Sunday, December 02, 2007

Healthcare in the United States: Expectations and Reality

Further down the page is a column I wrote about medical malpractice, which received a couple of comments. One of those comments was from a first-time visitor to the site whose comment I want to use as a mechanism to discuss the broader subject of healthcare.

First, to define the intent of this piece: On a site that I visit where I often disagree with the positions taken by the host, my efforts to explain things that the host suggests show hypocrisy on the part of non-Muslims most often get labeled as a defense of whatever behavior the host is criticizing. What I am offering here is an explanation of certain conditions that exist in the healthcare industry, not a defense of those conditions.

First, here is the comment from Marsha:

"Hi, this is my first time visiting your blog, I found you at blog village. I have very little experience with health care, but the experience I do have has all been pretty bad. My personal feeling is that health care providers don't give a fig about patients and that they are in it for the money. They cover for each other and there is almost nothing we as patients can do about this disaster. Keeping us sick means more money in their pockets. While I don't think that people should be monetarily compensated every time they don't get the outcome they want from the doctor, I believe that the accountability of doctors and hospitals needs to increase dramatically. Thanks for sharing so much detailed information, I learned a lot. I hope you don't mind reading my feelings on the matter."

And now, my response:

Hi, Marsha, and welcome to Observations. I value all sincere comments from readers, whether they agree with me or not.

“ … but the experience I do have has all been pretty bad.”

No doubt quite a few others have had similar experiences, and there are more than enough instances where people have been treated badly, or have received sub-standard care

I think that people look at the healthcare industry as somehow different than other businesses or industries, likely because of the reason that we utilize healthcare providers: We or a family member or friend is sick or hurt, and we want them cured. That causes a great deal of emotional stress on the people involved, and the emotional aspect of the situation frequently is a major factor in how we evaluate the way healthcare providers responded to our situation.

But the reality is that healthcare is “a job” or “going to work” for millions of people. You can find numerous instances where people weren’t treated properly at their bank, or at a department store, by the phone company, or by a plumber or electrician, and while that is an irritation, it is often dismissed as “just the way it is.” However, when someone goes to their doctor or to a hospital and gets less than they expect, it is worse than if they were treated rudely by a store clerk. So much of what we believe about our healthcare system is based upon what we expect it to be, and sometimes what we expect is not realistic.

I often try to get the people in the hospital with which I am associated to understand that many of the complaints the hospital gets are due to the unrealistic expectations of patients and their families, and it is sometimes because they weren’t told what to expect. I ‘m not suggesting that patients shouldn’t expect to be well taken care of, but so often they expect more than they can be given. Hospitals have an obligation to be attentive to patients’ needs, to provide clean surroundings and provide the best care possible, and nothing less is acceptable.

However, people often hold healthcare providers to a higher standard than other “businesses.” When someone is sick, they need competent medical care, not a stay in a resort. Patients have to understand that it may not be possible to cure them, or to do so without their experiencing some discomfort. Please do not take this explanation to mean that healthcare providers do not sometimes fail miserably in their duty to patients.

Doctors, nurses, techs, administrative personnel are just working people like the rest of us, and they sometimes make mistakes, or have a bad day, or just don’t do their job very well on a given day, and like the rest of us they may not like their job or their supervisor or some co-workers. It may be worse when those things occur in a healthcare setting, but they are natural parts of having a job. If we expect otherwise, we expect too much.

“My personal feeling is that health care providers don't give a fig about patients and that they are in it for the money.”

No doubt there are some providers who look at things that way. I can only speak for the hospital with which I’m associated, and that is not the case there. It is a not-for-profit hospital in a competitive situation with other nearby facilities, and as such it must work hard to be the hospital of choice in our region. I have noticed, however, that some physicians tend to become less “patient friendly” after they have been in practice for a few years. Their initial perspective of helping people gets affected by other influences, such as the rigors of running a business, having employees, dealing with Medicare/Medicaid agencies, paying tens of thousands of dollars each year for malpractice insurance, trying to avoid being sued and other such “real life” things. Some doctors and other providers don’t understand what it is like to be a patient, and as a result do not conduct themselves in a manner that is sufficiently sympathetic to patients.

“They cover for each other and there is almost nothing we as patients can do about this disaster.”

Again, I can only talk about my own experience, and I can tell you that our hospital has a process that looks into every complaint from a patient, family member or visitor. I chair a committee that looks at these complaints and is diligent in addressing issues of quality of care and relationships with patients/family/visitors, and while we do find cases where hospital personnel made mistakes or did not act appropriately, we also find cases where patients and family members were simply wrong in their assertions, or “mis-remembered” details.

“Keeping us sick means more money in their pockets.”

I don’t know about where you live, but where I live there are plenty of patients needing medical care and not enough doctors to treat them. Consequently, doctors have enough patients, and do not need to “keep them sick” to make money. I’m not saying that it doesn’t occur, but it is not common here.

“I believe that the accountability of doctors and hospitals needs to increase dramatically.”

You may be right, but as I said earlier the level of expectation for healthcare providers is much higher than for many/most other businesses; I really doubt that you can cite an industry that is more closely watched today, or which gets as much negative publicity as the healthcare industry. I’m not saying that such close scrutiny isn’t warranted, or that the negative publicity isn’t sometimes justified.

What I am saying is that to expect mere human beings to be less subject to the normal influences of the work-a-day world, or to be more perfect in their work just because they deal with sick and injured people is probably not a realistic expectation. It is a worthy goal to aim at, but I think it is a goal that we will never completely achieve.

Thanks, again, Marsha for your comment, and I hope you will become a regular visitor to Observations.

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