring Dr who knows who you are and cares about your health.

  •  it sure would be great to (1+ / 0-)
    Recommended by:
    tardis10

    ...have patients be the first priority of our health care system again...

  •  My dad is in his third facility (1+ / 0-)
    Recommended by:
    JVolvo

    because of a stroke. "They", whoever that is, keep moving him when a certain amount of time passes, just like they did with my mom until she died in a skilled nursing facility of pneumonia.

    I have to say though that the staff in all of those places was top notch at doing what they could under the constraints that they were and are under. It was a nurse not a doctor that told me my mom had no chance of recovering because of her debilitated state and to put her under palliative care. She described my moms labs and told me what they all meant, how it would go from that moment on and that my mom would probably die of pneumonia and at that point it would be a blessing.

    I will forever be grateful for the respect those nurses and support staff gave my mom and the ease they provided for her passing.

    I am very pleased with the new staff in every place my dad has been in so far.

    The people behind the doors? Not so much. It's a fight to the finish with them. First with my mom and now with my dad.

    Education is too big to fail. Truth is too big to fail. Justice is too big to fail. Peace is too big to fail.

    by Burned on Sat Apr 23, 2011 at 12:54:17 PM PDT

  •  I was a LVN at a Rehab Hospital, (2+ / 0-)
    Recommended by:
    rhubarb, scribe

    We did Team Nursing.  Due to the condition of the patients, it worked for us.  RN, LVN and CNA were able to care for the same patients every shift, and we all made sure the patient had someone near for pain management, potty assistance or just an outlet for any issue.  Then Corporate decided we needed Primary to save costs.  One LVN for 11 Patients.  CNA's stretched too thin.  RN's in a avalanche of paperwork.  They also switched from 8 hours to 12, saving more money. Then the hours were cut as Census dropped, sometimes only working 12 hours a week.  I would also only see the patient long enough to do a quick assessment, and spent more time charting about them then actually seeing them.  It's a disgrace.

    •  You know then (1+ / 0-)
      Recommended by:
      Catalino Jacinto

      ..how hard it is to have had to watch this horrendous process replace what we know good nursing care to be.  Not only is it a disgrace, it's the worst kind of moral wrongness, for any society to profit from the suffering of it's own most vulnerable. It makes me feel ashamed  for this country.  

  •  My father was a General Practioner - what they now (1+ / 0-)
    Recommended by:
    scribe

    call a "Family Doctor" or "Internist" - before he died in the late '50's.  In those days, he did house calls after his office hours and on Sundays when he didn't go to the office.  And patients had his home phone number and they called, sometimes at any hour.

    Imagine that - house calls and home access to your doctor.  Things certainly have changed.

    The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt. Bertrand Russell

    by accumbens on Sat Apr 23, 2011 at 01:52:55 PM PDT

  •  Oh God, what a trip down (1+ / 0-)
    Recommended by:
    scribe

     memory lane. Graduated about the same from nursing school as you.
     My experience was somewhat different from you; the medical floors I worked were always short staffed and the work was hard but the staffs were tight and we could somewhat influence what happened to patients in our care.
     This began to unravel with the introduction of DRGs, where hospitals were paid a "bonus" for discharging patients early;  the 2 day C section, one day for vaginal deliveries, etc shorter stays for orthopedic  surgeries, etc. A nurse now has no say in when patients can be discharged; this is all done by an algorithim.
     Now to be fair, technololgy in the medical field has improved vastly, the emphasis  on homecare has allowed for many patients to be discharged safely back home, but the drive to make profit king is way over the top.

    What do we want? Universal health care! When do we want it? Now!

    by cagernant on Sat Apr 23, 2011 at 07:38:11 PM PDT

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