Recently there was article being linked to on Facebook by a few of my coworkers titled “Patient Satisfaction is Overrated” written by Dr. William Sonnenberg. Here’s a link to the article. A few years ago we were called to staff meeting and some changes being made to how Medicare reimburses hospitals and doctors were explained to us. Basically, Medicare is now holding back a portion of what they would normally pay to a hospital or physician for a certain hospital stay or procedure. The hospital or doctor can then earn back that percentage of payment by having high/good patient satisfaction scores. The reasoning is that Medicare wants hospitals and physicians to provide not just mediocre, decent care but quality care. They want health care providers to not just do their job, but to do it well. I can understand that reasoning and in theory completely agree. Hospitals and doctors who skate by and provide just the minimum level of quality of care considered adequate should be told they need to improve. But as with many theories, putting it into practice has a few problems. The biggest ones were hit on perfectly by the author of this article. By being essentially forced to bend over backwards to give the patient exactly what they want and keep them happy, we’re not always giving them the best care we can. Sometimes not even the appropriate care they need, in the case of overprescribing antibiotics when they’re not necessary. It ends up putting the emphasis in the wrong place. It takes the emphasis away from patient teaching and preventative medicine and places it on what amounts to customer satisfaction. While listening to our patients and their needs is definitely a positive thing, making what they think they want and are asking for such a priority is not. It ends up creating frustration in doctors, nurses, and others directly involved in patient care. I’ve seen changes come and go over my years as a nurse. I hope this change goes… the sooner the better.
So, I’m sitting at home today not feeling well and bored out of my mind so I was just perusing some websites to kill some time. I came across a link on aol.com that caught my attention… a link to an article titled Why Does the U.S. Overspend on Health Care? One Simple Reason. (Here’s the link to the article should you want to read it yourself: http://www.dailyfinance.com/2013/10/19/health-care-why-america-overspends/) As a nurse, I am interested in different observations and opinions about our health care system. So, of course, I wanted to read the article. And it was definitely interesting. In a nutshell, the author theorizes that the amount of money we spend on end of life care, trying to buy a patient more time when they are going to die in a matter of a short time anyway, is how and why we’re overspending on health care. He writes “The U.K.’s National Health Service, for instance, is known to practice “denials of costly treatments for life-threatening diseases” toward the end of patient lifespans — a decision necessitated by “resource constraints.” But that’s not necessarily a bad thing.” I’ve worked with dying cancer patients, dying patients who’ve had terribly debilitating strokes. And yes, sometimes the aggressive treatment the medical community uses to prolong their lives is futile. They are going to die with or without the treatment; it’s just a matter of how soon. And sometimes that probably isn’t the best use of our resources and health care dollars. Sure, it’s easy for me to sit here saying that as it’s not my family member or loved one we’re talking about. I guess I’m saying, in theory, I understand and even agree with what the author of the article is saying. But I’m admitting I may very well feel differently if it were my family member or loved one we were discussing treating aggressively. I think the ethical problem that comes into play is already touched on when it comes to organ transplants. We only have so many resources to go around and who exactly gets to make the decisions about how those resources are allocated? Who gets to make the final decision about when a patient should be denied costly/aggressive treatments towards the end of their life? (That’s provided we know the patient’s wishes and they would want the treatment, of course. Otherwise it’s a moot point.) Those are the kinds of decisions that are incredibly delicate ethically speaking and letting the wrong people make them could be a very slippery slope. But who, exactly, are the “right” people? Not an easy question to answer at all.
In speaking to a friend (a U.K. citizen) about this article I was informed that the U.K. National Health Care System is very focused on preventative medicine and treatment of diseases rather than maintenance. That focus makes sense on many levels. First of all, it makes fiscal sense. It’s much cheaper in the long run to prevent a disease than to treat, cure, or manage it. And it just makes for a healthier society to prevent diseases so they’re not spread through the society. I don’t necessarily know if I think a national health care system is the right answer for the U.S.; but I do think there are some positive things about having one in place.
I came across this news article this evening that at first I was sure had to be hoax. So I did some quick searching and it only took me a moment to find it on a reputable news site (MSNBC). Here is the link to it.
In a nutshell, a 24 yr old Dutch nurse was asked to provide services of a sexual nature for her 42 yr old male disabled patient. She refused, and the patient had the woman fired from his care. The nurses union got involved and has started a nationwide campaign against the practice of patients demanding sexual favors from nurses. There are apparently a number of these patients who claim it is within the standard of care for nurses to provide these services. Oh, but I’m quite sure it is NOT part of the standard of care, and that is just the stance that the nurses union is taking. We, nurses, are NOT prostitutes. What we ARE is professional, educated health care team members. And I can’t believe in this day and age, the public needs to be reminded of that fact… no matter what country you live in. To think that we as nurses are responsible for providing sexual services to our patients is demeaning and insulting. It essentially says we are nothing but prostitutes, who provide those services for pay. I don’t know a single fellow nurse who would at all be ok with being seen this way or treated this way. It’s absurd to me that this topic even needs to be discussed. Helping a patient gain sexual satisfaction is so far across any line of professionalism that it shouldn’t need to even be discussed. It is so incredibly inappropriate that I’m astounded it goes on. But according to the young lady who was fired from this particular patient’s care, it does happen. The news article states that she witnessed “some” of the patients other nurses providing these services to him. I don’t know how many others she witnessed or in what manner they were doing this, but neither of those things are important. What’s important is that this inappropriate, unprofessional and flat out wrong behavior happened. Wow. Apparently, according to the nurses union, the police are now investigating. I’m happy to hear that. So… feel free to add your thoughts and comments. Always happy to hear from my fellow bloggers.
I came across this news story this morning and must say, I’m very much on the fence about what I think. In a nutshell, a brother and sister in their 30s came to the U.S. from their native Argentina on tourist visas in the 1990s. They settled into a nice American Dream life, opening a cafe and volunteering with the local fire department and police department. The problem is, they did not stay in the U.S. legally after their tourist visas were expired. They stayed as what the article refers to as “undocumented” immigrants. Some of us refer to that as an illegal immigrant. In 2005 the sister confessed their status to a friend who was a local police officer. She knew this police officer from her volunteer work as an interpreter for the police department. The police officer helped set up a meeting between the brother, sister, and a person from the U.S. Immigration and Customs Enforcement Agency (ICE). As a result of that meeting, the two were to be given special visas making their status in the U.S. permanent and legal in exchange for the brother and sister helping ICE as undercover informants. The two cooperated from the beginning and were asked initially to do just simple work. The things asked of them began to get more and more dangerous and they began to fear for their lives as this happened. But they continued to the best of their abilities. Eventually ICE felt the information the duo were obtaining wasn’t enough and they were no longer useful as informants. Relieved, the two went on with their lives. Until May 2009, over 4 years after the initial arrangement was made with ICE. Then ICE began to threaten to deport them. In November 2009 the brother was actually taken to jail in handcuffs being told his informant status was lost and the special visa he’d been given no longer valid. They are both still in the U.S. but after that, their work as informants was effectively public knowledge in the community.
I’m torn about this situation. On the one hand, they were in the U.S. illegally. By definition, that means they were breaking laws. But on the other hand, a government agency did make them certain promises and arrangements that they later backed out on. The actions of that government agency put the two in danger. I can’t decide just how I feel about this. What are your thoughts?
HERE is a link the news story.
Those of you who read my blog with any frequency know that I don’t normally write about political issues. That’s not to say I don’t care about them, I just believe strongly that everyone is entitled to their opinion and no one’s opinion is more “right” or “wrong” than another’s. But this is an issue I feel strongly about. Our presidential election coming up in just a few weeks now is going to be a historic one no matter which ticket wins. If McCain and Palin win we will have the first ever female vice president in the office. If Obama and Biden win we will have the first ever black president in office. Either way, it’s going to be a history making election. And there is one person up for election who’s ethics I have some issues with. That would be Alaska Governor Sarah Palin.
Fist a legislative panel of investigators deemed her behavior in firing the Public Safety Commissioner to be an “abuse of her power.” He allegedly was told to fire a state Trooper who had recently gone through a nasty divorce from Governor Palin’s sister and didn’t do it. That’s the issue in a simplistic nutshell. While the investigators stopped short of calling her behavior unethical or unlawful, they did agree it was an abuse of her power. And agreed that her husband, Todd, was involved a bit more than he should have been in the issue. My thought is that if she is going to abuse her power at this level, do we really want to give her even more power to abuse as the Vice President of the United States, and possible President? I, for one, do not.
Then there’s the issue of her spending tens of thousands of dollars on travel expenses for her daughters to accompany her on trips. In several cases, planners of the events Governor Palin attended with her daughters have stated the daughters were not invited. And in at least on case, it was stated that Governor Palin asked to bring her oldest daughter with her, and was told yes, but arrived at the event with all three daughters. In one case expense reports show that her and her oldest daughter stayed in a hotel room in New York City that cost more per night than I pay for rent for a month. Was that expensive hotel room really necessary? Was it even necessary for her daughter to be with her and had her plane tickets paid for by the tax payers of Alaska? I think not. If Sarah Palin wants to take her daughters on trips with her when she must go out of town or out of the state to stay close to them as a working mother, that’s entirely her decision and I don’t disagree with that decision. What I disagree with is her asking and expecting the tax payers to pay for her daughters plane tickets and hotel rooms on these trips. It would be more reasonable and ethical for Governor Palin to pay for her daughters travel herself. In one instance, Governor Palin took along all three daughters on a trip at the expense of Alaska tax payers and guess what? That trip just happened to bring the family to the same town where her husband, Todd, was participating in a snow mobile race. Isn’t that a nice little coincidence? The Governor and her daughters got to watch Todd participate in this race and have their travel paid for by the tax payers. That is unethical and unfair to the tax payers who paid for that trip. I can only imagine what kinds of things she’ll find for the tax payers of the entire country to pay for if she becomes the next Vice President of the United States. I sincerely hope that does not happen. And don’t even get me started on the $150,000 that the Republican National Convention has paid out for clothing for her!
We are spoiled. And by “we” I mean Americans. I know that’s a gross over-generalization, and I know there are certainly exceptions to that statement. With that said, I do think that as a culture, as a group of people, we are pretty damn spoiled in comparison to some other cultures. There was a discussion about this at work just last night amongst myself and two other nurses I was working with. One of them had spent a considerable amount of time in Bolivia and I’ve spent some time in Guatemala. Granted, not a lot of time in Guatemala, but two trips each approximately two weeks in length. Enough time to begin to get a feel for the culture. We agreed that we both came back to the United States feeling very blessed and spoiled and no longer taking things for granted we had taken for granted before. Things like clean drinking water, enough money to put a roof over your head or afford basic transportation, things like that.
Two examples from my trips to Guatemala stand out in my mind to make my point. During the first trip I was speaking through an interpreter to an older woman and she was telling me that she had pain in her neck often (most likely from carrying heavy baskets on her head frequently) and approximately two years earlier there had been an American medical team there in town and they had given her some small white pills that really helped the pain. She was hoping this American medical team could give her some more. I found out that those little white pills she’d been waiting approximately two years for were ibuprofen. Yes, just ibuprofen. She didn’t have any money or transportation to the pharmacy to buy them. Even if she’d been able to get the pharmacy, she wouldn’t have had the money to buy them. Ibuprofen. Something most of us give no thought to picking up on a quick trip to the store while you’re out running errands. But to this woman, it was a big deal to get these pills.
On my second trip there was another example of things we take for granted. A boy and his grandparents traveled for two full days to get 100 miles from their home to where we were setting up a clinic and doing some surgeries because the boy needed an eye surgery. They spent most of the two days walking. That was the only way they could get to us. A 100 mile trip is not a big deal to most of us. A two hour trip, roughly. But to this family it was a real ordeal.
We really are a pretty spoiled culture. As are most citizens of “industrialized” countries. But we sometimes forget about millions of citizens of third world countries who fight for things we take for granted. There are so many things we see as necessities that they see only as luxuries.
Ok, so this post is going to be a little different coming from me. Those of you who read my blog with any regularity know I don’t usually comment on political issues. But something has come to my attention recently I wanted to take the time to comment on.
I’m sure most of you reading this, if not all, have received a mass e mail about the campaign to send Christmas cards addressed to “Any Wounded Soldier” to Walter Reed Army Medical Center, right? And then you probably also received another one with a link to the page on www.snopes.com (a site that dispels urban legends) explaining why this mail can not be delivered. Basically, it’s a National safety issue. There is always the chance that a terrorist could put anthrax or some other biological agent in a Christmas card. Just because it’s a Christmas card does not automatically mean it is safe and innocent. There is also the issue of hate mail being sent to wounded soldiers in the guise of a Christmas card. I can’t begin to imagine the morale crusher that would be. Here’s this man (or woman) who was wounded fighting for their country and they are spending Christmas in a hospital instead of with family and then they receive hate mail.
There are those people who might say it’s an overreaction to stop this mail from being delivered. Some might say we could get around the problem of biological agents and hate mail by screening every piece of mail before it’s delivered. Now, I support our troops 110%. I have family members who are former members of the military. A few have fought in Vietnam and the Persian Gulf war. While I love the idea of Christmas cards being sent to these soldiers to support them, it is just not safe. Terrorist could very easily tamper with innocent looking Christmas cards for nefarious purposes. If the people in our country charged with keeping our military men and women safe have thought of this, you can be damn sure terrorists have, too. And as for screening every bit of mail, well, that sounds like a good theory. And if it were at all practical I’d be behind the idea totally. But it simply is not practical. You would be putting the people doing the screening in danger of being exposed to whatever biological agents may be in the mail. And you would also need to determine just where the manpower to spend the time screening each and every piece of mail was going to come from.
I don’t think it’s an overreaction at all keep this mail addressed to “Any Wounded Soldier” from being delivered. I think it’s a matter of it being better to be safe than sorry. That’s my two cents. Feel free to let me know your thoughts.