Here’s $100,” stated the nicely dressed parking attendant standing at the doctors’ entrance when I arrived at the hospital this morning.
“Pardon?” was all I could stammer in reply.
“The hospital realizes it isn’t fair to charge regional rates for your parking when really you’re parking in the middle of a suburb and no one else around here pays anything—the firefighters, city hall, school board, anyone. They asked me to give you this refund.”
I was still shaking my head with disbelief when I arrived on the medical ward. I couldn’t find my patient, Mr Smith, in his room so I asked the nurse where he was.
“We moved him to an empty room as we didn’t think it was fair that he had to stay in here with these three demented women who keep him up all night. We have to walk a little farther but it’s the least we can do,” she answered.
Just then I was approached by the pharmacist. “I know you ordered this medication for Mr Smith yesterday, but there’s some evidence that this newer, more expensive drug is probably better for the elderly so we substituted it. I hope you don’t mind.” The little hairs on my neck were beginning to stand up. From the corner of my eye, I spied the head of the utilization committee in hot pursuit.
“You’re not thinking of sending Mr Smith home are you? He lives alone and his daughter works all day. Considering the circumstances, we thought it would be better if he could stay a few more days to build up his strength. We don’t want to take any chances when it comes to his safety.”
I found Mr Smith in his new room. A look of contented bliss greeted me as he was getting a foot massage from an LPN. In response to my quizzical look she said, “We were overstaffed today so I’m trying to go around and make the patients as comfortable as possible.” I noticed Mr Smith gleefully consuming a fabulous meal of eggs and hash browns, a side plate of fresh fruit with accompanying juice, milk, and toast. “We also brought in breakfast from one of the local restaurants as the food here isn’t appetizing enough. Everybody knows that to get well you have to eat nutritious food.”
I often have daydreams like this one. They relieve stress, put a smile on my face, and help me face another busy day. Recently I stopped and pondered what about this story is really that funny. How did I get to the point where excellent care has become a joke? Why does anything above the bare basics seem extravagant and even humorous?
Perhaps it started in medical school where my professors expounded on the cost of this test or that medicine, or maybe as an intern struggling to find a bed for a new admission after recent budget cuts and bed closures, or even as a practising GP trying to juggle patient demands with fiscal realities. When did it become okay to wait 6 months for an MRI, over a year for orthopaedic surgery, or a month for simple diagnostic tests? How did special authority forms, hospital pharmacy automatic substitutions, and utilization committees become a part of my practice of medicine? Why is it acceptable for an older woman to have to use a commode separated from a middle-aged man by 12 inches and a curtain?
I go to work and accept “the way it is,” that “it’s all I can do,” “it’s not my decision,” and “it’s out of my control.” Gone is the advocate, the healer, the comforter, yes, even the aggressor. I would argue that it’s time to revisit our thoughts and beliefs regarding appropriate patient care. As physicians we need to continue to advocate for our patients and their needs. Our hospitals are being driven by budgets imposed by administrators and governments. Patients, often seniors with little political influence, have very little say in the quality of the health care they receive. Their frail voices are frequently ignored and if heard, placated on a case-by-case basis.
What can we do? On any given day, each of us encounters many people from all walks of life, some in positions of importance and influence. We can informally educate and debate issues during these encounters. We can encourage our patients to write letters and to call their local health authorities and government representatives at the municipal, provincial, and federal levels. Above all, we can lend a supportive ear and be vocal at our own hospitals whenever the opportunity presents itself.
I intend to continue to be a fly in the ointment, a wrench in the machine, and, yes, even a pain in the ass, all the while dreaming of the perfect day.
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Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
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