SENSE AND CENTS
This has got to be one of my most clever titles ever. It references what I consider to be one of the biggest problems our medical system has, the change from service to business.
The almighty buck is the bottom line.
Thus, common “sense” in practice has gone to worrying about “cents” instead.
If you follow Grey’s Anatomy, there is an episode that got me in a snit. It centered around a surgeon who knew she was having a heart attack but couldn’t get the doctors to listen to her because they were following their “protocol” and discounting the actual patient.
Of course, she ended up having a heart attack and almost dying because of it and I just sit there with my whole body tensed up knowing this isn’t just drama, it’s what really happens.
Last week I took Dad to his appointment with the cardiologist. The nurse had to check his pacemaker. She and I started chatting. Poor Dad. He must think to himself, “Oh God, here we go again.”
I explained to her that Dad had switched to palliative care. I found myself again having to explain what that means to medical professionals, even those that work primarily with the elderly.
Palliative does not necessarily mean a person is in the active stages of dying.
She told me that she was having the opposite problem in her family. I asked her to explain what she meant. She said while I was trying to get unnecessary services for Dad decreased, she finds herself fighting for services for her sister. Her story was appalling.
I was so grateful she shared it with me because it gave me an entirely different perspective. It’s the same problem of having to fight a giant, broken system, but she was coming from the other side of the fence. It stretched my mind and further ignited my passion to try to change the ridiculous way things are run these days.
Her sister is relatively young, in her fifties. She has a degenerative, incurable disease and is now in an assisted living place where she gets medical care 24/7.
At this point, her symptoms are similar to that of a quadriplegic as she has no use of any of her limbs. Like Dad, she has a swallowing issue. She was evaluated (like Dad has been a million times) and it was determined she requires thickened liquids.
What often happens at this point, is that dehydration becomes an issue. It’s hard to keep drinking when you are on thickened liquids. Dad made me taste his thickened water at his last rehab stay.
It was gross.
Dad has decided he’d rather take the risk of choking than live the rest of his life drinking that stuff. I don’t blame him.
This woman is in a different place though. She is much younger than Dad and her brain is sharp. Her body just isn’t cooperating. Her sister noticed on one of her many visits that a little bit of regular water was helping immensely. She could communicate with others and would feel much better for a brief time.
She even showed the medical team what a difference the water made and they agreed it made quite an impact.
Now is when the madness starts. Because she has been medically tagged “thickened liquids,” the staff is unable to give her even a sip of water. They can’t stop a family member from giving her some, but they can’t officially give her any.
Once she is labeled, there is no room for any exception, even when it is clearly medically indicated.
Upon inquiring further into this insanity, she was told they could indeed give her water if her status was changed to “comfort” care — i.e. palliative care. However, if they did that, she would no longer receive physical therapy or any other services she was currently given.
Is it just me or is that ridiculous? It seems particularly cruel to do to a woman who can’t move her own arms to get herself a damn sip of water.
It’s about billing and regulations. I certainly understand the need for regulations, but why should you have to stop using common sense? Is there absolutely no room for even the tiniest piece of individual need?
Not if you want insurance to pay for it.
My blood boils when I hear this stuff. To Dad’s nurse- I don’t know if you are reading this, but if you are, thank you for sharing your story. I have no idea how it will take shape, but I am working to try to effect change for people like you and your sister.
It’s an uphill battle with little or no success, but I’m not going to stop trying. Let’s try and bring compassion back to patient care.
Isn’t that just common sense?
-BJ Miller, MD