State of Maine: Human connection missing from modern health care



What is it with health care these days that is so deeply unsatisfying? Though diagnosis and treatment get better and better, once you have made your way into the hands of a practitioner, an experience that was once personal, even intimate, is now one frustration after another.

Most providers are no longer willing to give their lives up to medicine, 24/7. It used to be that if you became ill, it didn’t matter whether it was day, night, weekend or holiday. “Your” doctor could be reached and “your” doctor would see you.

That doctor knew you, literally, inside and out. Possibly she, but most often he, cared for you for years, if not decades. He might have cared for your parents and then, when you graduated from pediatrics, he cared for you. He knew your spouse and your kids, your medical history, whether you tended to exaggerate or minimize your symptoms.

This commitment to medicine by a family doctor was not without its costs. Patients came first. Spouses and children learned to live with unpredictable absences, disappearances from the dinner table, the empty seat at school plays or concerts. It was hard on a family, but there was also pride in his position in the community, beloved by many a grateful patient.

Somewhere around the turn of this century, younger docs were much less willing to put everything in their lives second to patient care responsibilities. They are still good doctors. They still give quality care. But they are not about to live a life dedicated exclusively to health care. Can you blame them?

Then there is the march toward “professionalizing” health care, with emphasis on the business side rather than the care side. Outpatient “prolonged care” is billable in 15-minute increments. It takes some of us 15 minutes to get our socks off.

These health care changes mean we no longer have our own doctor. There may be a “primary” doctor with overall responsibility for our care, but there is no guarantee that we will see that provider when we need her. We are signed up in a health-care conglomerate with hospitals, clinics and offices in multiple towns. Call with a problem and it’s “Dr. (Name We Never Heard Of) can see you in (Two Towns Away) on (Three Days From Now).” There is a sense, fairly or not, that no one cares.

Even this level of care applies only to those lucky enough to have a relatively stable life, who can establish themselves in a health-care community and who have some ability to pay. For the poor, the homeless, the indigent, it is the ER or, more likely, nothing.

Despite the vast amounts of money in the system, hospitals, clinics and medical practices are struggling to survive. The network of providers, payers and practitioners defies understanding. Weighted down by rules, regulations and redundancies, the health care system has succeeded in one thing. It has driven us to the point where we throw up our hands, surrender to whatever care we can get, and worry about how to pay for it later.

The costs are astronomical. Insurance is expensive too. Office visits? Triple digits. A hospital admission costs more than a car. Surgery? Forget about it. Private insurance seems bent on avoiding coverage rather than providing it for those who can afford the premiums.

Smaller hospitals, like those in Hancock County, depend on philanthropists whose contributions make up some of the difference between the cost of health care and what patients or insurers pay. But there is a limit to what even the most generous benefactor can offer. The Acadia Family Center on Mount Desert Island, providing addiction and mental health services, closed its doors last fall. Philanthropy accounted for well over half its revenue, a situation one board member called “unsustainable.” They are engaged in a process to determine the terms on which their badly needed services might be able to return.

The public bears some responsibility for this dilemma. When it comes to health care, we want what we want when we want it. Even in non-emergent situations, we do not want to wait. We scorn health care systems like those of our neighbors in Canada where people must WAIT, sometimes for MONTHS, for elective (non-urgent) surgeries. Yet the bulk of their health care is covered. Illness or injury does not bankrupt a family.

When we seek medical assistance, we want to be cured of an illness, mended from an injury. Studies show there is a better outcome when we feel cared for. Maybe “the doctor will see you now” should be “the doctor will hear you now.” We want our health-care providers to have time to see us, to hear us. We want them to have time to care.

Jill Goldthwait worked for 25 years as a registered nurse at Mount Desert Island Hospital. She has served as a Bar Harbor town councilor and as an independent state senator from Hancock County.

 

Jill Goldthwait

Jill Goldthwait

Jill Goldthwait worked for 25 years as a registered nurse at Mount Desert Island Hospital. She has served as a Bar Harbor town councilor and as an independent state senator from Hancock County.

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