72 Comments

1. J.J. Sefton:

I think one factor that almost no one seems to talk about is the vast amount of fraud that runs rampant through Medicare, Medicaid and the insurance industry as a whole. Not every doctor is dishonest, nor every patient a con artist nor every lawyer a shyster. But it is staggering how much abuse, waste and mismanagement there is which translates into higher fees for all of us.

One of the best scripts ever, and an amazing movie “The Hospital.” George C. Scott is tremendous and it’s a hell of an indictment of the medical system. It’s from 1971 but is as timely as ever.

Nov 13, 2008 - 1:14 pm 2. heather:

another issue with nurses is that hospitals have to have nurses around the clock. This means that nurses must acquiesce to shift work. This is very hard on family life, and almost impossible for middle aged people, as it results in physical problems we know as ‘jetlag’.

The nurses you cite, forcing a limit on the number of patients for each nurse is a very good idea. Moreover, my nurse relatives tell me that patients tend to be extremely sick in today’s hospital.

I still think that nurses lost status and admiration of their public when they decided that uniforms were only ‘work clothes.’ The profession has devolved into a technical handmaiden to the doctor. To patients, there is nothing to indicate a person’s role in that strange place, the hospital.

Nov 13, 2008 - 3:59 pm 3. Avi:

Unfortunately, Americans do not believe that they are their brother’s (or sister’s, for that matter)keepers. You have the healthcare that you deserve. It is hard to achieve a ‘compassionate’ outcome in a society that worships greed and glorifies a dog-eat-dog mentality. In the early 70’s (the good ol’ days about which many are reminiscing), hospitals were forbidden by law to operate for profit. Of course, a good idea could not be left to stand, especially where it interfered with the phantasmagorical, and utterly phony, “free market.”

Americans only complain about the healthcare system when they are forced to endure what they, themselves, have wrought. Why were you so easily persuaded by Harry and Louise, or any other insurance company propaganda? Maybe you stayed up all night, worried that someone, somewhere might get one penny that they didn’t deserve? Maybe you believed that your choice of deity wasn’t serious when it urged you to care for the sick - after all, maybe that deity just wasn’t aware of the freeloaders and malingerers that pose a much greater threat to your society than Enron or mortgage peddlers or _______(insert your choice of corporate freeloader here).

Ultimately, instead of worrying about that tired old bugaboo, “socialized medicine (scream, shriek, light hair on fire!),” perhaps you should ask yourselves to give a damn about your fellow Americans (you’ve certainly no trouble demanding that nurses do it in your stead), whatever their socio-economic-status. Whenever profit motives and healthcare intersect, the patient is the loser. Doctors are given incentive to recommend unecessary, or to withold needed, treatment. Hospitals are given incentive to decrease length of stay, to cut down on qualified nursing staff (nursing is the largest cost, overall, to a medical facility) and to engage in too many evil behaviors to list here.

While everyone loves a good round of nurse-bashing, it must be said that many members of the “helping professions (and that includes psychologists, social workers, clergy, etc., as well as medical folk)” are grossly impaired. Of course, in the American system of medical education, the emphasis is on status and status-seeking, rather than on helping people. Studies show that most doctors spend the time they should be interviewing a patient talking about themselves. Narcissistic personality disorder, anyone? Well, Americans, it’s up to you to ensure that misanthropes do not attend medical or nursing school. Hmm. Maybe if there were less emphasis overall on kicking the other guy when he’s down or on profiting at all costs. No, but you’d have to step away from the computer keyboard, put down the cell phone, turn off the TV - all for the sake of your fellow Americans, whom you just don’t seem to value very much. You want your nurses to be Mother Theresa, but you’d deny her the medical care she needs.

Nov 13, 2008 - 10:14 pm 4. Dan Smith:

Hate to burst your bubble, but the statistics you quote regarding deaths due to medical errors are wrong. They were estimates published in a New England Journal of Medicine article in the early 90s. The authors were trying to get within the ballpark of how many “avoidable deaths” occurred in hospitals. Their definition of avoidable was quite inclusive and went beyond the hospital boundaries. For example, if a breast lump was not diagnosed as cancer the first time around, the woman’s death was attributed to a medical error, no matter what the aggressiveness of the cancer. Similarly, a patient with a terminal illness undergoing invasive and heroic treatments who died as a complication of therapy was tabbed as an “error” eventhough survival was impossible. If you don’t believe me, look up the research yourself. The authors were looking at charts in New York hospitals, then extrapolated the results to come up with the 100,000 death number. A similar retrospective analysis performed based on hospitals in Colorado produced an estimate of 40,000. Well, which is it: 100,000 or 40,000? It’s not the same concept as the media portray, that of going into a hospital healthy and leaving in a body bag. In the state of Minnesota, state law requires hospitals report statistics of patient deaths as well as injuries. The last time I checked the rate was about 20 a year. If we extrapolate that to 50 states we get 1000 per year. That may still be unacceptable, but it is nowhere close to the inflated figure that the Institute of medicine published. The IOM has a political agenda about as large as Texas.

Nov 14, 2008 - 3:30 pm 5. Pam:

It is not a matter of anyone being “his brother’s keeper.” No one is supposed to be the “keeper” of an adult human being.

It is a matter of having respect for yourself and what you do. If a doctor, nurse, or, say flight attendant (which I was for well over 35 years before retirement) has no self respect and no respect for what he or she does, s/he will have no respect for anyone else including his/her patients, or passengers. It has nothing to do with any sort of self sacrifice and everything to do with self respect and taking pride in what you do.

I noted that in all the years I flew that flight attendants, pilots, and others who spent time rambling on about people being “selfish” and “greedy” and “being your brother’s keeper” were without exception the people who treated everyone else with absolutely no respect at all while at the same time expected to be treated like little demi-gods and goddesses themselves. It was their way of attempting to fake self respect.

Some hospitals are so horribly understaffed that the nurses barely know their own names much less have time to properly perform their jobs. I would think that 14 patients per nurse would be way too many unless all the patients needed little more than a band-aid or an aspirin.

When I had a mastectomy a couple of years ago, I spent the night after my surgery in the Short Stay Unit. This Unit consisted of nine tiny private rooms. This little unit was staffed with three nurses and a nurse’s aid. I never had to ring the bell for anything. Shoot, if I moved a nurse appeared at my bed within 30 seconds. No one woke me up for anything. I was attached to an automatic blood pressure machine that was simply set to take my blood pressure at certain times and report the results directly to the nurses’ station.

I had been sleeping a lot, of course. I woke up about midnight and was watching Emeril Lagasse cook on television. The nurse appeared and asked if I needed any pain meds or anything else. I didn’t need the meds, but I asked if she had any coffee. She told me they had the swill, as she called it, from downstairs, but that they had flavored coffee from Gloria Jean’s that they kept for themselves and asked me if I would like a cup, telling me I had a choice of French Vanilla or Cinnamon Hazelnut. I chose the French Vanilla and sat there in bed watching Emeril cook and the rain fall on the window panes while I sipped my coffee. It was almost like being in a First Class sleeper seat attended to by the best imaginable flight attendants who came equipped with pain meds and medical equipment. Considering the circumstances, it was a very pleasant experience.

These women were intelligent, very well trained, and took enormous pride in their chosen profession. I certainly did not view them as some sort of handmaiden and they did not view me as some sort of whining miserable nuisance who was bothering them. I treated them with dignity and respect and they treated me the same way. This is the way it’s supposed to be done. No self sacrifice from anybody. It was civilized human beings interacting with one another in a civilized and proper fashion. Not some bunch of non-entities verbally abusing and debasing each other in a vain attempt to feel like a big shot.

Nov 15, 2008 - 5:28 pm 6. Pam:

Heather wrote:

“another issue with nurses is that hospitals have to have nurses around the clock. This means that nurses must acquiesce to shift work. This is very hard on family life, and almost impossible for middle aged people, as it results in physical problems we know as ‘jetlag’.”

Jetlag is caused from crossing many time zones in a short period of time. This plays havoc with the body’s clock. I am well acquainted with jetlag. A crew flying Rome might land at 9:00 AM Rome time. Trust me, your body knows it’s 3:00 AM east coast time. When you leave Rome at noon the next day, Rome time, you body knows it’s 6:00 AM east coast time. If you think the crews, including the pilots, are all young sprouts who fly these trips, think again.

Working an overnight shift in a hospital would be no problem for a middle aged nurse, especially if the scheduling is consistent and she works those shifts on a regular basis. After all, middle aged, and older, doctors are often called to perform surgery in the middle of the night. This works out very, very well for people who are night owls to begin with.

Nov 15, 2008 - 7:13 pm 7. Doctor Tom:

Phyllis:

Dan Smith has it correct, but given the MSM’s propensity to continue to “report” proven false data in order to promote their agenda, it is not at all surprising that the “numbers” continue to be bantered about. Nonetheless, what we in the Operating Room (OR) field of medicine refer to sardonically as a “clean kill”, do happen, albeit rare in the extreme. On the other hand, medical mistakes do happen all the time, just as in any other enterprise utilizing humans. The VAST majority of these are minor and would be classified as a Class II error (in our QI program, an error which did not have an effect on patient outcome). We should obviously try to minimize these errors, since most major mistakes are the result of a sequence of minor mistakes which coalesce into a disaster (NB: The Three Mile Island accident.).

The BIG question is: Which system is most likely to minimize those errors which occur and try to prevent them from coalescing into major errors. The competing theories are government management verses free market management. I can already hear the heads exploding on the left for me to suggest that we should turn over all control for “our” health care system to “those greedy capitalists”.

In the entire history of humankind, I simply ask for one example where a government bureaucracy was shown to be safer (and/or more efficient) than free enterprise. Even in such a heavily regulated industry as transportation, who has the better safety record, AMTRAK or Norfolk-Southern?

As in my previous comment on your earlier article, let me make an academic proposal. To the “leftist” who feel that it is “their” health care system (despite the total absence of any “ownership”), let us “give” a hospital (and its staff) to be run by their beloved government. In parallel, we will have a private hospital competing for the clientele, not only with the “government” hospital, but also any other private institution. Which facility do you think will offer the best service?

Of course they will scream: “But what about the poor and uninsured, the will HAVE to go to the government hospital.” To which I reply, you can also keep all the government subsidized insurance such as medicare and medicaid, the private hospital would not request a single dime of the taxpayers money. You can “mandate” whatever level of quality you desire in the government hospital, but the private hospital only has to satisfy its customers.

Now you see the crux of the problem. Socialized medicine only works when you can mandate it for the entire population, with no exception (government workers excluded of course). If somebody can get something better because they can pay for it, it will be deemed “unfair” because those who go to the government hospital can’t get it.

If the government provided everybody with a car, but prevented you from buying a better car than what they were offering, what do you think would happen to the auto industry? Just wait, with the current “bailout mania”, we may actually get to see for ourselves.

The government cannot tolerate competition in any aspect of our life they have determined to be within their control. Why do you think they have effectively outlawed any insurance program for seniors except medicare (not counting “copay” insurance). When I retire, I would like to be able to take my medicare money (sort of like a voucher for all the medicare taxes paid over my working lifetime) and buy my own private insurance out of pocket, but hope springs eternal. I am confident that if allowed, the competing insurance companies would offer a better program than the mandated medicare.

Nov 15, 2008 - 8:19 pm 8. Doctor Tom:

Let me add a caveat to my previous “academic discussion” about government vs. private hospitals. Even if the government decides to allow competition (a VERY big if), they will still have control over the distribution of the clientele based on the tax structure. If the tax is high, it would shift the population to utilizing the government hospital, because the “value added” of the private facility would not be worth the added expense of private insurance. If the tax is low, more people would buy private insurance (or pay out of pocket) to go to the private facility. Which scenario do you honestly think is more likely?

This is the system in Canada. While there is “nominally” a vestigial private practice in Canada, the expense imposed by their public health system has effectively killed it except for the very rich, though they still claim it as being some kind of hybrid system.

This is the major flaw with all of the health care proposals coming from Washington, DC. Obama (president elect) has repeatedly said “if you are happy with your current insurance, you will be able to keep it”. The problem is that the additional tax for “universal” health insurance (since that money can’t be applied to your own premium), most people will be unable to afford the “universal health care tax” AND pay for private insurance at the same time. Unless outright outlawed, the private hospital will still be available to the very rich (and government employees), but not to the “mere” citizens.

This situation was made clear recently in Hawaii, where they recently abandoned universal child health care insurance because most people stopped buying their children’s health insurance and put them under the state run program. The law of unintended consequences is universal.

Nov 15, 2008 - 8:52 pm 9. Pajamas Media » Cause of Death: Hospital Stay:

[...] Read the entire piece here. [...]

Nov 16, 2008 - 7:53 am 10. keebs:

I have been a nurse in hospital systems for 21 years.
“Why go into nursing?”

Young women and men choose nursing because they can do the work (it requires a gut of steel and the courage to place objects into human orifices), and because it pays quite well. The job is rather recession proof. There is an altruistic component but that’s not enough incentive to get through nursing school.

It is because we are human that mistakes happen. There are many, many safeguards in place that help us avoid them. The “near-miss” MUST be safe to report so processes that are not working can be repaired.

Nurse-patient ratios protect the patient from errors and the nurse from burnout.

Doctors must be held accountable for their poor behavior. Do you want to be cared for by a a graduate nurse who is afraid to call the doctor because he shouts when he is interrupted? This happens EVERY DAY.

Have an advocate with you when you are in the hospital. Establish a relationship with the nursing staff that you are an ally and not there to play “gotcha”. Insist on being involved in the plan of care and being kept up to date on what is going on.

Ask questions, do not make assumptions. The internet will not give you answers about your specific condition TODAY.

Nov 16, 2008 - 8:26 am 11. C. Siegel:

Pam–Your stint in the “short stay unit” sounds like a nurse’s dream. Most of us nurses get tremendous satisfaction out of solving patient problems, and are really frustrated when lack of staff and proper resources prevent us from doing so.

“Jetlag” from shift work is a problem mecause of a lack of flexibility in scheduling–and overwork–due to a lack of staff. Management’s solution seems to be to whip the old grey mare until she breaks down and then look for another one. Nursing initiative, intelligence, and involvement is a resource just like anything else, and hospitals tend to waste it.

Nov 16, 2008 - 8:29 am 12. Tina Trent:

One central answer is raising the prestige, status and endowments at nursing schools and revitalizing respect for the mission-oriented career track in nursing care for female religious orders. A powerful, prestigious discipline will carry more weight legislatively. This seems obvious, but I fear it does not reside on anyone’s radar at universities themselves.

At my graduate institution, the founder of the women’s studies program was deeply committed to nursing as a profession. She was also simply disinterested in arguments about nursing being a lesser degree for women, and so on. Nursing was never her sole focus, but the departments worked beautifully in tandem. An initiative to promote the advocation of nursing in religious academies and to align nursing with women’s studies — constructively — would not only aid the profession of nursing but would bring healthy focus to women’s studies programs plagued by debilitating narcissism today.

Tragically, at the end of her life, my professor suffered at the hands of some indifferent and incompetent nurses — and underpaid nurses aides who were used for procedures that should never have been handled by some poor, overworked woman making seven dollars an hour, with minimal training. After working a lifetime to promote the profession of nursing, it wasn’t there for my professor when she needed it, and while she was succinctly not one to complain, what I witnessed I will never forget.

I hope you recover quickly and comfortably. You are raising crucial and uncomfortable issues here. Per la salute!

Nov 16, 2008 - 9:09 am 13. Judy, NYC:

hmmm. i wonder how anyone reading the comments would like to have DR. TOM as their doctor. a doctor who has no patients. he calls us, customers. and he doesn’[t need any government money (or regulations)at his hospital, because apparently only rich wallets are treated there. of course, what the rich wallets don’t know is that his hospital nurses are the lowest paid, bottom of the class, dumbest, disguised in nurse’s uniforms to make them look professional. a hospital has to makka profit, donit. what an inspiring fella. and, a one-jackass testament to his profession.

Nov 16, 2008 - 10:22 am 14. Dave:

To answer the basic question: “Universal health care” will make the situation worse,
how much worse is open to conjecture.

Don’t forget that all the troublemakers in and around hospitals would then be “civil servants”. Civil masters would be a more accurate term.

As to what can be done, pay attention to Governor Jindal in Louisiana. This is his primary area of personal concern and he is good at it.

Nov 16, 2008 - 10:26 am 15. Pam:

C. Siegel wrote:

“Pam–Your stint in the “short stay unit” sounds like a nurse’s dream. Most of us nurses get tremendous satisfaction out of solving patient problems, and are really frustrated when lack of staff and proper resources prevent us from doing so.”

It would be a nurse’s dream. It was wonderful for me. The service and the care I received could not possibly have been any better.

A friend of mine had the same surgery I did in another hospital in another city. The first thing the nurses did when she arrived in her room was to disconnect her fluids. Bad move. Anesthesia makes her very, very sick. She dehydrated very badly and spent 8 days in the hospital after her mastectomy.

The nursing staff appeared to be approximately 20 years old and from outside the country. They had turned the pants of their scrubs into Daisy Dukes and seemed to have an excessive interest in flirting with the doctors or any other male hospital staff who made more money than they did. Inexcusably poorly run hospital. The hospital administrator has to be an absolute idiot, an incompetent fool.

C. Siegel also wrote:

““Jetlag” from shift work is a problem because of a lack of flexibility in scheduling–and overwork–due to a lack of staff. Management’s solution seems to be to whip the old grey mare until she breaks down and then look for another one. Nursing initiative, intelligence, and involvement is a resource just like anything else, and hospitals tend to waste it.”

The fatigue and the burnout that results from this kind of thing needs to be addressed. Airlines do the same thing with flight attendants and it would be worse if there were not laws to prevent it.

The flight attendant job was created by a nurse from San Francisco named Ellen Church in 1930. She had been taking flying lessons in hopes of getting a job as a pilot. That was not to be, but while she was talking to the manager at Boeing Air Transport (became United Airlines), she came up with the idea of hiring nurses to do the food and beverage service and have some safety and basic first aid duties. This kept the co-pilot from having to leave the cockpit to serve the sandwiches and coffee and kept the passengers from being injured standing up for take-off/landing.

From that time to this, there has been an idea that neither nurses nor flight attendants need to eat or sleep and that they can do amounts of work that, at some point, simply becomes impossible. This is caused not only by financial constraints but due to ignorance of what these people actually do and how much energy, both mental and physical, it actually takes. A nurse is not a mindless chunk of meat who passes out pills and fluffs pillows

Nov 16, 2008 - 10:35 am 16. KG2V:

In the last 18 months, both my parents went through their final illnesses. Mom “got lucky” as Dad was still in good shape, and therefore we could keep her at home with private nurses/Nurses aids. Every one of them except one “vaction” nurse was a wonderful care giver

Dad wasn’t quite so lucky. We ended up having to put him in the best nursing home I could find - the first we tried, I pulled him out after 4 days. Ring the bell, no one came for 3 hours (I took care of the problem, and then waited to see how long it took them). Most of the staff was rude, and the place was a dim, dirty dungeon - then we got him into a nice place - what a difference!

During his illness, he had to shuttle off to the hospital a few times (Glen Cove on Long Island) - there was a nurse there (Paul if I remember his name right) - he not only cared for Dad, and really took care of him, he worried about ME - made sure I got the info I nneded, had a place to sit (I’m handicapped and can’t stand very long) and was always willing to talk a bit about Dad

You darned well know that even though Dad’s been gone since June, I’ll be dropping by there with a basket of Fruit, or something, for the staff

Nov 16, 2008 - 10:35 am 17. John Moore:

Although the focus is on nursing, it should be noted that US hospitals are often sorely underautomated.

In a hospital with suitable automation (charts on computer, orders on computer, computer readable ID on patient, on all medications, etc), a significant class of errors will go away.

I would also suggest that people study the Mayo model. Workers at Mayo, at all levels, are reportedly unusually happy with their jobs. Mayo is highly efficient. It’s Mayo designed hospital in Phoenix has infection control built in - with single patient rooms (the new accrediting standard for all new hospitals) and hand sterilizing stations between and in each room. Mayo clinic is likewise efficient. Mayo is also highly automated. Interestingly enough, doctors at Mayo are not highly compensated.

The best role of government would be to make publicly available statistics and measures of hospital performance and characteristics (including nurse to patient ratio). Informed patients will drive competition.

Another role of government, which it so far has botched (see HIPPA electronic communications) is to mandate automation, especially standardized intercommunication between providers and between providers, payers and customers. Done right (which is asking a whole lot of government), this would significantly cut down on the overhead of the system while improving care.

For example, a relative was taken to the ER for hear arrhythmia. She had a prior history, with recent test results at her private physician. She was kept in the ER for almost 24 hours, primarily because of the time it took to get faxes of her records to the hospital (they were lost once or twice along the way, which is typical of clerical medical tasks). A suitable automation system would have had those records instantly available. Not only did this prevent the patient from getting the appropriate diagnosis in a reasonable time, it also cost resources at the hospital.

We can do better.

Nov 16, 2008 - 10:43 am 18. Teri Pittman:

My husband spent two weeks in the ICU in October of this year, dying from pneumonia in the end. He did not have insurance, but was treated like everyone else. It looks like about $157,000 in hospital bills right now.

I cannot say enough good things about the nurses, doctors and staff at SW Washington Medical Center. The hospital has hand sanitizer dispensers on the walls everywhere. The staff and professionals were compassionate, going out of their way to keep an eye on me to make sure that I didn’t wear myself out. The ICU nurse and the hospital chaplain kept watch over my husband at the end, as I was too emotionally wrung out to go myself. They even helped me find the names of funeral homes to conduct the cremation.

There are two things you don’t discuss, that I know from my time there. One is from an ICU nurse, who told me that the average age of an ICU nurse is 47. They are aging and retiring. The second issue is computerized medicine. Nurses not only have to know patient care. They also have to learn software. It is especially hard on the older nurses, who are used to writing out reports on the patients while observing them, not typing the notes out into a computer with their back to the patient. The hospital is redesigning the rooms, so this may get easier in the future. I saw a lot of people tending to expensive machines, with a lot less physical contact with the patient. I’m not sure this is a good change. I suspect we are losing nurses that want to interact with patients, not computers.

Nov 16, 2008 - 10:55 am 19. cedarford:

My impression of a hospital and hospital emergency room, after watching my mother die there over time, and my own experience with a ruptured appendix and a 4-hour wait to be “officially” diagnosed with what I called 9/11 saying I had, what paramedics said I had - 7 hours from 9/11 call to surgery - then convincing 2 shifts of nurses postop my chart was in error, that I didn’t have a “simple lapro”???

1. Well, that ERs and hospitals bustle with people, but few are actual frontline caregivers. This compares, sadly, to the “broken military” which once had a ton of rear ech “careerists” on easy hours, while us “frontliners” in the Army, Navy and AF put in killer hours from being shortstaffed for missions. Some of the “rules” make it difficult for people to return to nursing after having kids and moving to a different town. Union rules (for example) that say the undesirable backshifts shifts are to be assigned on seniority - which makes it a non-starter for nurses with young children - and for adept aspiring, returning middle-aged nurses told they have to start with 3-4 years on the graveyard shift in hospitals and nursing homes. Unlike the military, the medical profession has not worked hard on getting more frontliners.

2. My Mom had two “meds error” events, neither which killed her but one put her back in intensive care. One of her patient roomates bled out, though, a day after surgery and undiagnosed internal bleeding. Their family attorneys interviewed my mom for what conversation and knowledge of events happened in the woman’s last 4 hours. (It wasn’t good news for the nurses, as the woman complained something was really wrong the whole time she was dying and told to drink fluids, the doctors would come by in the morning).

3. My own stay was marked by a doctor in 1 15-second “swoop-through” telling the other patient in the room that he had no infection from my emergency appendectomy - which may or may not have reassured him. Meanwhile, I left the place with the worst conjuctivitis imaginable, a wound site infection I doused with peroxide, and a severe fungal infection of my feet.

4. I’d believe Dan Smith’s rosy assertions that only 1,000 people a year die in the US from “medical misadventures” if there was full transparency, instead of a system where lawyers seek to obscure the extent of “problem hospitals, nursing homes, surgeries, and infectious disease transmittal”. Until then, the stats Chesler cites, seem more in line with other nations that do track such “misadvenures”, thus more credible.

5. Solutions are everywhere, just not the willpower to break the inertia of medical bureaucracies, unions, the “professions”. There are arguments for and against universal health care and “laissez faire capitalist health services” - as forcing badly needed reforms. If we elect to join other advanced nations and go with universal health coverage, we would be far better going with the German, Japanese, Singaporean, French model than Canada’s or the UK’s abysmal PHS.
If we went with “Ayn Rand Healthcare”, we could see improvements for some, but not for society overall - as the whole system would not support “cherry-picking, dumping high-cost patients, hospitals for only the wealthiest.”

Nov 16, 2008 - 11:01 am 20. nitwit:

It all fits with the model we use for health. As long as we keep pursuing an allopathic model this is what we’ll get. It’s great for accidents, but not for illnesses.

Nov 16, 2008 - 11:03 am 21. notutopia:

Ms. Chester,
I pray you are healing and recovering both in body and soul.
What you describe is harrowing and real. The patient IS the business! I must place heavy emphasis here that the Hospital Administration itself and it’s Board of Directors(which for the most part are mostly comprised of community business persons and laypersons) are ultimately responsible and have authority over and for the entire Hospital Chain of Command. It is of my opinion that until requirements for these positions are mandated by Health Care Regulation and Fed law(For Medicare and state reimbursement and their job descriptions are equally represented by dual ends of the opposing and conflicting spectrum. One end as the Caregivers and the other end as the Financiers and Profit makers. I have strongly suggested those positions be filled with experienced and Licensed Health Care Practitioners WITH MBA’s. Until this conflict is amended, the current system will stay in their present condition state of “Critical”.
The system itself is broken starting from the top down. When accountants spreadsheets and fiscal cost reporting and profits are the primary concerning factor in the management of any healthcare facility, then it is only fruition that the rest of the system is suffering all the way down to the CQI patient outcomes. I can say this from an unbiased firsthand perspective, employed for 37 years in Healthcare Administration and now a retired Healthcare Consultant. I am a Licensed Practitioner in Healthcare who also has a MBA.

Nov 16, 2008 - 11:46 am 22. Wil:

John Moore

While I agree with your sentiments , hospital automation does not equal success and while the Mayo model works arguably well , you should understand that it may not work at all in many American hospitals even with highly competent staffs that are extremely tech savvy because of a) hospital culture b) costs c) implementation and d) support both technical and hospital .

Avi

We are nobody’s keepers and I agree with Pam’s post all the way through . It’s easy for you to talk , but those of us who are working in American hospital knew this simple truth . Whatever illusions prospective nurses and doctors have about status disappear once they start working the hospital units for real . And the only things that matter are these , you helped a patient 2) you did a great job and the only praise you want are from the patient and his or her family and your unit colleagues . The Rest is either pure vanilla or waste of time .

Nov 16, 2008 - 11:47 am 23. Wil:

cedarford
I hate to tell you this sad reality but it would not do anybody good if there are fewer medical infrastructure like hospitals and medical centers being built than those being closed . Tell me cedarford , how do you think we felt when we heard that Lincoln park Hospital had closed . Imagine the dread knowing that the hospital I currently work for which had already covering for the lost of EdgeWater Hospital and Ravenswood Medical Center will absorb another group of patients considering that we are already being maxed out and winter is coming . For all your talk about universal health coverage or lack of it , until somebody from both the private and public sector recognized that reforming healthcare also involves building hospitals and getting motivated , well educated , trained and competent people to run it , every type of reform would make it worse and with the solution you are peddling . That’s one extremely competent way to hasten the closure of more hospitals and medical centers throughout the US.

Nov 16, 2008 - 12:20 pm 24. kasper:

I agree, our healthcare system needs some serious tweaking, but forcing universal healthcare on society is a huge mistake.

I believe in Florida has or will have soon with have a system in place that considers 30 year olds dependent children. That is insanity.

Here’s another problem. Has anyone researched the impact a large illegal population has on hospitals and clinics. Seems to me I heard of hospitals and clinics closing in areas where this burden is the greatest.

My children in their 20s pay for their own healthcare and there are private insurers offering not cheap, but fairly reasonable policies. They pay the their insurance bill themselves. Granted there is a deductible, however, any more serious illness or injury will quickly add up beyond the deductible. But, like having a car inspected and insured, it is a responsibility. I’m not saying its perfect, it’s not, but at least they making an attempt at being responsible adults.

Being our “Brother’s keeper” is great when it is your brother. But when society is asked to provide everyone at every level with every need, you have a system that is unsustainable. We see the results with all government programs right now. There is never enough done, and never enough money to do it. And people are just caught in a system of limitation.

That’s not to say there shouldn’t be some way individuals and families can get health insurance not associated with their jobs. Or some kind of pool of insurers available that has more flexible coverage according to need.

I suggest those who want a universal or government run healthcare system be the first to try it out for themselves, and get back to us after 10 years. See what happens when doctors and healthcare professionals are given no control as to where and how they will practice.

Leave the rest of us with the system of our choice.

Nov 16, 2008 - 12:35 pm 25. kasper:

I meant to add that healthcare workers in the UK recently demanded that they have access to private healthcare, because apparently the care they give to those in their own system is so deplorable.

How much proof does there have to be that government run healthcare falls apart.

Nov 16, 2008 - 12:39 pm 26. Pamela D. Wilson:

Allowing the government to control more health care and insurance issues is not the solution. Look where we are already with Medicaid, a system for the low income that pushes individuals into nursing homes that are reimbursed less than the cost of daily care to provide services. Yet people complain about the quality of care in nursing homes. Whoever believes that a government-run healthcare system will provide better care need look again at the failings of the current system.

Nov 16, 2008 - 1:19 pm 27. Sharonsj:

This is a red herring. Some health care is better than none. I couldn’t afford health insurance for six years, so I took tons of vitamins and drove very slowly. Now that I’m on Medicare, if fraud was being committed, I’m not sure I’d know. The Medicare booklet is huge but contains very little information. I have a very high IQ and still can’t figure it out by myself. Our health care non-system (except for those with enough money) is disgraceful. By the way, a hospital killed my elderly father and I swore I would not go to a hospital unless it was an emergency or I got knocked unconscious and was carted there by ambulance. As for ending my life in a nursing home, that won’t happen: I’m saving up my pills….

Nov 16, 2008 - 1:52 pm 28. Wil:

kasper

Bingo , that is a massive problem that many people both within and those outside of healthcare refused to recognized . All hospitals need to make a profit in order to expand , buy new medical equipment , hire and retain staff and of course , provide for charity . The health care cost of an indigent American patient is often being absorbed by the hospital and the remaining balance is passed to every paying and insured patients . Now , add non-paying illegal immigrants to the mix . Imagine how much money each hospital is losing by treating both indigent americans and illegal immigrants at the same time and if they are suffering chronic diseases like CHF , COPD and CRF with renal dialysis , it adds up to the point that no amount of cost cutting can keep the hospital from drowning in red ink . It does not matter if that hospital is an elite hospital like NWCH or Mayo or John Hopkins or IMMC or a small community hospital near the Mexican border , as long as health care facilities are being forced by law to treat everybody without any though of payment of treatment rendered , sooner or later , even hospitals with large amounts of money reserved for charity will be forced to cut down on services , reduce staff and finally closed down if the cost of doing business is too much to bear .

Universal Coverage only prolongs the agony because when bureaucrats find out that no amount of taxes can replace the shortfall , they will then cut services and benefits in order to minimize the losses regardless of who suffers .

Nov 16, 2008 - 2:07 pm 29. Judy, NYC:

i must respond to “we are not our brother’s keeper”. are you kidding? you must never have been hospitalized after lengthy surgery. the worst thing you can ever do is have a private room. patients who share rooms (and the more the better) always care for each other, because we are in different stages of recovery. if your roommate didn’t shlepp out to the nurses station or the hallway and let them know you are in great trouble of some sort and need someone desperately, we would all drop dead in our hospital rooms. i know this from actual experience. my fever spiked in the middle of the night and i was shaking with chills and going into shock and seizure. my next bed roomie saved my life, literally.

our very wealthiest and most recognized famous citizens, patients in what are considered the finest hospitals, died because they were in jprivate rooms with private nursing care. so, for those of you, who do not think we “keep” each other, get yourselves private rooms and you won’t be responsible for anyone else, nor will anyone “keep” you. good luck with that.

Nov 16, 2008 - 2:18 pm 30. K. Johns:

One only has to read the horror stories of socialized medical care that come out of Canada and England to learn that socialized medicine is NOT the answer. If you are over 65 England and Canada both are now wanting to refuse you more than palliative care so you will quickly die and rid the system of a non contributing member of society. Likewise with smokers, drinkers or the overweight. Socialized medicine is only for the healthy young, everyone else loses out.

Nov 16, 2008 - 2:26 pm 31. Pam:

Hospitals, like airlines, operate 24/7. If someone simply has to be off nights, holidays, and weekends, I strongly suggest they do not go into the medical profession or work for an airline. Working the back of the clock is part and parcel of both hospitals and airlines. It’s just the nature of the beast.

I realize that hospitals have to do something about poor scheduling policies and procedures, and under staffed and over worked nurses. However, that back of the clock work just goes with the territory.

A very high patient to nurse ratio is asking for disaster. When people are overworked and exhausted they make mistakes. They don’t see things they would otherwise see and they do things that are inappropriate. It is unavoidable. This is good for exactly no one.

We do not need fewer health care facilities, we need more. We need intelligent, educated, skilled, motivated people to staff them. This costs money. The people who have your very life in their hands should not ever be expected to work for subsistence wages or be abused by anyone. They are not selfless non-entities. They are professionals who work very hard under sometimes very trying circumstances and deserve to be rewarded for it.

Nov 16, 2008 - 3:10 pm 32. Kirk:

I’ve been in hospitals on both coasts, and in the interior. It’s the coastal hospitals that are populated with those people. Your blue state cities also create blue state hospitals, and they are staffed by blue staters. It is not an oversimplification that the trashy people of the gimme states make poor caregivers. the best hospital I have ever seen, from San Francisco to Hampton Roads, Virginia is in Rapid City, South Dakota. The cancer care is humane the the best in the world, the people hardworking and compassionate. Once my wife and I are out of the military, we would retire there just for the health care alone. Keep your blue states filled with hate and give me wholesome America instead anytime.

Nov 16, 2008 - 4:00 pm 33. mk:

I’m a nurse. I quit (as we call it) “clinical nursing” three years ago and now adjudicate claims for a health insurance company. I will never ever ever go back to clinical nursing. I told my parents once that I would work at Walmart before I went back into nursing.

Nursing in a hospital is a terrible profession. You’re treated like a mindless automaton. You’re expected to work all sorts of shifts with next to no money “rewards.” Patients, family, doctors, other nurses treat you like crap ran over twice. Shift work drains the life out of you.

I loved my job as a Neonatal Intensive Care Nurse, but after six years of being treated like crap, I left and I’ve never looked back.

Socialized medicine will not change this. The salaries for nurses will get worse. Much, much worse.

Nov 16, 2008 - 4:41 pm 34. ate mely:

Free market capitalism is the answer.
In 1969, I was one of your “outsourced, foreign nurses, trained outside the US”. English was my 2nd language. All our nursing and medical books then and now are American textbooks. We, foreign trained nurses are not part of the problem. Then as now, we are part of the solution. Then as now, my skills and compassion are comparable to American graduate nurses. Then as now, it’s foreign trained nurses who work most off shift (3p-11p, 11p-7a or 7p-7a) because we have limited extended family to take care of our children and help at home. Then as now, it’s foreign trained nurses who work most American holidays - Thanksgiving, Christmas and New Year’s Day. It’s all individual response to a situation.
More government authority is not the answer. Whether people are insured or not, will make no difference in the level of skill care or compassion.
Apply the principles of Adam Smith in ‘The Wealth of Nations’ and Milton Friedman’s Capitalism and Freedom to health care. Chapter l of The Wealth of Nations is ‘Division of Labor’. “The greatest improvement in the productive powers of labor and the greater part of the skill, dexterity and judgment with which it is anywhere directed or applied, seem to have been the effects of the division of labor.” Starting in the ’70’s hospitals and nursing applied this division of labor concept, skillwise, hence the rise of medical and nursing specialty. These specialties though are skill, task oriented and compassion was never emphasize in training. These skills must be broken down farther in order to incorporate compassion.
Milton Friedman states: Free market is an ‘impersonal market’. This ‘impersonal market’ separates the economic activities of health care from other views, political or emotionwise.

Nov 16, 2008 - 5:05 pm 35. ate mely:

Why go into nursing?
In 1969, it was the fastest way I can see United States of America as a 21 yr old newly wed with my husband as a hospital sponsored immigrant. Six years later my country of birth became totalitarian dictatorship.
God Bless America.

Nov 16, 2008 - 5:33 pm 36. Doctor Tom:

Judy, NYC:

I hate to burst your bubble, but you know the old saying about assumptions (no, I won’t lower myself to your level of name calling). Perhaps you should also add a critical reading class to your education, because nowhere in my comment did I advocate FOR or AGAINST regulations. My argument was centered solely on the economics of health care. In a funny kind of way, you actually made my argument for me, since ultimately, the problem (of poor treatment or care) exists because we don’t treat our patients as customers. I guess nuance and subtlety is beyond your comprehension as well, sorry.

For your information, the hospital I work for has a patient population which is 75% medicare/medicaid, 15% self-pay (which translates as no-pay) and 10% commercial insurance. You will have to look long and hard to find another facility which even comes close to these demographics. I suspect you will also say that I am somehow lacking because I “HAVE” to work in such a poor facility. Actually, I spent more than a decade, after finishing residency, working in academic medical centers, training the next generations of physicians. I won’t say where, exactly, but they routinely do better than Massachusetts General Hospital in national rankings. I came to this facility in order to be closer to my Mother who was in poor health at the time (she died in 2001), and I stayed on because my services were needed and appreciated. My income is also far below the median for my profession, and job offers abound, but there is more to life than making money (something you, poor dear, may be unable to understand).

I see the toxic effect of government run health care on a daily basis, and the impact it has on compassion and quality of care. As you so correctly note, the driving force is to view CMS (Center for Medicare/Medicaid Services) as our customer instead of the patient, because they are the ones paying the bill. When the patient is viewed as something other than a customer, you get the horror stories that are reported in the article and discussion. Paradoxically, while excellence in health care will suffer greatly when socialized, my hospital (and myself incidentally) will profit financially, so your argument is wrong on both counts.

Be careful of what you ask for, since you may just get it.

Nov 16, 2008 - 5:51 pm 37. ate mely:

Why go into nursing?
27 years later, I am not an employee nurse anymore. I have a non-nursing business, take care of my grand daughters until they’re in pre-school so my daughter who loves her job can work fulltime and been trolling in the internet before it was a worldwideweb.
I love America.
I don’t agree with ‘universal health care’. Universal health care is un American. America stand for individual freedom, free enterprise and small government. In health care terms, it is individualized freedom, free enterprise and small, individualized, private enterprise nursing care. Maybe I’ll start a nursing care related business if and when health care truly embrace free market.
God Bless America.

Nov 16, 2008 - 6:06 pm 38. Martge:

I have two horror stories that turned out OK but were are two different hospitals.

The first one was the nurse was very uncaring, which I first noticed when the elderly lady in the other bed in my room could not get the nurse to answer. Then late one night I happened to look at my IV tube and there was blood running up to the bottle. I called the nurse and they changed it immediately, as the nurse forgot to change it and it had ran dry. Well sometimes thing happen correct. Well the next night she came in and changed the IV but soon I was all wet. Again I rang the nurses station and someone came in and found she had stuck the needle in a cork instead of in the place for the tube. I immediately told the nurses to remove the IV altogether I was afraid next time she would do something to kill me.

Then at the other hospital I had gall bladder surgery, thankly not the old type they use the laposcopy. But when I had to get up to go to the bathroom, when the nurse came in she didn’t know how to put the leg pumps back on. The ones they used to keep the blood circulating so you didn’t get clots. Which was common in gall bladder surgery. I struggled with them, got them back on and found she had slid down to the floor and was asleep. The next day the male nurse told me they couldn’t find her after that, and when they did find her she was out on drugs and was fired on the spot.

Nov 16, 2008 - 6:11 pm 39. CRNA2BE:

The elephant in the room is Americans’ unhealthy lifestyle (read: personal responsibility). Not much is going to change in healthcare until lifestyle choices are addressed. Your irresponsble fellow Americans are draining the limited pool of resources. (And not just in healthcare.) It might also be wise to take a look at end of life care. We might consider taking a look at conditioning Americans to the reality of death and the reality of healthcare costs. It’s time to get real. Let’s admit the problems and then work on a solutions.

Nov 16, 2008 - 6:16 pm 40. Allston:

A side story, but relevant:

I worked for around 15 years in Biomedical Engineering, finally peaking out in the mid-90s and leaving the field. There were several reasons, but main one was identical to the Nurse/Patient ratio issue under discussion.

(Biomedical or Clinical Engineering - the maintenance, calibration and repair of ALL equipment used in a Clinical setting, for those unfamiliar with the field)

At the time I left a certain large, prestigious teaching hospital here in Boston, I was maintaining all of the equipment in 14 Clinical units, including the ER and multiple ICUs and step-downs. The workload was crushing at times, and just as with MDs or RNs, we dared not make an error.

A faulty piece of diagnostic, monitoring, Surgical, or life-support equipment can terminate a patient in the blink of an eye, just as surely as physician or nursing error.

For me, the rise of the HMO and “Capitation,” e.g. the capping of costs to maximize profits, was the final straw.

One of the units I maintained was the NICU at the aforementioned hospital. An average infant incubator had at the time as it’s highest failure rate component the DC fan motor used to keep heat and air moving inside the incubator, to maintain a regulated environment.

In 1990 dollars, I could purchase this item for a mere $5 at any electronics supply house. But counting over-regulation and the plethora of corporations and regulatory agencies with their hands into this cash-cow, we had to pay an astonishing $225 each. That’s a markup of 450% over true costs. And I could replace around 20 of these weekly, on average.

Ultimately this is the root cause of the failures of our healthcare system: everything is far too costly, and in the end, the patient was the one who paid the price.

Nov 16, 2008 - 6:31 pm 41. Allston:

Sorry, faulty math - long day. I meant to say 45 times the true cost of the item, in reference to the fan motors. Mea Culpa.

Nov 16, 2008 - 6:36 pm 42. Doc99:

Guns don’t kill people. Hospitals kill people.

Nov 16, 2008 - 6:42 pm 43. ate mely:

“How do we raise standards, quality control performance, and reward excellence?”
Adam Smith principles has work in business and other industries and it will work for health care:
Labor by division or specialization.
Price of labor, material and rent through supply and demand, determines standards and quality.
Profit, a must, to survive and continue and a reward risk and hard work.
“nursing and nursing aide infra-structure?”
Dismantle the infra-structure. Infra-structure like unions and rent control protects nurses and nursing aides inside that structure not patient/client/consumer. Unions protect union member’s jobs. Rent control control the rent of tenants already in those apartments. It does not increase the number of apartments which negates the law of supply and demand.
Divide and subdivide nurses and nursing aides task and price each and every skill including the time spent sitting doing nothing with a patient. If by an experience ICU nurse (higher price), new graduate nurse (lower price) or a nursing aide (economy price). Night shift higher price than much demand day shift. Remove the call lights in rooms and replace it with a call board with voice or keyboard with common needs of patients in default key that will connect immediately to whatever mini unit it is connected to. If your hungry, press a key directly to 24 hr dietary dept that already have the info of your diet, amount of food consume that day and price pay by credit card or on sale or free if there’s an oversupply of the food you want or need.

Nov 16, 2008 - 6:55 pm 44. Galinar:

One thing I don’t see discussed here -for some reason it’s extremely hard to get a nursing degree in this country (I know from my daughters friends who are trying really hard to get into nursing programs).Private ones are very expensive, and public are unbelievably small and competitive. On the other hand, nurse with a degree from other country and in some cases totally inadequately prepared just needs to pass an exam – I am sure there is a thriving business to “help” them.

Nov 16, 2008 - 7:14 pm 45. Scrapiron:

The ‘in hospital’ death rate will decline, drastically. If you aren’t admitted you can’t die in the hospital. The death rate in the back of ambulances ‘waiting’ outside the E.R. will shoot up. Try the U.K., if they can’t treat you (to meet government mandated time frames) they hold you in the back of the ambulance so the hospital’s record isnt effected. I’ve delivered thousands to the E.R. and have never held anyone outside. We are sometimes contacted enroute and diverted to another hospital, that’s the procedure in the U.S. Get your socialized medicine, no one who has it likes it.

Nov 16, 2008 - 7:31 pm 46. Avi:

I am a kibbutznik and a Jew so I think I am my brother’s keeper, and I am happy to behave as such. Nonetheless, Wil & Pam are very wrong if they think I have no experience with American hospitals. I’m Israeli, so forgive my bluntness, but your society seems plagued with a meanspiritedness with regard to its weakest members. Americans can be so fulsomely demanding that I have come to believe what bothers them most about so-called socialized medicine is that it means they might not come first. This is not to say that all Americans feel this way, but those who don’t, do nothing.

Yes, your medical system is a wreck. There is a frightening magnitude of unnecessary surgeries. My observation is that perhaps only 10-30% of surgeries are truly life-saving or urgent. You have an FDA captured by big Pharma so that taxpayers pay for both research and for patenting and marketing of new drugs that are largely unnecessary. In the last 30 years, there have been only a handful of drugs invented that were useful (a low bar), while the rest were (and continue to be) mere copycats. Hospitals take cost-cutting measures that grossly undermine patient care - after all, it is hospital associations who work to overturn, or to defeat, initiatives to establish nurse-patient ratios. There are practice administrators who give presentations to doctors on how they can produce “$5,000 days,” by maintaining x number of hospital admissions and seeing 6 or more patients per hour in the office. Insurance companies scheme to deny payment of claims, both with computer programs (with input variables like, “Has patient ever filed a lawsuit?” Nice, eh?) and with teams of employees who compete for extra rewards by successfully evading payment. I’m sure I’m not telling you anything you don’t know. Forgive me, but these things strike me as fundamentally wrong.

I do not believe that perfection is to be found in any human endeavor, but surely, you can do better. Americans seem to be worried about limitations to what healthcare they can obtain, while they consign the sickest to nothing. In the 70’s, dialysis patients were automatically enrolled in Medicare because so many lost their insurance coverage after experiencing renal failure (and someone related to a congressperson died). Yes, Virginia, it can, and does, happen here (I believe I just heard that the county hospital in Las Vegas will now provide chemo for cash only, if the recipient has no insurance or if claims were denied). Still, you can attack the messenger, or you can do something. Don’t just become angry at crappy nursing care, etc., for yourself. If you are only for yourselves, what are you? If not now, when?

Nov 16, 2008 - 8:51 pm 47. JGAlt, MD:

There are not enough nurses. Why? Because over the years, State nursing boards have minimized the numbers of nursing educators (via limiting the number of ‘approved’ nursing training programs). It can take more than 2 years AFTER meeting the pre-requisites to enter an RN (not BSN) program.

Then, nursing programs eat their young. The attitude of many ’senior’ nurses towards new, inexperienced nurses is horrible: As bad as some residency programs for physicians in terms of abuse.

Nursing management: Taking working nurses off the floors, where they are needed and turning them into clipboard carrying moronic harpys is another problem. The practice of nursing demands, for some reason, useless paperwork (nursing plan? Give me a break) that keeps nurses away from patients. Problems with scheduling, as have been mentioned. Lack of understanding that nurses are specialists, too: A labor/delivery nurse is not an ICU nurse is not a scrub nurse is not an ED nurse….yet nurses are assigned (to fill critical gaps) as though they are little square blocks being pounded into round holes.

I try every day to remember that the nurses I work with are essential to taking care of patients - they do things that frankly, I wouldn’t have much of a clue about. Likewise, what I do as a physician requires different (and, frankly, a lot more) training than nurses get. We truly are members of a team, each necessary to accomplish the goal of taking care of the patient.

How to fix the problems: Keeping the government the hell out of it is a good first step. Too bad it won’t happen. There is nothing the government does that it does efficiently at all, even the things it does tolerably well (National Defense, for one) is horribly inefficient, virtually everything else the government does is done poorly (if you really need a package delivered across the country, does Fedex, UPS or USPS give you the warmest feeling)?

When the government (civil service) controls the assignments of nurses, then there will be no control at all. A practical experiment of this occurred at Martin Luther King hospital in Los Angeles: An ‘ICU’ nurse (county employee, protected by civil service and race relations) couldn’t be bothered to actually take care of critically ill patients. So, when their monitors triggered, she would just turn the noise off and not deal with the patient.

After this was discovered (after the deaths of more than a half-dozen patients) she was ‘counseled’, ‘retrained’, and given another chance. Another dozen or so patients died, since the training didn’t take. Picture that sort of indifference and ineptitude across all skills in a government-run hospital, filled with government (civil service) employees.

State nursing boards need to revise the nursing curriculum. The ‘biopsychosocialenvironmental model of health care clients’ or whatever the latest claptrap is a waste of time. Nurses need to know how to provide NURSING care. They need a knowledge of anatomy, physiology, pharmacology, etc - not to replace physicians, but so they will have some idea of why they do certain things. Take the woo out of the training process, don’t look down on RN’s vs. BSN’s, get them into the hospitals in two years instead of 4 or 5. Pay nursing educators more (they usually make less than practicing nurses), and let other qualified people teach nursing students (ie, a pharmacologist teaching pharm, not a ‘nurse educator’). There is no need to create a ‘nursing metaparadigm’. Just teach nursing.

Technology (electronic medical records, especially) won’t fix a broken system. Automating that broken system just wastes time faster. Requirements for charting need to be reviewed, and reduced to the essential - and frankly, as a physician, I put the multi-page nursing plan at just slightly higher import than a history and physical done by a 2nd year medical student. The student pays for the privilege of learning how to do an H&P, the nurse is paid to do it (keeping her from taking care of patients) and is severely criticized and disciplined if it isn’t done.

One thing the government should do is allow (currently, it’s not) companies and involved organizations to develop data interchange standards, data security standards and the like so data on your personal physicians system will be available at 2 AM in the hospital.

Should the government run a program like that? Only if you like the way government agents used government data systems to investigate ‘joe the plumber’ illegally. Who’s been fired over that? When a private company loses credit records they have to make an effort to protect people, when the government loses VA records it’s ‘Oh, sorry: You should watch out for identity theft - but you’re on your own”.

I could go on (and on, and on)….but medicine (and nursing) has so many problems that almost anything not involving government intervention will be an improvement.

Nov 16, 2008 - 8:53 pm 48. Wil:

Galinar

Those who took the American State boards would tell you this , it does not matter where you came from . It’s an equal opportunity pass or fail and believe me , there are a lot of people who came here from abroad or who had studied and graduated here have a devil of a time passing it . It is not unusual to know a colleague who took a nursing board exam twice or thrice before he or she get’s the coveted nursing license . It takes a lot of mental and emotional preparation just to be there and not choke in front of the computer .

Judy NYC
I really hate to burst your bubble but here is the problem . Various stages of recovery is well and good for a reasonably healthy patient room mate , but most of the time , you don’t get that kind of room mate . What you get is a very sick and elderly confused patient who either screams a lot , gets out of bed and roams around the room and hallway or you get a very complete bed ridden patient who needs to be cared upon every 45 minutes . That means being turned in bed , being suctioned , given his or her medication @ 300 in the morning and being monitored non stop . I will bet you that after a few days in the hospital , you will be either asking for an early discharge or more likely , a transfer to a private room .

CRNA2BE:
You never deal much with real live patients who talk back to you , do you ? Here is the deal , health care teaching is fast becoming a joke because patients are growing sick and tired of being told what not to do , what not to eat , what not to take and so on and so forth . They especially hate nurses who think that that the reason they are there is because they lack personal responsibility and having such unhealthy lifestyle especially if they are frequent flyers . What I found out that the best way to follow doctor’s orders is to have them participate in their care and giving their health teaching with a positive attitude . If you want a non compliant patient and having the rest of the nursing and medical staff hate your guts , be a self righteous SOB and see how far you can stay in nursing . Lifestyle changes is nice if they can afford it , if they are healthy enough to do it and they have the motivation to make a a good try and if their culture and belief allows it . The vast majority of them can only do one or give up when they notice that there are no apparent change in their well being after six months to a year .

Dr Tom

I agree , our real clients are the insurers and CMS and never the patients . They are just expensive goods or numbers that we are paid to treat medically , to take care of and if it’s time to get them discharge according to the parameters set for a particular diagnosis , it becomes a tug of war between the case managers and the MDs on who gets the last say in the discharge of the patient .

Nov 16, 2008 - 9:05 pm 49. Pam:

The cost of medical care in the U.S. started spiraling out of control in the 1960s when the government started meddling in it. Every additional regulation adds to the cost.

As far as good medical care being available only for the rich, that’s a bunch of foolishness. I am a retired airline flight attendant. I pay for my medical insurance and I do without various things to be able to do that. I am very glad that I did and do. I was diagnosed with breast cancer two years ago and received the best of care. My insurance covered all of my surgeries, chemo, radiation, and other treatment except for $405.00. I have a laundry list of doctors that I am required to see once every three, six, or twelve months for check ups. That costs me a $40 co-pay. Big deal.

It is immoral to expect a human being to exist for the benefit of another adult human being. That is slavery, pure and simple. It is beyond bizarre to expect someone to exist for the benefit of another, but not for himself. Marxism is a system whereby every person is sacrified in a million ways to every other human being. This destroys all ambition or initative or progress.

Nov 16, 2008 - 9:36 pm 50. Wil:

Phyllis

What you are forgetting is the high attrition rate of experienced American nurses and immigrant nurses . Let me ask a question to American nurses . How many in your class are still in nursing after 2 years , after 5 , after 10 , 15 and 20 years . The theory I held is this , by the time the graduates of a particular American nursing class had reached a decade in their profession , almost half of them will be gone , another half will gone 5 years later and in another 5 years , a handful will be left to continue on , most likely in a managerial position . Once a nurse leaves nursing , most of the time , they will never come back , same goes with MDs and therapists . During the great nursing recruitment of the 80’s and mid nineties , there are tens of thousands of foreign nurses who came to this country from every part of the globe and at the same time , American universities and Colleges have thousands of nurses graduating each year . If the average age of immigrant nurses who came here in the eighties is 25 , 1990’s is 26 and the average age of an American graduate nurse is 24 in both eighties and nineties , in 2008 , the US should have a surplus of experienced nurses whose ages would average between 34 to 55 and with nursing graduates from 2000 and up , there should be more nursing staff to cover hospitals , nursing homes , agency services , Home health and where ever nurses are needed . Instead , another nursing shortage and this time , only a few will come to the call .

Here is the sad part , a lot of former nurses and current nurses had persuaded their children to not pursue nursing as a profession and more than enough had heeded that advice because modern American nursing ceased to nurture it’s young nurses , instead we throw them to the wolves and hope they survive the experience and stay as nurses .

Nov 16, 2008 - 9:50 pm 51. CRNA2BE:

Wil
Lifestyle changes are cheap. Stop eating and start walking.

Nov 16, 2008 - 9:51 pm 52. ChrisPer:

DAMN, that headline number 195,000 HAS to be spurious. I suggest you read the earlier comment explaining where it came from and correct the article, because it just discredits Pajamas Media to imply hospitals KILL that many a year with carelessness.

Nov 16, 2008 - 10:12 pm 53. Pam:

JGAlt, MD, wrote:

“How to fix the problems: Keeping the government the hell out of it is a good first step. Too bad it won’t happen. There is nothing the government does that it does efficiently at all, even the things it does tolerably well (National Defense, for one) is horribly inefficient, virtually everything else the government does is done poorly (if you really need a package delivered across the country, does Fedex, UPS or USPS give you the warmest feeling)?

When the government (civil service) controls the assignments of nurses, then there will be no control at all. A practical experiment of this occurred at Martin Luther King hospital in Los Angeles: An ‘ICU’ nurse (county employee, protected by civil service and race relations) couldn’t be bothered to actually take care of critically ill patients. So, when their monitors triggered, she would just turn the noise off and not deal with the patient.

After this was discovered (after the deaths of more than a half-dozen patients) she was ‘counseled’, ‘retrained’, and given another chance. Another dozen or so patients died, since the training didn’t take. Picture that sort of indifference and ineptitude across all skills in a government-run hospital, filled with government (civil service) employees.”

Keeping the government out of it is a grand idea. You’re right, it won’t happen.

National defense, civilian law enforcement, and the judicial system are all proper functions of government. They cannot even manage to do those things with any degree of efficiency.

I frankly would rather be in the charity ward of a hospital operating under a Free Market system than be in one of those nifty little private rooms being allegedly cared for by a bunch of civil service employees — government hacks.

Universal health care is a way of allowing those who actually need charity to pretend that they don’t and relieves them of the necessity of even saying “Thank you!” to the people who have cared for them because, after all, they have their rights. It also puts the taxpayers who have to foot the bill in the position of being berated for not providing more. That is a master/slave relationship not two human beings doing business with one another by mutual consent for mutual benefit. The benefits only go one way.

Nov 16, 2008 - 10:37 pm 54. ate mely:

“Will hospital and health care improve if we allow free-market capitalism to prevail?” Yes. Milton Friedman wrote: “Freedom is a rare and delicate plant. Our minds tell us, and history confirms, that the great threat to freedom is the concentration of power.”
For Friedman, licensure is control by those already licensed, to control the number of people who can practice thus limiting competition within that profession. Licensing boards limits the number of nursing professionals. Hospitals have their way of licensure lite for doctors called admission priviliges. This limits competition among doctors and other health professionals. Nurses competition among nurses is limited by institution employment and accepted nursing agencies. Competition is healthy for the health industry. Any control of competition is a loss of freedom!
“If hospitals and insurance companies actually had to compete for our business would standards of care and coverage improve?” Yes, competition increase transparency of service. Competition lowers prices. Competition is freedom from the concentration of power. Deregulate the health insurance industry.
Can Medicare and Medicaid renegotiated?

Nov 16, 2008 - 10:41 pm 55. Wil:

Avi

Then let me be blunt in return . I’m not an American citizen yet but working in American hospitals and nursing homes for about 12 years , you get to learn how the American healthcare system works . It’s all about covering your ass . Why do you think doctors are performing unnecessary procedures ? To earn more money ? How about not getting sued for x amount of dollars because you did not check the patient very thoroughly . Hell , why do think

About not taking care of our weakest , surely you jest . Let me give you a brutally clear picture of what kind of care we do for our weakest . Last Spring , I took care of an undocumented immigrant whose diagnosis is pneumonia . After several blood test and radiological exams ( MRI , CT , ECHO and PET) . They found out that the guy had a massive tumor on top of one of his lungs . So after two weeks of expensive antibiotics , he underwent major thoracic surgery , spend a several days in ICU and later to a step down unit prior to discharge . Since this patient is self pay , the hospital did not received anything in payment for services rendered which would amount to a million dollars more or less . He got treated for FREE . The joke in american hospitals is this , that the patients who are self pay gets the best treatment , the best medicines and most of all , it’s totally free .

About the FDA and big Pharma , here’s the awful truth . Big Pharma spends more money in protecting itself from frivolous lawsuits than trying to influence the FDA who is also under pressure from litigators as well as politicians to make sure that all medications that are approved are “safe” . Big Pharma spends billions of dollars to released 1 successful medication and has only x amount of time to recoup research and development before it becomes generic .

Nursing- patient Ratios is a nice catch phrase if you are assuming that there are enough hospitals to cover every person in the city I lived in . I know the ratios , 1-2 in ICU , 1-2 in IMCU , 3-4 in CCU , Telemetry is about 4-5 , Med-Surg - 5-7 . I’m working in a telly unit . Here is the problem , it’s a 36 bed unit that can be used as an overflow in case of bed unavailability , so in other words , it may go up to 40 beds . Staff is 7 nurses , 1 Charge , 4 CNAs and 2 unit secretaries . Do the math . So if the hospital is desperately in need to place patients , 5 rooms can be converted to a 2 patient rooms and 6 nurses will have 6 patients and only 1 nurse would remain at 5 . To make it worse , since Ravenswood , Edgewater and Lincoln Park Hospitals had closed and the hospital hadn’t constructed any new buildings to add more units , our Cardiac unit is now transformed into a Cardiac/psych/medical/surgical/ neuro/ post op unit and the hospital is now on bypass , ER is already screaming and there are no discharges in any units ordered . Try to think how overwork bed board managers , unit managers and charge nurses would care about nursing-patient ratios when nursing care is needed right away . Since you think you have the answers , how can you take care of a post cath patient who is on q 15 vital signs and the last BP read about 87/45 , HR 124 , your next patient had an O2 sat of 87 and you just suctioned her 5 minutes ago , your next patient is a 32 yr old male who is undergoing alcohol and drug withdrawal and trying to hurt his sitter The 4th patient is on Dobutamine Drip and Heparin Drip and btw , his cardiac rhythm converted from SR to -Afib with noted SVTs and pt is symptomatic . 5th patient is a 92 year old lady who is a fall risk , very confused and the family is calling you every 5 minutes . And then your admission who just came up from ER with a panic D-Dimer level , patient lethargic , BP is 90/60 , HR 100 ,O2 Sat 88 and the Spiral CT result indicates massive PE and there is no ICU or IMCU bed available . And all of your patients are Full Code . Try dancing your way out of that mess , genius . The other hospitals near you are in bypass as well . Real life screws up the ratio so bad that only a naive idiot believes the hype . And oh btw , in real life , I got 4 patients who are near to what I described above and the remaining two , was stable enough to be temporarily ignored while me , my charge nurse and the medical staff try to figure out what to do with the admission . `

Nov 16, 2008 - 11:08 pm 56. Pam:

Wil wrote:

“Then let me be blunt in return . I’m not an American citizen yet but working in American hospitals and nursing homes for about 12 years , you get to learn how the American healthcare system works . It’s all about covering your ass . Why do you think doctors are performing unnecessary procedures ? To earn more money ? How about not getting sued for x amount of dollars because you did not check the patient very thoroughly . Hell , why do think

~snip~

“Try dancing your way out of that mess , genius . The other hospitals near you are in bypass as well . Real life screws up the ratio so bad that only a naive idiot believes the hype . And oh btw , in real life , I got 4 patients who are near to what I described above and the remaining two , was stable enough to be temporarily ignored while me , my charge nurse and the medical staff try to figure out what to do with the admission . `”

Thank you!! I can see that having a nurse/patient ratio that is huge on a regular basis would be disastrous. However, I have been sitting here thinking that if that ratio is legislated it would mean that people would simply go without medical services in the event of something like a 30 car pile up on the interstate, a fire in a high rise apartment building in the middle of the night, and any number of other things. I would surely hate to see people die simply because, well darn, it would mess up the ratio.

Nov 17, 2008 - 12:18 am 57. Tao Te Truth:

Greedy capitalist system abusing the poor working class nurses in search of profit: average nurse’s salary $50,000

Altruistic UK government run utopia for the working class nurses average salary: $47,000

Avi, don’t let the facts get in the way of your collectivist economic ignorance.

Shall we look at how much the UK government takes back in order to run their “utopia?”

Nov 17, 2008 - 8:04 am 58. Wil:

CRNA2BE
Good , would you want to walk with me carrying 40 pounds of camera gear and walking from Belmont harbor to Shedd Aquarium or from the Northern end of Michigan Avenue to Soldier Field and back . I will be doing that for three weeks in December and btw , I don’t have a car to cheat . I have to walk . I walk the talk and you just open your mouth .

Nov 17, 2008 - 3:33 pm 59. JGAlt, MD:

Wil: It doesn’t much matter what you do for three weeks, if you still live a lifestyle replete with bad choices.

And as I tell patients (without a lot of success), EXercise is what you do that is EXCESS to your normal activity. If you expend (say) 3000 kcals worth of energy a day, and intake 4000 kcals a day you will gain more than a pound a week. If those excess calories are full of saturated fats and alcohol then you’re doing even worse.

I’m an emergency physician. I work at a Tertiary/Quarternary medical center Level-I trauma center medical school complex that sees well over 200,000 patients a year. The vast majority of those patients are simply sick: there is little enough trauma and way too much primary care. And most of those patients are sick because of poor lifestyle choices - smoking, over eating, drug abuse, drinking, generally acting stupid.

Some (many) of these people feel that health care is free: A night shift rarely goes by when someone doesn’t come in (often via 9-1-1 ambulance ride) for a ‘free’ pregnancy test. They can’t be bothered to actually go to the market and buy an EPT: They ‘don’t have any money’. Unless it’s for cigarettes, booze, or drugs.

People will spend $5+ for a pack of cigarettes, but won’t spend $4/month for drugs that will improve the quality of their life. It’s not their responsibility (they think) to actually be a part of their health maintenance, it’s my job to fix them when they’re broken. And I’m liable for not diagnosing their problems, when they lie to me or are drug seeking: If someone comes in complaining of a migrane, or lower back pain, or fibromyalgia or a dozen other ailments I have to do a full workup on them, spending taxpayers money - or I may get sued when the 10,001th time they go to the ED they actually DO have a real problem.

Want to fix health care expenses? Fix the tort system, and get rid of EMTALA. Then I can quit spending $5-10K on the same loser I saw last week, who only wants me to write them a script for their vikies…And while you’re at it, change the DEA’s policy that will send me to prison for the rest of my life if I actually just take the path of least resistance and give the slackers the drugs they want.

Nov 17, 2008 - 4:23 pm 60. ahemq:

Phyllis:

Sit down, grab a cocktail and go surf the British newspaper web sites. Read the first ten articles that come up from a search for “NHS.” That should quell your desire for socialized medicine immediately.

Nov 17, 2008 - 5:36 pm 61. ahem:

Phyllis:

Sit down, grab a cocktail and go surf the British newspaper web sites. I don’t care if they’re Left or Right. Read the first ten articles that come up from a search for “NHS.” That should quell your desire for socialized medicine immediately.

Nov 17, 2008 - 5:36 pm 62. CRNA2BE:

J Galt, MD
Thank you for the patience to write that. As an ICU nurse, I have absolutely lost the patience necessary to keep dealing with it. The problem is so massive and so pervasive it’s become NORMAL. Do average Americans not really know what goes on in hospitals? Do you all not see where the money and resources go? Spend a couple of days at the ER or an ICU and just see for yourselves…the vast majority of patients are there because of poor lifestyle choices.

Nov 17, 2008 - 5:55 pm 63. Wil:

Don’t smoke and don’t drink and don’t do drugs . And honestly , doc , I’m getting tired of people we received from the ER especially after the holidays . Hell , I have seen patients who wants to be discharge early in order to get their fix even when their Cardiac Troponins are greater than 0.99 and whose BNP is over 500 and their blood culture is positive for HEP B , Hep C and MRSA . You are lucky because in ER if they refused treatment , they get to go home , in our case , once they get admitted , we floor nurses are screwed because we have to deal with them until they get sober or at least , well enough to go home and since winter time is coming , we are totally screwed because aside from the nursing home patients that are our repeat customers , we get the patients you described who only uses the hospital for free meals and a warm bed and when they get discharged , they use the same excuse to get themselves to be admitted in a different hospital to avail themselves of some creature comforts . But hey , if you tell them that they have to stop drinking and smoking and doing drugs , the first thing I will hear is it’s none of my business and and the second one is this , that they are paying our salaries . And oh yeah , when it’s discharge time , they blame the hospital for losing their money and belongings and they threaten to sue the hospital unless their money ( they have none) and their belongings ( it reeks to high heavens ) are given back to them .

Nov 17, 2008 - 6:31 pm 64. Phlebotech:

Med Tech/CLS here. After working in three hospitals in two different states for over a dozen years, I can tell you that nurses aren’t underpaid; they do quite well compared to the other professions. They don’t suffer from a lack of respect; as a result of the “Poor Nurse” propaganda campaign they have run for several years now, they have an overinflated view of themselves with Hospital Administrators doing everything they can to keep them happy. This contributes to the poor patient care received by so many: “I’m a Nurse; it is the Aide’s job to take care of the patient.” It is frightening to think how thin the resources of the hospital are stretched. While Administration is hiring nurses and freezing or cutting other positions, patient care is compromised by under staffing other departments. When you consider the ratio of nurses to patients, ask your self what is the ratio of Respiratory Therapists, X-ray techs, phlebotomists, or MLT/MTs for every patient? Due to costcutting by one hospital, I was the only Med Tech on nights for several months at a one hundred bed hospital. As I could draw blood, run the tests and do the maintenance on the equipment, others weren’t replaced as they left. Doctors may yell at nurses but I have had many nurses scream at me because I couldn’t be in Labor and Delivery sticking a patient, crossmatching blood for surgery, and running a urinalysis on a baby at the same time. Eventually I left for a better paying job where there are more MTs in the lab.
Poor care comes from unhappy people. Many places claim to have a healthcare team in place, but there are too many chiefs and not enough indians. It is time to re-organize and reassess healthcare. Patient care should come before perks; good workers should be recognized and administrators need to be few and far between. Regulators should be required to explain the rules in plain English and then, if there are any conflicts between one set of rules and another, the rules won’t be implemented until they are resolved.

Nov 18, 2008 - 1:25 am 65. RF:

59. JGAlt, MD: Yes, very good post. Excess, and lack of education is a big part of the problem here.
“detrimental effects of alcohol on the fetus may also be transmitted by paternal alcohol consumption.” - Darryl S. Inaba, Pharm.D.
This is just one tiny example of how much damage people can do.

“alcohol-related crashes cost an estimated $148 billion in the United States every year.” (NHTSA, 2005, NIAAA, 2000)
Doesn’t matter what the government does, the people have a problem.

Nov 18, 2008 - 2:51 am 66. L. Davis:

I wonder if the figure of 100,000 people dying of drug resistant hospital infections is even close to the reality.

My personal experience is something I’m still trying to understand and cope with long afer 2005, when my Mother went in for hip surgery (determined by her surgeon as a success) and died of MRSA. She died 15 months after her surgery, in a nursing home. The infection appeared relatively soon after her surgery…although I was never told under months later that it was MRSA.

After a follow-up operation to ‘cut out the infection’ and subsequently multiple rounds of strong antibiotics that had many side effects, it was determined that she was ‘not responding’ and no more treatments were given. She died over a period of days from rampant infection and no more intervention which meant no food, fluids, diabetic medication, etc. She didn’t die in the hospital where she got MRSA, but in a nursing home.

I am certain that this was not ‘counted’ as a MRSA death by the hospital or anyone else. I am also certain this happens over and over again, taking the responsible institution off the hook and changes the national infection rate dramatically. I am also convinced that this infection was due to incompetency and carelessness.

Sorry I sound bitter…. but I am.

Nov 18, 2008 - 9:13 am 67. Tex Taylor:

It is folly to think that a hospital can prevent all infectious disease. While hospitals can do everything possibly to prevent it, and some should do better, there is still a degree of risk in exposure.

It is difficult to completely sterilize an environment. It is practically impossible to continually remain that way.

In addition, many of the more ill patients are immunocompromised person making them particularly vulnerable to infectious disease.

While I argue with no one the board in particular, I sometimes wonder if it isn’t our expectations needing to be fixed first.

As a doctor in making, I can perform no miracles, nor am I capable. And like most medical practitioners, whether techs, nurses, or the doctors, you’ll just have to trust me when I say, given the set of circumstances, the incredible degree of irresponsibility prevalent in society, and the difficulty of continual learning while working rotten hours, most of us are doing the best that we are capable.

Nov 18, 2008 - 2:53 pm 68. morbshock:

It’s all true what you wrote in your article. My wife is a RN for close to 30 years. She is burnt out from working in those conditions.

Nov 20, 2008 - 4:04 pm 69. Saul Wall:

While some hospital acquired (nosocomial) infections are caused by failures in hygiene, it is not all about incompetence or indifference. Bacteria are given lots of opportunity to develop defenses to disinfection agents and antibiotic agents while being provided with many reservoirs of immuno-compromised or otherwise weakened patients to re-establish themselves in.

I recently heard about a nosocomial infection which authorities were trying everything to track down. They had employees in for retraining, they monitored their hand washing, their janitorial practices were scrutinized - people were tearing their hair out about this bug that was causing infections in people who came into the hospital. Eventually someone decided to test the disinfectant soap. The bacteria was living in the stuff. People were washing and scrubbing their hands with stuff meant to kill the bug.

I am as critical of government and bureaucratic organizations as anyone but nosocomial infections are not largely the fault of hospital employees but an intrinsic result of having large numbers of very sick and injured people being treated with antibiotics in close proximity to each other.

Nov 20, 2008 - 9:20 pm 70. Tina Trent:

Allston — you hit the nail on the head (watch out though, those nails are expensive). We pay more for a few inches of IV tubing than we pay the nurse’s aide who is sticking it into the patient.

AVI — interesting point about putting dialysis patients automatically onto Medicare. Unfortunately, when they get transplants, that changes, and disability, which ought to be automatic for them as well, is not. Disability remains a game in which the ones who need it least are the most successful at getting it because the process is onerous and lengthy, and, also, whoever screams loudest gets a special place at the front of the line.

But the real lesson for those who oppose any and all government intervention and regulation is dialysis clinics themselves. They are exempt from ordinary nursing rules in many states — thanks to the owners’ lobbies — and they employ grossly untrained people to do what basically consists of serious, multi-hour surgery on chronically ill and physically unstable patients. Yet, they bill the government richly for providing the service: they’re not hurting. Or, they’re not hurting themselves. They get paid thousands to dialyze every patient, then cut corners with nursing staffs and patient safety, then scream like evil infants when people ask to hold them to the types of staff licensing standards we demand of cosmetologists.

Here is the reality of medicine in America today: if you are rich enough to afford the best care, you’ll probably get it. If you’re poor and flagrant and have lots of babies but don’t marry the fathers or demand money from them; or if you’re otherwise so irresponsible that you just expect others to pay your medical bills, or if you’re illegal and simply expect Americans to foot your bills, you get all the care you need. By law. And that care is more comprehensive than what the rest of us — the working and middle-classes who pay for their own insurance and medical costs — receive. They only people being denied care in America today are the vast middle, who have watched their co-pays and premiums soar and their access to doctors and real insurance shrink. Or disappear.

When I worked in social services, I saw firsthand the quality, quantity, and accessibility offered to indigent patients. It was better than anything I ever got, or could afford. We have two political parties in the country: the one that pretends we aren’t already “socializing” grossly inflated, government-supported pay-outs to the insurance and medical bureaucracies they pretend represent a free market, and the other Party, which cares exclusively for the indigent, illegal immigrants, and others they deem oppressed people. Hillary would have changed that, but the DNC wants what the DNC wants.

The rest of us are simply being lied to and ignored by both ideological extremes.

And people die from that.

Nov 21, 2008 - 10:44 am 71. Jenny Hatch:

Phyllis,

I believe complete privatization of the medical system is the only thing that will save it. Getting all government money out of it and letting the market decide what will stay and what will go is the only way to shake out the fraud and waste.

My blog is dedicated to home childbirth. The promotion, education, and defense of it. As a childbirth educator I have spent the past twenty years studying and writing about normal childbirth in every spare minute. Believe me, even with 99.1% of American Women receiving prenatal care, the prematurity rate, infant and maternal mortality rates are going UP UP UP, and the problem is NOT lack of money or resources.

I believe that the American System works well with emergencies. True emergency childbirth, accidents, traumas, we have all watched the amazing stories that are available to share the good news of our medical system. Seeing a soldiers face restored by plastic surgery, or technology used to replace limbs or excellent psychotherapy to help a traumetized person heal…all of these sides of the american system are awesome.

We do have a free market health care system in America. It is called Alternative Healing. And it is thriving. Wether it is homebirth midwives, chiropractors not covered by insurance, homeopaths, massage therapists, herbs, chinese medicine, etc etc…for the most part these therapys and healing modalities are NOT covered by health insurance and/or government money and the practitioners of these healing arts are thriving.

The fact that the medical powers that be want to regulate and even dismantle that system has been well documented. Perhaps the best documentary on the subject is found here:

http://herballure.com/Special/WeBecomeSilent/QuickTime.html

The global elites love the promotion of drug and surgery socialized medicine because it just makes us all more toxic, dependent, and broke…while they cash in, and we the people are much more easy to manipulate and control when we are doped, drugged, and dealing with toxic children. Do you personally know a family with an autistic child? The whole family dynamic revolves around the needs of that child, finanacial, emotional, safety issues….etc etc…

Socialized medicine only addresses one aspect of healing…the allopathic side of drugs and surgery. And if America decides to fully nationalize that particular side of health care and then outlaws natural healing as is being done in Europe right now, I predict the next fifty years are going to be a hellish time for families, especially for those of us who are giving birth to our children and grandchildren.

What I promote on my site is a near complete divorce from the medical system, medical self sufficiency, and the promotion of a constitutional amendment that would protect consumers in their health care choices.

Personal family responsibility coupled with completely privatized health care will win the day…but with the way things look in America, we will all get a chance to see how a nationalized health care system will run in America. A medical system that is somewhat deadly, disorganized, and dangerous will gradually become a rationed behemoth of dysfunction and death.

My only prayer is that no one from the government will be standing by with a gun to my head to go force me to give birth to my next child in the hospital as it gets socialized.

Jenny Hatch

Nov 22, 2008 - 4:15 pm 72. Nightmax:

Hello, I am really upset about my treatment recently by a Dialysis Head nurse in my clinic. Last weekend, she called me to yell at me for not getting the right lab tests done. It came as such a shock to me that I was automatically stunned into silence while she ranted and raved about not getting the correct lab tests done. When I told her I had nothing to do with the lab work she immediately jumped into to tell me that she had given me a lab requisition that I was supposed to give to the lab technicians at at local Quest lab? I remember the exact conversation I had with her, about previous doctors giving me my own Standing Order Requisition which I had carried in my purse for well over a year. What she does is at an Epogen appt she hands me a lab slip. Then a few days before my appointment she faxes the same lab slip to the lab. I stopped carrying my lab skips when the lab said that they received faxed requests. ALl of a sudden she calls and for 30 minutes I deal with her yelling about what I am not doing right. Then the following Monday, the Dietician calls me to yell that my labs are way off, and instead of just telling me to get back on track, she too somewhat yells that obviously its my fault because I now need a contract to sign and return to follow directions.

After six years od waiting for a Kidney Transplant and following directions, how dare they send me a contract to sign about actions they want me to agree to to keep Phosphorus levels between 3.5 and 5.5, Calcium levels between 8.4 and 9.4, limit fluid gain, maintaining an Albumin level of 4.0 to become more physically active, etc. How dare they. Actually, I am one of the only patients at the Dialysis Lab who maintains her labs at a decent level. I personally feel with all of the stress I have to deal with Davita Dialysis, they are lucky that I follow directions at all. I find their actions to be extrememly unprofessional and unwarranted and now, do not want to be bothered with Nurses/Dieticians who loose theie perscpetics. Not to mention she had the audacity to complain about my last name? “I don’t know what last name you are using, but when I call for your lab results, they can never find you. SOunds like a lab issue not mine. Especially when I have to hand them my Insurance cards and they get a faxed law slip form from the head nurse. How is that all of a sudden my problem? I sign it using the same last name as listed on my insurance card, however they have hyphenated my last name so how again is that my problem? I am literally fed up with the nonsense I receive from dialysis nurses. I do well and am almost taking care of my self. They have placed the owness of my health care on me and are almost not really doing anything but going over lab slips, and giving me an EPO shot every two weeks. I manage my own dialysis treatments at home and am using the doctors treatment plan as required. I am literally tired of the back and forth I get. If you have too many patients and can’t deal with me, then give me to someone who has the time. Yet, the doctor can close his office early on Friday for a golf game and send the nurses home early is he has any office day on Friday at all? This is my third dialysis clinic and I won’t go into why I’ve switched clinics so often, but its been ridiculus.

Feb 8, 2009 - 7:34 pm

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