I got a parking ticket today. It was worth every penny. The logistics behind why I was in the wrong spot don’t matter (do they??). What does matter is the fact that I made a conscious decision at 10:30am that I was happy to pay the fee that was going to be coming my way if I didn’t exit the building.
I was able to attend a portion of the Pediatric Bioethics conference entitled “Who’s Responsible for the Children” this morning. I was planning to return to other work after a couple of talks. But I couldn’t pull myself away. In perfect form, bioethics’ discussions draw a feisty and varied crowd. In keeping with this, I sat between a lawyer and a nurse, behind a pediatrician, and in front of a philosopher. For someone who has studied bioethics, this is a little bit of nirvana.
Did you know that recent data finds that 40% of children in the US have Medicaid and/or no health insurance?
I’m left reeling, my head spinning webs of thoughts and streams of information together that make me want to do more, speak out, stand on a table and improve health care for children. I’m somewhat humbled and intimidated by the brilliant thinkers I heard. So until all that settles, there’s one thing that came up, and often does, that I must write about. It seems it’s a theme.
It’s about the division between us. “Us” can mean doctors and patients, patients and doctors, doctors and nurses, patients and parents, policy and patients, or doctors and policy. These divisions don’t deviate far from those that arise between breastfeeding and formula feeding moms, SAHM (stay-at-home-moms) and working moms, or vaccinators and non-vaccinators. It all feels so similar, so partisan. So divided. We are always forgetting our similarities.
“We want health care for all children” — Dr. John Lantos
The morning talks (which you can watch LIVE) twirled around issues related to obligation and duty in the health care space, cost of healthcare, and resource/clinician allocation. Basically, bioethicists discussed their take on how communities, and pediatricians more specifically, are morally obligated to care for and protect children regardless of pay, cost, complexity, or access.
Dr Art Caplan spoke about policies to mandate flu shots for health care workers (to protect hospitalized children) and the reasons he believes our nation’s health care workers are only getting flu shots 50-60% of the time in many hospitals. We need about 90% of all those working in hospital immunized against the flu to protect those vulnerable. Nationally, we’re not meeting the mark. Dr Caplan talked about codes of ethics and oaths and duties to put patients first. When he was asked about vaccine hesitancy in the US and how to mandate flu immunizations across the nation, Dr Caplan responded that we need to clean up our own house first…
Yup.
But it was after the talk on vaccines and after the talk on our moral duty to care for all children that a panel discussion unfolded. It was opened up to the audience for questions. At one point the conversation we got into health reform in pediatrics, on who would provide preventative care, how to help families get good access to pediatricians and afford it. The idea, many echoed today–and one I’ve heard before–is that we will likely shift our duties in care. In the future, it is likely that nurses will provide well-child care and check-ups while doctors will provide more care to the sick. To that, a bioethicist asked the nurses in the audience if they would want to do so. People nodded. “Yes,” I heard someone cry out in the center of the room. And then a nurse took the mic.
She said that nurses should be providing well-care because nurses work in the realm of compassion. It was clarified after she spoke, that this compassion was in stark contrast to a lack of compassion housed by doctors. Just before this, someone at the mic had said they didn’t think their primary care doctor cared.
At one point the nurse with the mic asserted [I’m paraphrasing] that doctors had too much power in the hospital and that at the end of the day, the doctors had all the influence but that the nurses had done all the work.
I groaned a little. Because this perspective aches of error and misses the true point of quality, efficient, and effective health care. WE WANT PARTNERSHIPS. Partnerships! Between nurses and doctors, nurses and patients, patients and doctors. We don’t want more divisions. I could tell you how many hours I worked yesterday, but that misses the point, too.
It’s ludicrous to think that doctors aren’t compassionate. It’s ludicrous to state that one group in the hospital is more compassionate than another. We’re forgetting our similarities. And our similar goals. The parallel between this discussion and the mommy wars (where we all long for the same outcome: happy, healthy children) rang loudly in my head. There I was sitting in a room where someone was deciding who was more compassionate…
I contend that nearly everyone working in a children’s hospital or a clinic is committed, on some level, to the mission of a hospital. Or I hope so. I believe clinicians, nurses, doctors, therapists, aides, volunteers, receptionists, and cafeteria workers and all the others I haven’t listed here, want to help, want to be compassionate, want to improve lives. Don’t you agree? I work in a clinic. I work for a hospital. I am married to a specialist who does too. We care. We ache. We worry. We work to be as smart, efficient, helpful and compassionate as we can be.
I suppose the discourse today reminded me how far we have to go. The nurse who confidently announced to a room of hundreds of people that doctors don’t have compassion is simply a flare. And it burns brightly in my eyes this afternoon. We have many more miles to go to bring patients and clinicians, and clinicians and patients, back together again. We really do need to regain our similarities first.
What do you think? Were you at the conference? Do you think I misrepresented this?
Footer
Catherine Fairchild Calhoun says
I cannot find words to express how compassionate the team of doctors and nurses and staff who work so hard for my son are, they continually amaze me with their grace and kindness. I think the miracles of this grace and kindness are all around us, I believe this with every ounce of my being. Doctors like you are making a huge difference for so many people, in tiny ways and big ways. Trust me. Sorry to have missed you this morning. : (
Mignon says
I can share from both sides of the healthcare spectrum (initially insured then to a state plan) that in my son’s short little 5 month’s of life he TRULY has had providers that care!! I will admit I had both enormous guilt from not being able to provide health insurance to huge,very miss guided, stereo types of the care he would get on the state plan. I have been beyond pleased with his providers they’re efforts and ability to ease me & all my questions as a new mom- from the front desk to the doctors we have been blessed- to moma doc thank you for sharing day in and out from your perspective- for some parents sadly your posts are their only exposure to a pediatrician!!
kelly adams says
I agree that our society as a whole must stop with the “us vs. them” divisiveness. However, as a mom and daughter I often see how my remaining parent is treated disdainfully by both docs and nurses. My children are treated with the utmost care. But my mother laid dying while the doc flippantly dismissed our request for hospice. Med schools desperately need classes in communication with and compassion for the aged. Anyone who has been lectured by an arrogant medical provider (nurse or doc) remembers the frustration of balancing their need for treatment with their righteous anger!
Nursemomma says
It makes me so sad to hear what the RN said about doctors not having compassion. Maybe I’ve just been lucky, but in all the years I’ve practiced as an RN (over 25), the vast majority of doctors have exhibited kindness, caring and compassion for their patients.
It also makes me sad that the RN doesn’t feel like she works in a partnership with the docs. We have different jobs-nurses don’t typically do the work of the physician and doctors don’t do nursing work. But when they work together (along with wonderful social workers, therapists and the myriad of other health care specialists) the patient gets their needs met and is on the road to a quicker recovery or in the case of clinic patients-parents get the guidance they need to raise happy and healthy children & the treatment their children need when they’re sick.
Nurses and doctors HAVE to stop the \us vs them\ mentality-its divisive and ultimately does not serve our patients!
I must also add that I’ve been dealing with aging parents, multiple doctor visits, etc and their doctor and his MA have always been friendly, kind, helpful in all their interactions-their actions, words and manner tell me that they really do care.
Mama Doc-you sound like a wonderful, compassionate & caring pediatrician, wife and mother-I would love to come work with you if I didn’t totally enjoy and respect the docs I presently work with 🙂
Julia says
I am also horrified that having accessible medical care for children is not of the utmost priority to everyone in our country. One of the arguments against health care reform that I’ve personally heard are “If you can’t afford health care for your kids then don’t have kids!” which sound completely heartless to me. Punishing a child for the parents being poor is unthinkable cruelty and horrible for our society’s well-being. I think that should be number one is the social issues that our country is dealing with.
The other issue I would like to see changed but I’m not sure how – except maybe through better public education and a little more control over non-factual propaganda – is the large amount of middle-class people I’ve met who have health insurance but refuse to take their children to doctors believing that Western medicine, vaccines and the like are “poison”.
Diana says
No way. I would change providers if we only ever saw a nurse. My daughter has never had a sick visit or an emergency visit, and with my sister a nurse, I’ve heard too many stories about the incompentent nurses that get hired sometimes for lack of better candidates. And I love my OB–amazing and caring–but it drives me crazy that I can only ever see her nurse. Even when I was experiencing an imminent miscarriage, I could not even call or leave a message or send an email to get advice from the OB. I had to rely on the advice of her nurse–the same nurse who over the years had made many mistakes. Now when I choose doctors, I aim for small offices without a huge bureaucracy designed to protect doctors from patients. And I also have friends who are doctors and veterinarians, and I know patients like to pester their doctors and waste their time. But still, when I need help, I want access. Now that I think about it, the only time my five year old was ever sick was when we were in Italy on vacation–just completely scarily sick as a baby with mucus coming out of her eyes and nose and not able to breathe or sleep–eyes glued shut with mucus. I called back home to ask the doctor what to do and the nurse wouldn’t even let me leave a message for her. She just said take her to an Italian doctor–not easy to do in the middle of the night in an unknown place when you don’t speak the language and don’t have a car. In the end, Internet research alone helped me care for her. By the way, in Italy the doctors prefer to make house calls and everyone gets free healthcare. And nurses come to your home just to give you routine injections.
Viki says
I think health care would be cheaper to provide universally if people would not define “good health care” with highest trained provider possible. I had low-risk pregnancies, and received amazing care from midwives each time. People often disparage midwife care to me by saying “but, no, I would want someone really qualified to attend my birth.” right. Maybe that is why my midwife teaches at the medical school and med students trailed us around. Similar with check ups. I love when I can catch our family doctor. But I’m a healthy person. All I need is to check my cholesterol and vitals each year. I have found the physician’s assistant she works with to be very competent. It frees up our doctor to work with patients with more complex or chronic needs. Do my kids even need a pediatrician if they are healthy kids? Why wouldnt a PA or nurse practioner do well-baby checks and the dr handle sick kids or kids with chronic medical conditions? My next to last employer was major university with a top 5 med school and hospital. Yet the employee health plan provided nurse practioners for routine OB care. You saw an OB as necessary for a medic condition. So I’m on favor of blurring the lines between the nurses and MDs.
PS: as a parent it is frustrating when you just want to speak to the Dr. But it seems like much of pediatrics phone triage is managing parents. I’ve probably called 2 dozen times and have been triaged to bring the child on question in about 20%. I call a LOT less now because I’ve learned from those nurses about fevers, pink eye, diarrhea, weird bruises. Other practices with more urgent concerns and patients that might understand when to call (say, the allergist) have Drs answer the calls themselves.
kristophine says
This reminds me powerfully of when I was an undergrad in Psych and for one project I had to interview professors in the field I hoped to go into (child psychology, at that time).
Academic experimental psychology is a hotbed of competition. Professors from different schools, even different departments, will say wildly different things. Issues like co-sleeping and attachment theory become bitterly divisive.
The professor I interviewed was a stern person, who said often, “I may be friendly with my students, but we are not friends,” and who maintained very clear boundaries with his students. As a consequence, I didn’t know much about him when we sat down. At one point, when I was asking him about some of the political divides that invade what is supposed to be impartial research, he said, “We all want to help children. Everyone. Democrats, Republicans, no matter what school or school of thought you’re working from, nobody wakes up in the morning and says, ‘I think I want to see fewer children get help today.'”
I’m a highly political person, and that was probably a very good thing for me to hear. I get set in my mentality and it becomes not only possible but easy to think of opposing schools of thought as “the enemy.” I get frustrated with proposals that I see as limiting healthcare access and driving unreasonable profits for big business, and I start to forget that the people on the other side of the aisle are also human.
…which also reminds me of Star Wars–fear leads to anger leads to hate leads to the Dark Side–but my nerdage is showing.