Healthcare in America---Not What the Doctor Ordered

I know you cannot hear me, but I am screaming out loud from frustration. We live in a country whose citizens would say has a great healthcare system although we are not even ranked in the top 10 worldwide—in fact, we are ranked 37 of 190 countries studied by the World Health Organization. We are one of the richest countries and spend more money on healthcare per capita than most yet are only ranked 46 of 48 countries when it comes to healthcare efficiency (Bloomberg Ranking). You would think money buys everything, but not true.  Our outcomes for life expectancy, infant mortality, and coronary artery disease continue to lag behind Great Britain, Canada, and Japan, who are just a few of the countries spending considerably less on healthcare than we do.

I have been employed in this system since I was 15 when I started working at my father’s podiatry office.  brick wallI graduated with my Bachelors of Nursing in 1984 and began my nursing career in the hospital setting. I received my Doctor of Nursing degree in 1999 as a family nurse practitioner and have practiced in the primary care setting ever since. I have seen many changes in healthcare– both positive and negative. Today my frustration level has boiled over and if it weren’t for the possibility that I could get a concussion, I would be hitting my head into the brick wall right now, instead of writing this.

I remember when I first started as a hospital nurse; many of the patients had no idea what medications they were on, although they knew the colors and the reason why they were taking them. They would tell me that that yellow was for their heart, the blue one for their diabetes, and so on. Patients trusted the entire healthcare process from any provider (doctors, nurses, etc.) of their care with few questions. Many times the doctors would tell their patients what tests were ordered but the patients did not want to ask questions because they did not want to be a bother to their doctor.  I learned long ago never to assume anything, so I would ask my patients what they knew about the test they were scheduled for.  The last thing a patient needs is to worry unnecessarily because they were unsure what was told to them or just too afraid to ask.

Your doctor ordered a stress test for you so look at your hospital bill!

When I was working in the hospital I had a patient who was 83 years old and scheduled for a stress test.  I asked her if she knew what a stress test was and how they will perform it.  She said, “Not really, is this test when they hook you up to a monitor and tell you stressful things?” I told her no because if that were the case all they needed to do was give her the hospital bill and if she could make it through that her heart is just fine.  We both chuckled and then I sat down and explained the entire test to her. While she may have been worried about what the test results may show, at least I could alleviate any fear of the test itself.

Nurses were the patients’ advocate while in the hospital back then; I am not so sure if this is even possible today.  Before any of my fellow nurses get enraged, please let me explain.  I believe the reason is primarily due to how hospitals are run today.  When I started in 1984, the hospital I worked at followed the primary nursing model for patient care.  I would have the same patients on the days I worked which gave continuity of care to the patient.  The unit I worked in was a cardiac telemetry unit where we monitored patients with chest pain, irregular heart rates, and those discharged from the Intensive Coronary Care Unit. I would have no more than 4 to 5 patients during the day shift and would care for my patient for everything including bathing and taking them for walks.  This gave me an advantage to quickly note any changes in their health status and call the doctor promptly with my concerns.  As the years progressed, nursing assistants were hired to do the vitals, bathing, and helping patients with their walks which allowed hospitals to increase the number of patients given to nurses. Many hospitals now only hire certified nursing assistants to do some of the procedures nurses did such as putting in urinary catheters and testing blood sugars which would alleviate some work from the nurses thereby justifying increasing the nurses’ patient load again.  Why does this matter you ask? Today, nurses have a higher patient case load of very sick people since only the really ill get admitted.  There are also so many individuals involved in the patient’s care that the hospitalized are not sure who does what and what is being done.  Our complex health system is creating more stress for the patients and their families in an already stressful time.   Something needs to be done.

Knowing there is a problem is the easy part; fixing it is quite difficult. We have improved technology, better trained/educated staff, and specialized workers which is an asset on one hand and a detriment on the other. Patients need an advocate to make sure their needs do not slip through the cracks, someone who understands the process and can get things done in a timely manner. If you are thinking that this is a fabulous idea, thank you; however, with all good ideas come other problems. Who would pay for this? The wealthy would be able to afford this benefit but what about the poor, the under-served, those without family?

Why am I frustrated? A very dear person to me was in the hospital in another state. She was having some difficulty breathing on and off throughout the night. She would let the nurses know, they would call the doctor, tell her to relax, and move on to the next patient. They did not know her, they did not recognize the changes in her breathing. She called me scared, telling me that no one was listening to her, that she was having trouble breathing. I recognized her shortness of breath because I know her. I immediately called the nurse, explained what was occurring, and made sure that her needs were getting met. I was her advocate. In fact, I am now known in that hospital as someone not to mess with and I am perfectly okay with that. I just wish that everyone could have their very own healthcare advocate, too.

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    Nancy Chodash

    I am a nurse practitioner who not only treats patients, but has had chronic illnesses including cancer so I understand how frustrating medicine can be. But through all this, I have never lost my sense of humor and my ability to make people laugh. I love to cook, and since becoming gluten-free a year ago, I have recipes for everyone's tastes whether it be healthy, decadent, vegetarian, or gluten-free. My philosophy is all about health, food, laughter and life!

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