I have unfortunately spent quite a bit of time in the hospital over the last 4 years.
In all the hospitals I found the same short comings. They are sterile and cold, the food is not only sub par but not ideal for promoting healing. Ill stop there for now but I have found from personal experience that the above concerns can have a great impact on health.
My question is, is this all about the money? I just feel like patient care could be taken to new heights by incorporating some pretty basic things.
I know, I know, I am idealistic and ignorant to the reality of health care as a business but I would love to understand the in's and out's of the business side (I have a finance degree and see myself heading that way eventually)
What would you recommend as a resource to help understand for profit health care in the United States? I would like to learn about old issues that have plagued the system for a long time and new ones as well. I would really love to get an understanding of how the national health care act has effected hospitals as well; good or bad.
I would love to know who would be ideal to talk to in a hospital that could guide me.
Specializes in NICU, PICU, Transport, L&D, Hospice.
toomuchbaloney,
I think you will agree that the language of your earlier post that I copied below, which I replied to, conveyed a meaning that was not nearly as considerate of the patient/family and their wishes as you now assert in your post above.
I believe that we are obligated to educate patients and their families about expected outcomes of their chronic diseases whether or not they initiate the discussion. We also, as health professionals must address end of life issues and the notion of palliative care and hospice, again, regardless of whether or not the patient and/or family has initiated the discussion. It is our job to provide people with the information that they require to make informed decisions. Many of us have experienced the wrath of the family who does not want to hear that their loved one is dying. Many of us know that such wrath does not remove our obligation to provide them and the patient specifically with ALL of the facts surrounding their illness and the likelihood of recovery or death. For too long the medical field has preferred to sugar coat talk of death after waiting until the very last moment in care to discuss it. That practice is outdated, centered on the professional rather than on the needs of the patient, and is costing our health system millions of $$ in futile care.
Yes, there will be some folks who are "not ready" to hear about palliative care or hospice yet. But we mention it anyway and by the time we mention it AGAIN, some of them have changed their minds or are ready to hear more information. People don't always know what they need to know. Some of them are under the impression that they "have time" to make the choices about hospice when they really don't have much time at all and they are wasting their time and resources trying to keep living when all they are doing is trading their comfort and peace for a vague sense of "hope".
I guess you are welcome to "interpret" my intention however you prefer. However, now that I have clarified you are left with only your opinion and your interpretation, neither of which accurately express my position or opinion.
I have been doing this nursing thing for working on 4 decades.
I know a thing or two about building good professional relationships with patients and families and am really not troubled by your distant and minimally informed opinion of my professional conduct or how I respect the wishes of patients.
What is true is that nurses are the professional discipline generally educated and charged with advocating for patients and charged with providing necessary and needed health information so that the health behaviors and decisions of the patient are informed and outcomes are improved. Just because the patient is not "comfortable" with the topic or the material does not mean that we just stop. It means that we use our skills and tools and judgement to find a more palatable way to provide the needed information.
Specializes in Mental Health, Gerontology, Palliative.
Ah, if ONLY this were true! Yes, no US law requires this, but it's extremely common....expected, actually....that utterly futile, utterly useless and very expensive treatments WILL continue to be carried out at a family's behest. How many times have we seen families threatening to SUE if Grandma doesn't have "everything done for her"? Families typically equate failure to continue futile treatment with neglect.....quite wrong, but still they do, which means that suit-fearing physicians will continue to say "what the heck, keep Grandma getting CPR until she cracks apart completely". Paraphrased, of course
Our system is far from perfect however we have a scheme called ACC (accident compensation) which has removed the ability of the public to sue re medical care. Now that doesnt mean if health professionals screw up they wont be held accountable, at worse they could be deregistered and loose their ability to practice. Its really nice to be able to nurse without fear of being sued if the patients non medical family are unhappy we wont provide some completely inappropriate treatment for their family member
And let's face it, we wouldn't have a DEAD GIRL lying in a hospital bed using INSANE amounts of expensive resources if it were not for a demanding family insisting they do this very thing. Jahi McMath, anyone?
I dont think we've ever had a case like that here before. I do alot of work in community palliative care. There was some controversy a year or so ago re 'The liverpool care care pathway" which is a model of care to be used with patients who are actively dying. People were being placed on it and being on it for weeks, it should only be used in the last 48-72 hours.
However people were confusing do not resusitate/ with do not treat eg nausea, pain etc. As nurses we have the right to refuse to deliver care if its in an area that may go against a nurses personal/religious POV eg abortion. However I would struggle providing nursing care to what is essentially a dead person on a ventilator.
Specializes in UR/PA, Hematology/Oncology, Med Surg, Psych.
It ****** me off to no end that this country spends so much on expensive and futile care, while millions of Americans are without basic insurance and health care. There are Americans that die because without private insurance/Medicare/Medicaid, they can't get treatment or if charity care is available, it may be inferior. This happens while some Americans can have thousands/millions spent on their futile care by the government. This just boggles my mind.
What constitutes futile care is a huge debate all by itself. Physicians and other medical professionals, along with patient advocacy groups and medical ethicists, do not agree (i.e. there is no consensus) on the point at which care becomes "futile," or even on a definition of "futile care." Hospital ethics committees can be helpful when there is disagreement between the physician and patient/family wishes in regard to treatment, and can ensure that the patient/family 's position is fairly represented. There is the potential for much conflict of interest between the patient/family interests and the physician/hospital interests. So yes, patients and their families do have a voice in these decisions via hospital/facility ethics committees.
Yes, of course they "have a voice." But that doesn't change the fact that there is no mechanism by which clients and families can require healthcare professionals to provide treatment which the professionals consider inappropriate or futile. I just wish that more physicians and hospitals would take a stand on "futile" treatment and work to educate clients and families about some of the unpleasant realities in healthcare (instead of caving because of fear of lawsuits). IMO, there is far too much of it going on in US healthcare, and we are all paying for it.
It ****** me off to no end that this country spends so much on expensive and futile care while millions of Americans are without basic insurance and health care. There are Americans that die because without private insurance/Medicare/Medicaid, they can't get treatment or if charity care is available, it may be inferior. This happens while some Americans can have thousands/millions spent on their futile care by the government. This just boggles my mind.[/quote']
Specializes in OR, Nursing Professional Development.
I just wish that more physicians and hospitals would take a stand on "futile" treatment and work to educate clients and families about some of the unpleasant realities in healthcare (instead of caving because of fear of lawsuits). IMO, there is far too much of it going on in US healthcare, and we are all paying for it.
I think this issue is twofold:
First, death and aging are viewed with fear by many in this country. Quantity of life is given a much higher value than quality of life.
Second, I think a lot of physicians feel that withholding futile care means that they've lost, they've been defeated by death. This kind of ties in with the first point- death is feared.
Unfortunately, it's going to take a major cultural revolution for people to stop fearing death, and to realize that it's just a part of the life cycle to influence peoples' personal health care choices and the willingness of physicians to deny futile care.
To compare our "system" to systems in countries with better outcomes (I don't think it's really a system, it's actually unbridled capitalism), you could spend a few months in the WHO database at WHO | Country statistics
The reason our health care costs more, and why our outcomes are worse, than most other countries, is simple: profit. When the primary goal is not health, but profit, you get the results that we have here. That's why no other country has a mess of privateering as we do in the U.S.
Just wondering - what sort of indicators are there, of change? I've not read anything indicating that, not in the U.S. Are there changes taking place, perhaps, in the hospital where you work? Our outcome statistics as a nation have been going progressively down.
It's not really complicated: follow the money. There is plenty of money for adequate food, supplies, space, care, etc - but not if you want to pull more and more profit out of the investment. Profit is the ONLY motive - when you remember that, it isn't complicated..
About the hotel-like hospitals - it's all about attracting those 1% patients. They'll get the best in food, rooms, decor, equipment, supplies, and care. These are great profit centers. These boutique hospitals have 2-3 star restaurants for visitors - and that's a big profit center, too.
The other hospitals, located in high Medicaid/uninsured population areas, won't have nice rooms, equipment, adequate supplies, staffing, or food. The lowest profit-makers are mental health: those inpatient units are the bastard stepchildren, and those rooms will be dirty-looking, with uncomfortable beds, broken tiles, ugly showers (and not enough of them), small spaces and bad beds, lower staffing levels, etc.......because the well-off patients will go to private-pay boutique psych hospitals....
Regardless of the hospital's amenities and level of care, though, the CEO and other execs will still be pulling in the tens of millions, as will the investors.
Problem with the "big awakening" is that people don't know what evidence is, how to critique it, where even to find out if there is any......I've seen a lot of patients harmed by this anti-science agenda - and yes, that's exactly what it is. Patients who think taking a natural supplement (untested and unregulated, could be what it says it is, or maybe not) is better than thyroxine; patients who "believe" vaccinations are ineffective and unsafe.
It is not just the patients who are uninformed and jumping on the "natural" bandwagon. It's health care providers too. How about hospitals who actually provide do-terra junk scent and promote it as doing something beyond smelling nice? No evidence for the stuff, not one study. How about hospitals that actually provide "healing touch" or Reiki" - all hokum and snake oil, and for which there is plenty of evidence - evidence showing that these bunkums don't work as well as placebos?
If there is going to be any movement toward prevention, we need to have the evidence, and work toward an educated populace. And that education better start with the health care providers.
Hello. I should have clarified this statement; otherwise you are absolutely correct.
What I meant was for people to pick food over scripts, not hospitals.
For instance, I was diagnosed with ocular rosacea, rosacea on my face, seborrheic dermatitis and high blood pressure and high cholesterol. It wasn't long before I realized what the Dr.'s had me on was crap and was making my quality of life worse. I turned inside and changed things up complete, I no longer have any of the above problems but the BP, its a bit elevated a 135/70 but I am off the beta's and now on a 5mg CCB.
There is a real awakening among people with common disorders like diabetes, high blood pressure, high cholesterol etc to turn away from tradition meds and seek out other methods. Look at Lipitor, massive lawsuit against Pfizer, the drug not only gives people diabetes (which apparently they knew) but the artificially lowering of cholesterol is shown not to even help people. Recent research shows that the cholesterol is a good thing b/c it is patching week spots in there arterial wall due to inflammation....inflammation most likely cause by diet. In my case it was, my cholesterol after 5 months plummeted, not by the use of drugs but by diet.
Pipe dream, maybe, but with results like mine its a dream worth having and pushing forward.
You are right about lifestyle changes, but when you become a nurse, you will see that very, very few patients actually want to make those changes. The people that do, aren't in the hospital!
Yes, behavior changes are so difficult that there is a specialty area just for that - CBT. Another thing making health behavior changes difficult is the pseudo-science propaganda out there........
toomuchbaloney
16,029 Posts
I guess you are welcome to "interpret" my intention however you prefer. However, now that I have clarified you are left with only your opinion and your interpretation, neither of which accurately express my position or opinion.
I have been doing this nursing thing for working on 4 decades.
I know a thing or two about building good professional relationships with patients and families and am really not troubled by your distant and minimally informed opinion of my professional conduct or how I respect the wishes of patients.
What is true is that nurses are the professional discipline generally educated and charged with advocating for patients and charged with providing necessary and needed health information so that the health behaviors and decisions of the patient are informed and outcomes are improved. Just because the patient is not "comfortable" with the topic or the material does not mean that we just stop. It means that we use our skills and tools and judgement to find a more palatable way to provide the needed information.