Tuesday, January 1, 2008

Disjoint Necessities

For the past 2 1/2 months, I have had the opportunity to study our American medical system in some detail. Spending time visiting a family member in Intensive Care, critical care units, rehabilitation hospitals, and skilled care rehabilitation units has simultaneously increased and decreased my respect for the quality of medical care in our fine country.

The one word that stands out to me in thinking about this experience is disjoint. Every aspect of the medical care is disjoint from every other. Doctors are disjoint from their institutions, each other, the nursing staff, the patients, and, of course, the patient's families.

Institutions are disjoint from each other. Medical priorities are reset at every transfer, and transfers are often done to satisfy non-medical priorities. Care givers change every day, even within one institution, and thus the patient is confronted with an interpersonal environment that is chaotic and confusing - especially bad for those with head injuries, memory and perception problems.

Some of the disjointness is due to the "Patient's Bill of Rights." Under this law, people are not allowed to talk to each other, to put it crudely. In order to avoid breaking patient confidentiality, communication is limited to 'need to know' which, IMO, cuts down on options presented to patients, for patients, and which forces family members to execute "Medical Power Of Attorney" for people who are temporarily incapacitated. This, in itself, is somewhat traumatic,for patient and family, possibly causing further disjointness.

All in all, I am humbled by the care with which all of the medical staffs have worked on behalf of the our patient, and by the quality of the medical decisions made at times. The medical care itself has seemed to be quite good, done diligently and with care and respect.

On the other hand, I am somewhat mystified at the medical system we have, in which every action is made into a commodity, weighted, measured, and doled out through distant invisible money agents through medical agents that are constrained in what they can say to others due to confidentiality and also due to fear of later lawsuit. Calling it a system is generous, being an impossible collection of competing interests.

Longer term questions are neglected - institutions can cherry-pick what procedures they want to provide - leaving the overall trajectory of the patient's care up to the family, who are generally informed enough to make those decisions only after the care has been rendered.

My family member is recovering, but, in the process, my family has become somewhat sick at heart, exhausted, and in great fear of ever ourselves needing critical medical care. This is less due to projected pain and suffering than to the prospect of being at the mercy of a mindless set of financial and legal strictures that possibly override our own best interests.

Profit motive is not good medicine.

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