Modernization can at times be very expensive
by admin on 10/10/2018 1:20 PMI served my internship at Wayne County General Hospital. We were the first class of 36 interns to work in the new 500 bed orange and silver aluminum hospital built in the form of a Grecian cross-a square center with four arms of equal length. The old hospital had the standard characteristic large 40 to 60 bed wards that most of the public hospitals had in the 1960s, whether county, city or state. Furthermore, Michigan was the first state that placed doctors under state wage laws which was $300 a month for full time work. The majority of the hospitals in the United States were paying interns $25 to $50 a month. Since at that time most house staff were unmarried and received free room and board at the hospital, it was a living wage. We felt privileged. There were 500 beds on four floors above the street level with 125 patients on each floor, as I recall. There were 2 five bed rooms in the corner of each floor which was one wing of a red cross. The rest of the rooms had 4 beds, with a couple of two bed semi-private rooms for special medical needs such as isolation or an occasional high-level county official.
Going from 40 and 60 bed open wards to the large number of semi-private rooms required a significant increase in nursing staff. Whereas two RN’s could oversee 40 or 60 patients in the old facility, it would take two RNs to oversee every three or four rooms of four patients each. The county balked at the expense of tripling the number of RNs for the same number of patients. The county hired efficiency experts to evaluate the RNs and to reduce their number. The efficiency experts recommended exactly what they were hired to do—documenting overstaffing.
The doctors observed the nurses working feverishly at the desk taking down the orders the physicians had written and proceeding to implement them. The efficiency experts making their rounds would count out loud the number of nurses at the desk: one, two, three, four nurses at the desk not seeing patients. We asked them what they thought the numbers meant. One said, “Obviously you’re over staffed when more than one nurse is sitting or standing at the desk. Shouldn’t they be out on the floor doing some nursing?”
The experts obviously had no understanding of nursing. When their report was submitted, and administration tried to reduce the number of nurses, a firestorm erupted. For a while it looked like we might not have RNs at all. I don’t think the doctors were very thrilled with the prospect that they might end up bathing their patients and emptying their bedpans.
Eventually the administration tossed out the expensive study and we all went back to practicing medicine and the nurses resumed the care of our patients.
Are we having the same problems today, except on a more massive scale? Don’t we have medical efficiency experts, the insurance carriers, HMOs, Medicare, Medicaid telling us how to practice medicine? Telling us what tests we are allowed to order, what drugs we are able to use, which hospital we are allowed to admit our patients, which consultants are approved, which x-ray facility is in our patient’s insurance plan, which laboratory will they reimburse, which respiratory company are we allowed to order oxygen for our patients in lung failure. And since each insurance carrier and HMO has their own preferred drug formulary and consultants, it sometimes is not easy to steer a patient in the correct direction. This top-down management ultimately comes from the White House, the Senate, the House, and the Supreme Court who don’t seem to have a clue as to what the practice of medicine entails.
Instead of being lean and efficient, it is turning out to be costly and inefficient. Many of our patients are relating horror stories as to having been on medications for decades which were working beautifully and now, because of new regulations or an insurance change, being placed on substitutes. The blood pressures became out of control; diabetics noted their glucose levels were out of control; asthmatics were wheezing more than ever because their bronchodilators had been changed by a new insurance company; their new oxygen company took two months to get oxygen to them while they are gasping for breath not being able to walk to the next room. Patients also complained that their health insurance premiums had increased; that their medications cost had spun out of control.
The patients have now partially accommodated to these huge changes over the past two years caused by Obamacare. This now creates a challenge if we toss out these changes that Obamacare made, without a smooth transition to a market base plan.
The most dangerous campaign statement is to “REPEAL” and “REVISE” when no one has submitted a revised plan that the public will accept. This could destroy the Conservative Political Party from making constructive changes and the “Tax /Spend/ and Regulate” party would proceed to destroy American Medical and Health Freedom. Their success is really guaranteed with the ease in which the “Tax /Spend/ and Regulate” party operates. Since the regulation and control of human beings is essentially impossible, as the Fascists, Communist, and the Socialists have well demonstrated but still don’t believe, they can continue to SPEND. With the progressive income TAX, it will be easy to increase taxes on the masses who may not fully understand what they are approving, and when this doesn’t go as planned, they have to REGULATE our freedom as we drift backwards into a Statist Civilization. We will then have to try to advance to a free society again repeating what our forefathers accomplished by establishing American Freedom. How many hundreds of years will it take to reach 1776 again?
Follow this HealthPlanUSA column for some answers to our health care conundrum.
America, it is critical to wake up before it’s too late.
Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .
Well-Meaning Regulations Often Worsens
Quality of Care.