Vol. 12, No. 3,009 - The American Reporter - October 19, 2006


by Cindy Hasz
American Reporter Correspondent
San Diego, Calif.

Printable version of this story

SAN DIEGO -- Years ago I worked as a patient-care coordinator for a hospice, and as I told a doctor this weekend at a meeting on health care for seniors, it completely ruined me.

Being medical director for a local Hospice, he understood perfectly.

There is a philosophy intrinsic to care for the dying that infects one's practice of medicine forever. It is an emphasis on the sovereignty of the human person, on holistic systems, physical, emotional and spiritual. It is an understanding that the patient and their family is a "unit" of care which is just medical jargon for the fact that a person's family and social matrix are not separate from them.

Hospice care puts high value on empowering the patient to be part of the decision-making process and to own both their deaths and their lives. Good hospice workers understand that it is a great privilege to be present at the most significant time in a person's life, and they walk gently, with great respect and compassion, know the difficulty and magnitude of that moment in people's lives.

Coming to them with the philosophy that life and death are a person's own journey, in which medical professionals are only facilitators and guides, changes the way you approach health care.

So much of the time, when a patient is institutionalized either in an acute care or sub-acute facility or nursing home, there's a tacit agreement that they must give up personal power in order to have the "medical clergy," i.e., doctors and nurses, take care of them. The whole system is oriented around the providers, and patients are basically at the mercy of caregivers.

Patients turn on their call bell for help and wait until it's convenient for someone to come. Most hospitals are famously understaffed, so that wait can take minutes, and sometimes seemingly interminable periods of time when you are in pain or suffering some other urgent need. Patients often have to contend with nurses who will second-guess their need for pain medication and, in some cases, downright refuse to give what the doctor has clearly ordered in favor of a less effective substance which may also be on the books.

Most of the time patients don't have access to their charts or even know they can have access to their charts - or don't want to be seen as a problem patient - so they don't see what their doctor has actually ordered for them. They must simply rely on the nurses to share information about the perimeters of their care.

This is not to say that there are not good facilities and good doctors and nurses out there. Some of my best friends are doctors and nurses, but tongue-in-cheek aside, no matter how wonderful even saintly 50 percent of the care providers are, the system simply militates against quality care, That's due almost entirely to shortages of personnel and lack of reimbursements and the scarcity of resources at every level.

This is why innovative (which translates to "maverick" and "trouble maker" in many circles) practitioners like my doctor and pharmacist friends are finding ourselves enthralled with new ideas of interdisciplinary teams whose built-in feedback loops allow communication and follow-through that alone ensures good care. It is the only way I've seen to restore the humanity to health care and do it in a way that makes sense - both common and financial.

One doctor is doing a mobile house-call business which serves the homebound elderly. Another is forming an integrated, on-site, full-spectrum health care delivery system. The pharmacist is doing new ways of getting medications to home health patients to simplify and prevent problems asscociated with not taking medication correctly. I am working to pull eveyone together to form a collaborative to expand rural health care. We will all work together eschewing the old competitive model and, paradoxically, not only give better service but do better business in every sense of the term.

Form follows function, and likewise - and more importantly in this case - function follows form. These ideas are reaching critical mass and are fast becoming "ideas whose time has come." It's not "if" but "when" healthcare providers will pioneer new collaborative techniques and dare to make our patients the center of practice, not numbers in an HMO equation and cogs in the corporate wheel.

Hey, it could happen. The Wright brothers were once just men with preposterous dreams. From my vantage point, Kitty Hawk looks very possible.

Cindy Hasz is a nurse and writer living in San Diego. She can be reached at cyn1113@aol.com

Copyright 2006 Joe Shea The American Reporter. All Rights Reserved.

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