I believe in the power and sanctity of the relationship between nurses, patients, and physicians. A feeling that one is part of a team, part of a triad, whose sole purpose is centered on enhancing the patient’s health. This security empowers a patient to move forward on his journey of health. In recent years, this strong bond has been tested and shaken. Why?
We live in a nation blessed with such abundance. But yet, at the same time, the cost of health care continues to rise, and health care quality continues to lag. There are those among us who have fallen between the cracks, who are unrecognized and lost and forgotten. They are the unfortunate souls where disease lingers and festers, where disease fosters destruction and death. A demarcation line of sorts between the haves and have-nots, between well-being and the demise of health.
We see the terms on the pages of medical journals and articles, “patient-centered care” and the “patient-centered medical home.” These phrases lead us to assume that the patient is the central focal point of the health care experience. But is this the case, or rather is it to camouflage what is, in actuality, the true focus of attention: to bolster the bottom line and pockets of corporate medicine. In today’s world, the practice of medicine has evolved into a business entity. Income versus expenditures. Profit margins must always be paramount. But at what cost does the commercialization of health care have upon the patient, the physician, the nurse?
Health care has evolved into a multi-billion dollar business. Corporate entities have absorbed the majority of independent practices, promising security and cost savings to the physician. The autonomy of the primary care physician, especially, has been eroded in recent decades. Decision-making processes that had initially involved the physician and his patient now pass through a myriad of intermediaries before service is approved and dispensed. Guidelines and requirements dictated by the health care system, health insurance companies, pharmaceutical companies, and governmental agencies all now share in the process of determining what’s appropriate care for a particular patient. Oftentimes, those who sit in board rooms have no medical training but are making life and death decisions about whether or not approval is given for a medical procedure or drug. How have we arrived at this troubling time in health care?
The triad of health care is a very intimate one. The secrets that lie within the body, mind, and spirit are often laid bare. Words are spoken or those left unspoken carry immense importance. Words of encouragement, words of hope, words of solace cushion the body and heart as patients try to maneuver the treacherous path of illness and disease. A touch upon the hand, a cold compress laid upon a feverish forehead are expressions of compassionate care. They are signs that say to a patient that he is seen, that his welfare matters, that he is recognized as a worthy individual.
In the world of corporate medicine, the simple things, the basic connectors of human interactions, have often been sacrificed to satisfy the multitude of check-off lists contained within electronic health records on ubiquitous computer screens. There seems to be no time for meaningful interaction between physician and patient. The patient who sits before his physician, who sits before the nurse attending to his care, is a unique individual with a story to be told, one which is interrelated to the malady that has sent him to seek help. This patient is not simply patient #8 to be seen that day or a list of conditions on the computer screen. To think otherwise is a discredit to both physician and patient alike.
Hope is often the driving force that enables a patient to regain wellness or, more importantly, a state of well-being. Hope allows a patient to have acceptance of his illness and to move forward on his health journey. A cure may not always be possible, but certainly coming to terms with a health condition is. Time to communicate between a patient and his physician allows the patient to feel that his life matters, that he matters. I have seen the inside of the world of being a patient. To have glimmers of hope and encouragement mean all the difference in living a life in slow motion to one of living life to the maximum possible. What is life if not to be one lived to its fullest measure?
And what of the physician, the nurse? What becomes of the dedication to a healing profession they once loved but now has been turned topsy-turvy? Moving between the living and the dying, days morph into weeks, into months, into years with barely the time to process the people and events they witness. The schedule of corporate medicine must be adhered to, no time to linger at the bedside, no time to touch the spirit of the patient that is before you.
As members of this triad, we each share a responsibility to make sure that quality health care is at the forefront. For far too long, the voices of the patient, the doctor, and the nurse have been drowned out by the corporate gears grinding away. Doctors and nurses have called for change, have formulated blueprints for constructive changes to the practice of medicine, but their voices have amounted to little more than a whisper, barely being heard above the din of the noise of those who are not the true stakeholders in medicine. These highly trained medical professionals, our doctors and nurses, serve on the front lines of medicine, but their input is barely acknowledged or implemented. Is this just? Let their voices be heard; let them have a true say in how medicine is to be practiced. Corporate medicine must come to realize that their most valuable asset is, indeed, the physicians and nurses who have taken oaths to heal and do no harm. The welfare and well-being of patients depend upon this.
Michele Luckenbaugh is a patient advocate.
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