- A Head Start physical exam that becomes advice from a 5 year old about how to get your first bike: "you crush cans until your grandma says you have enough money".
- An elderly woman's "dizzy sometimes and tired most of the time" work up, the kind that can be so unrewarding in terms of hard information from the lab. But the patient adds at the end of the visit that her son is the Medicine Man, the Shaman, and this is just a second opinion.
- Colleagues after a holiday weekend, Health Aides, giggling about sore muscles and chatting about the best recipes for frying the pinon nuts they have gathered from a field, on their knees, all day yesterday. Their families may have different recipes, but the basic facts are shared with me just the same, once they switch to English and finish laughing at their sore thighs.
- Preparing to intubate a very elderly, dying woman who can't breath well at all, with two other generations of family about to leave for the hallway. Then, before the procedure tray is ready, having the eldest daughter stop the procedings to talk about doing nothing further for their loved one.
Being a PA is a ticket to a world that is sometimes intimate with strangers, vulnerable with colleagues, and rarely free of opportunity for the details that make us human and infinitely interesting.
I share these notes from the front line of medicine because so often I find what we do is dehumanized once it finds its way to print. Maybe even before it becomes electronic ink; maybe while it is still forming a thought in the minds of those who would think of medicine as consumed or purveyed. In the present state of bias and disconnect, the patients are sums, the clinicians are producers of income, and the product of our work is reduced to the grand total below a bottom line.
I challenge anyone to summarize my work, by the metric of a day or a career, by a number you find below a bottom line.
Those of us in between the consumers and the owners ( the ones who deliver) are not, speaking for myself, comfortable with the present model of life as a statistic. Especially when that statistic is so boldly linked to a commercial commodity that is to be bought and sold. Or, in the current case, held ransom by insurance companies.
Health care should not be for sale as if you were buying a car or a house, say, for a major disease. Or buying new shoes in the case of, perhaps, the flu. There should be no negotiating necessary, no fine print, no lawsuits to get it right on redux, or bankruptcy when the right balance was not realized.
It's the mark of a civilized society to figure out how to care for the health of its citizens. All of them. Each of us. Just as we have built a functional, safe interstate highway system since World War II, and managed complete and thorough environmental protections that did not exist before the 1970s, and an entire space exploration program since the 1950s, just to name a few major federal projects, our country has proven that with focus, big successful and expensive things can happen.
No doubt there was resistence to something as outlandish as Interstate Highway I-40 cutting ramshod across the landscape when it was first proposed. Why can't people just use the perfectly good two lane system already in place? It has worked for years! Route 66 - love it! Don't change a thing!
But like Rt 66, whose time had passed by 1950, those who have enjoyed their time at the health dollar trough for far too long need to step away. Business models would have to change dramatically, and this, of course, is why change has not come already. Money doesn't shift to places of need from the stronghold of greed on its own, irrespective of the legitimacy of need. This could be an axiom of poverty.
Over time, business models favoring the greed of health and insurance care have become legislative realities. It's no surprise when businessmen become our lawmakers how this could happen. It's predictable. Should we think they are going into politics for statesmanship? Really?
Rules don't need to bend at all when laws are made to support overcharging patients and bear no oversight on insurance company fraud. When the things insurance companies do sometimes walk, talk and look illegal, well, it's because the definition of robbery was purchased by those who lobby for these companies and with enough money, definitions can be blurred beyond recognition. Insurance companies function nefariously with impugnity because the laws simply allow it their way.
Changing this will be like turning a very large train. One, unfortunately, that does not care if you and I and all of our patients are on the tracks. Historically, anyway, we've been on the tracks already and nothing has slowed the train. There is a body count. It's just difficult to apply exact science to the quantification of who died from lack of preventive or diagnostic care, or who died from lack of chronic need medications, and who died from failure of ability to pay for a life saving surgery. But they were all on the tracks, these folks, when the insurance train sounded in the distance. And they were not covered. Or they had not met their deductible. Or they were out of network for the specialty. Or the requisite waiting period was not up. And the train just kept coming, because trains are unweilding machines.
I told the little Head Start princess that she will likely be the smartest girl in her class. Who else had earned enough money for their own bike at her age? I sensed an eagerness in her twinkling eyes and a grin, albeit absent one front incisor, that would take her far from her grandma's careful accounting.
Grandma just looked on, pleased with the course of this exam and conversation with her young charge. Our eyes met for a fraction of a moment. There is a graceful understated humility in the people here that can bring me to a caring silence. I'm in a place where less sometimes is more. Less, in this case of shared understanding, can be the greater part of the whole.
And, thankfully, I have no idea how to bill for this, a moment of invaluable human connection.
- An elderly woman's "dizzy sometimes and tired most of the time" work up, the kind that can be so unrewarding in terms of hard information from the lab. But the patient adds at the end of the visit that her son is the Medicine Man, the Shaman, and this is just a second opinion.
- Colleagues after a holiday weekend, Health Aides, giggling about sore muscles and chatting about the best recipes for frying the pinon nuts they have gathered from a field, on their knees, all day yesterday. Their families may have different recipes, but the basic facts are shared with me just the same, once they switch to English and finish laughing at their sore thighs.
- Preparing to intubate a very elderly, dying woman who can't breath well at all, with two other generations of family about to leave for the hallway. Then, before the procedure tray is ready, having the eldest daughter stop the procedings to talk about doing nothing further for their loved one.
Being a PA is a ticket to a world that is sometimes intimate with strangers, vulnerable with colleagues, and rarely free of opportunity for the details that make us human and infinitely interesting.
I share these notes from the front line of medicine because so often I find what we do is dehumanized once it finds its way to print. Maybe even before it becomes electronic ink; maybe while it is still forming a thought in the minds of those who would think of medicine as consumed or purveyed. In the present state of bias and disconnect, the patients are sums, the clinicians are producers of income, and the product of our work is reduced to the grand total below a bottom line.
I challenge anyone to summarize my work, by the metric of a day or a career, by a number you find below a bottom line.
Those of us in between the consumers and the owners ( the ones who deliver) are not, speaking for myself, comfortable with the present model of life as a statistic. Especially when that statistic is so boldly linked to a commercial commodity that is to be bought and sold. Or, in the current case, held ransom by insurance companies.
Health care should not be for sale as if you were buying a car or a house, say, for a major disease. Or buying new shoes in the case of, perhaps, the flu. There should be no negotiating necessary, no fine print, no lawsuits to get it right on redux, or bankruptcy when the right balance was not realized.
It's the mark of a civilized society to figure out how to care for the health of its citizens. All of them. Each of us. Just as we have built a functional, safe interstate highway system since World War II, and managed complete and thorough environmental protections that did not exist before the 1970s, and an entire space exploration program since the 1950s, just to name a few major federal projects, our country has proven that with focus, big successful and expensive things can happen.
No doubt there was resistence to something as outlandish as Interstate Highway I-40 cutting ramshod across the landscape when it was first proposed. Why can't people just use the perfectly good two lane system already in place? It has worked for years! Route 66 - love it! Don't change a thing!
But like Rt 66, whose time had passed by 1950, those who have enjoyed their time at the health dollar trough for far too long need to step away. Business models would have to change dramatically, and this, of course, is why change has not come already. Money doesn't shift to places of need from the stronghold of greed on its own, irrespective of the legitimacy of need. This could be an axiom of poverty.
Over time, business models favoring the greed of health and insurance care have become legislative realities. It's no surprise when businessmen become our lawmakers how this could happen. It's predictable. Should we think they are going into politics for statesmanship? Really?
Rules don't need to bend at all when laws are made to support overcharging patients and bear no oversight on insurance company fraud. When the things insurance companies do sometimes walk, talk and look illegal, well, it's because the definition of robbery was purchased by those who lobby for these companies and with enough money, definitions can be blurred beyond recognition. Insurance companies function nefariously with impugnity because the laws simply allow it their way.
Changing this will be like turning a very large train. One, unfortunately, that does not care if you and I and all of our patients are on the tracks. Historically, anyway, we've been on the tracks already and nothing has slowed the train. There is a body count. It's just difficult to apply exact science to the quantification of who died from lack of preventive or diagnostic care, or who died from lack of chronic need medications, and who died from failure of ability to pay for a life saving surgery. But they were all on the tracks, these folks, when the insurance train sounded in the distance. And they were not covered. Or they had not met their deductible. Or they were out of network for the specialty. Or the requisite waiting period was not up. And the train just kept coming, because trains are unweilding machines.
I told the little Head Start princess that she will likely be the smartest girl in her class. Who else had earned enough money for their own bike at her age? I sensed an eagerness in her twinkling eyes and a grin, albeit absent one front incisor, that would take her far from her grandma's careful accounting.
Grandma just looked on, pleased with the course of this exam and conversation with her young charge. Our eyes met for a fraction of a moment. There is a graceful understated humility in the people here that can bring me to a caring silence. I'm in a place where less sometimes is more. Less, in this case of shared understanding, can be the greater part of the whole.
And, thankfully, I have no idea how to bill for this, a moment of invaluable human connection.
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