Tuesday, September 22, 2009

Missing in Health Care: Common Sense

When I was a boy of roughly 10 or 11, I came across a phrase spoken by teachers and other similar role-modeling adults that baffled me: common sense. It's only now, decades later, that the undefinable, ineffable "common sense" rears up its head again, this time to cover everything that's missing in U.S. health care -- not to mention the debate about its reform.

Let me paint a picture that is a composite of several experiences, my own and those of others.

You go to a doctor because you feel pain -- or a growth, or something that makes you feel uncomfortable about the state of your health, all of which, in the end, is pain. Yet the first thing that happens when you present yourself at a place designated to dispense healing is you get barraged with questions which you are usually in no mood to answer, or if you are, often cannot quite come up with one. Why? Because you are in pain.

I once tried yelling out "I am in pain." No one moved, everything proceeded as usual. So, you're in pain but they're there first and foremost to CYA and M-I-C-K-E-Y M-O-U-S-E you to death.

You're not important. The doctors are important; if not the doctors, then the stockholders, the managers or their aunts in Timbuctu -- anyone but you. Their time is money and their employees know better than to waste it. In this economy finding a new job is tough.

Assume you get treatment before your great grandchildren go to college -- a big assumption in most emergency rooms. Seriously ... the only time I ever got immediate assistance was when I literally collapsed on the desk of the receiving nurse.

Then they ask you what is wrong with you, yet saying "X hurts" -- where X is the part you are clutching like you'll fall into the Grand Canyon if you let go -- is never good enough. They want "I have an episomataspermoanthrodosis that has just trifulcated endomatically." What is wrong with these people? Do you look like you went to Harvard Medical School?

Then come forms of torture that the Inquisition abandoned sometime in the 1840s -- called "tests" -- to determine why that severed foot is bleeding. "Aha, your foot is disconnected from your leg hence the blood vessels have nowhere to go and the blood ... "

They can't say that. So they invent something that sounds good. Shrinks diagnose anything they don't really know what it is as "borderline." Physicians call anything to do with skin "dermatitis" (essentially skin+itis). Borderline dermatitis should just about cover anything.

There's a whole slew of scientific sounding terms for "Hmm ... I don't know what the hell is wrong with you, but since I'm going to charge you at least a few hundred dollars, I might as well make up something." If you don't know what the term means and they can't explain it in simple terms, you've got that Don'tknowwhatitis Syndrome.

Then you don't quite trust what they say, in part because no doctors look like Marcus Welby any more. Did they ever? I mean, Welby was a TV character. Old doctors can't afford the litigation insurance, young Welby-like people are making money on Wall Street securitizing insurance against unknown diseases, or starring in TV shows.

The doctors can never be bothered to explain anything from a normal person's perspective. Nurses dig into your duodenum while they chirp happily, "how are we feeling today?"

Everybody robotically follows some list of tasks written up by the MBA who runs everything from an office tower in Chicago. Even nurse cheer, probably quantified under Baldridge Criteria for Performance Excellence, is prescribed precisely.

U.S. health care, after all, is designed to imitate the assembly line of a Ford Model T automobile. Put an insured patient with the proper documentation at one end and spew out a much poorer, somewhat healed, not healed at all or even dead person, at the other end. All very efficiently, you understand.

If you're tempted to say it's the profit motive -- which in part it is -- you're missing the entire point. Profit is part of the problem, but it's not the essential problem.

The basic problem is a deficit of common sense.

That's a social problem. As we develop into an ever more individualistic society, we are losing our sense of commonality and the ability to trust in our own judgment as adults. That's what common sense was.

"Common sense," growled by exasperated teachers and adults, was what we children lacked when we did something dangerous or foolish or simply without thought. We failed to rely on the accumulated social wisdom concerning some basic basics.

Patients must be ask what they are allergic to, because that way, if we goof, it's their fault. Medical people can't trust their senses because they will be sued. Besides, they make more money testing.

It's a bother to apprentice and train people to use some horse sense about the degree of cheeriness a patient can take while you are rearranging the duodenum; so just give them a clipboard and a checklist: "Item 7: rearrange duodenum while proffering a toothy smile and Baldridge level 4.7 cheer."

The common sense of what is really needed to apply a modest amount of healing -- pain, after all is what keeps us alive -- has gone out the window.
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