Wednesday, March 4, 2009

Re-thinking the System - While in a Staff Meeting

I hate staff meetings and rarely attend them. I went to one yesterday – but only grudgingly.

It's not that I dislike my co-workers, or my boss for that matter, but getting together for a morning meeting to hear what the plan will be for the next month or two is always an exercise in frustration. I deplore the minutia of health care. I am not one who likes to dot the “i's” and cross the “t's”. I like to look at the bigger picture. Except for the time I spent in management, that preference has always been an issue.

The problem with seeing the big picture is that you usually have a good idea of just where things are headed. Since I am fascinated with economics and politics, I am well read on and all too well aware of the financial crisis that is just getting started. I see nothing but problems for health care on the horizon unless certain things are done and done correctly. Because I like to pull back my view, sitting in a meeting listening to someone enthusiastically discuss details I consider trivial and wastes of time quickly sends my mind wandering.

I have written here before about the pending failures of major health insurers. It is my belief that health care will be nationalized as a result of these failures and the threat they pose to the industry. The cost will be staggering, though it will come in much lower than the cost of rescuing the banks. One benefit of a new universal health program that will be forged in today's financial dire straits may just be a necessary change in the attitudes within and outside medicine about just what health care is and should be.

At the meeting, I listened to my manager talk about the “service” we provide to our “consumers” and how it is the goal of our hospital to not only meet the expectations of our “consumers”, but to exceed them.

While she was talking, my mind began to race and got stuck on the words “consumers” and “service”. I started thinking about just when health care sold its soul. The “consumers” of health care used to be called patients. We did not treat patients like they had money in their pockets and could go spend it anywhere they wanted. We didn't used to approach our jobs in the same way retailers approach theirs. What happened?

While my mind was working on the above discussion in my head, my boss continued to talk about a pending visit from the state to inspect the facility. This is a huge deal for hospitals because, in theory anyway, the state can reduce funding and reimbursement levels if you don't get rated high enough by the inspection team. In this state, where Maine owes hundreds of millions of dollars for care already delivered several years ago, I am wondering just why the inspection is a threat. What is the state going to do if they don't think we are worthy – not pay us? That's already happening.

And so my mind again went off – wandering through all the things nurses and others have to do to jump through ridiculous regulatory hoops to appease someone who finds such things important. I spend more of my work time on silliness, like adding certain phrases to orders so we can make sure we get reimbursed for things like CT scans, or documenting the same actions in multiple places, that I can get distracted from doing the other things that patients actually need me to do. Recently, my wife and I compared our workdays today with what they were like 10 years ago. We realized that up to a third of our workdays can now be spent away from patients, documenting on paper as well as in computerized charting systems. We both concluded that the levels of bureaucratic garbage which detract from actual care is getting to be too much to take.

Still in my meeting, I began thinking that when health care does get nationalized, it will force all of us to re-think just what health care is. It is a service to be provided for the sick and the injured. It's not something that should be looked at as if it were a retail store in need of customers. Simply stated, a hospital is not Wal-Mart.

And that's one of the biggest problems today – we approach our jobs as if we need the “customers”, not the other way around. We have and offer too many choices, yet people are always asking for more. Well, when the money to fund this system runs out, we will be forced to let our “customers” know that they can no longer demand tests and procedures that providers feel are unnecessary. They can't expect that every last possible thing will be checked or tested because they feel it should be done. They will have to accept that reality dictates that not every person will get everything they wish for from the system because we will have to care for more patients than we do today – but with even less money.

A realistic health care system will look more like a military chow line from the Korean War than an all you can eat buffet in Las Vegas. It will keep you alive and sustain you when you need it, but it will not fulfill your every whim and desire. In fact, since the government is going to be so short of funds, even the chipped beef may be substituted for peanut butter.

I missed most of the rest of what was said at the meeting. But I had a smile on my face thinking about just how good my big picture began looking to me. It even began to smell good. Maybe these meetings aren't so bad after all. I may just go to another so I can flesh out the details of our new system.

In the meantime, I'll start looking for an apron and hairnet to replace my scrubs.


  1. Sounds like me at a staff meeting. I try and avoid if at all possible. The thought of nationalized health care is scary! I fear for our future as health care providers and as "consumers".

  2. We now have "The McDonalds Generation". We've had "The Victorians", "The Lost Generation", "The Flappers", "The Baby Boomers", "The Hippies", "Generation X", and so on. Now we have "The McDonalds Generation" - "I want it and I want it now!" is there motto. "And if you don't give to me, I'll sue your ass." It's going to take dynamite to change these screwballs.

  3. I crave "nationalized" health care! Give me four patients (or more) to a room, procedures and tests a fraction of the cost than they are currently, wait lists for elective surgery, patients bestowing gifts upon their nurses because they are so grateful for their care, being able to afford health care (!!)
    To me that is far preferable to the mind blowing costs of health care today and the constant unease of being underinsured and what if something terrible happened and I lose everything feeling. Of course I could go on mainecare then and I'd be sweet!