I have had a long career in healthcare, and as I look back on it, I see that it was forty years ago that I started my first internship as a Biomedial Technologist. (This career is something little known outside of healthcare itself; it is a person that inspects and maintains medical equipment for use by others, usually in a hospital or clinical environment. People who to this type of work are called by many names; In my area it was BMET - Biomedical Equipment Technologist.)

During that time I have seen profound changes in the healthcare work environment; some good and some bad. I live in the US, so these may or may not relect on the rest of the world.

Then

• When I entered my profession, comraderie and relationships amoung people in the hospitals I worked in was high. Most of us had the attitude that we were there to work together and try to help the people that our jobs existed for; those needing our care. The Love and Compassion we gave came first.
• The stress levels in the job were also high, but we were able to balance that with having fun when we could. We weren't worried about being spied upon and called out for not meeting some imagined standard of Polical Correctness.
• We were from everywhere, with all kinds of different ideas, beliefs, sexualities, etc. What mattered to us what what we could accomplish together, not what divided us.
• We were very much in touch with the realities of life and death, because we saw it every day. We prided ourselves on doing what we could for the hurting and dying, because we knew that we would be in that spot also.
• There were many different organizations you could work in. In my career, most of the BMET or CE (clinical engineering) departments were in-house (run by the healthcare organization) not contracted.
• We faced a lot of unknowns that kept us realistic on our own chances for survival. First came the Hepatits B Epidemic, then an unknown disease killing people that came to be known as AIDS.... There were also communtity disasters, such as one that I remember at another hospital nearby where they had a fire in their ICU (Intensive Care Unit); our hospital and another one nearby went to Code Yellow - External, and received all of the evacuated patients to care for. And, if we had something like that happen, the other hospitals in the area were there to help us. It didn't matter who we worked for, we helped. It was all in a days work.
• We knew that a lot of medicine was imperfect, and that we still had a lot to learn.
• The cost of healthcare was relatively low. We did not have a lot of technology or medicine, so it relied on people instead.
• People who did not have insurance were covered by government programs that paid for their care.

Now

• Healthcare is a very fragmented and fractured industry. Spiraling costs mean more and more people that need care cannot get it. Minor problems multiply until they become severe, but that doesn't change the fact that they cannot afford it.
• Many states, such as the one I live in, require hospitals to provide care even if the patient cannot pay for it, but the care they receive in that situation is very poor - only the minumum required to stabilize them - and the problems continue to compound.
• The people with Health Insurance or the ability to pay for their care get somewhat better treatment, but not much. Insurance costs spiral higher and higher, and so do the amounts you pay out of pocket.
  • Part of that is the high cost of drugs and technology.
  • Some is caused by malpractice settlements. These cases often don't go to court because settlement is cheaper. That encourages suing over almost anything.
  • Some more of it caused by changes in patient expectations as they watch commercials showing just how much better you'd feel if only you got our drug/procedure/etc. "Look at that! Can I get it too?"
• Government programs such as Medicare and Medicaid do not provide enough money so that patient care can be provided without losing money on it. This was originally started to encourge healthcare organizations to reduce costs, and has failed miserably at doing so. People who have Health Insurance or who can afford to pay for their care are subsidizing the care of those who cannot. This has become an endless loop of spiraling costs and has created much resentment.
• Medicines and Technology are much more expensive. It is my opinion that most of them, if measured in impacts on human life, do not justify their cost. But with a competitive open-market in healthcare, everyone tries to keep up with their competition.
• Healthcare institutions are in a mad frenzy of buying up each other in a struggle for power and dominance. This leaves them with debts that must be paid, usually by gutting services to those who come to them and cutting staff to bare-bones levels.
• Healthcare workers often need care themselves. They are in a production line evironment where there is no time for relationships with their patients and coworkers. They come to look at their patients as objects on a production line, not people to love and care for, much as an assembly line worker looks at the job that they do. Efficiency has triumphed over humanity in many organizations and the resulting alienation from their profession drives many to seek a different career.
• Lastly, there has been a huge change in the attitude of people towards death. Medicine has been selling us for years on the idea that they can make you live a long a productive life, and by implication sweeping away the idea that you die. People simply don't contemplate their lives anymore; even when I read someone's obituary, I never read that some one "died". Instead phrases like "Passed" or "Passed away", or maybe "Left this world" are often used. We have forgotten that death is the other half of life. It can happen anytime, and we have no control over it. It is as natural as breathing. Refusing to think about it means we make choices that hurt us.

I'd like to make it clear that I don't have answers to every problem listed here. Here is the US, healthcare issues are very polarizing to many people. Perhaps because we don't want to think about the fact they we will die too? Or maybe because the "haves" don't understand the impact that denying healthcare to the "have nots" affects the health and well-being of the nation they live in?

I don't know, but one thing is clear to me; Healthcare in the US today is going in all kinds of different directions, but the mission of caring for people has no priority on that list. The companies and organizations involved in healthcare here seem to have forgotten the person who they should care for.

If there is one thing that I would ask of you, dear reader, is that you ponder on the state of the healthcare that you see people receiving. There is no perfect answer to this or any other question, but I'd love to have you take off the blinders of your own opinion and take a look around.

One place where we humans can express Love for each other is helping and comforting the sick and distressed. I think we have been ignoring that fact to our own hurt. What do you think?

Till next time,

Duane