One of the secondary effects of obamacare – along with any government takeover of health care – is the decidedly negative and inhumane bureaucraticization inherent in such gargantuan system. The cliched reference to service in such a system being on the level of a visit to a DMV office run by inhabitants of the film “Brazil” being the end result feared by experienced physicians and patients. The idea that bigger hospitals by nature of having greater resources automatically provide better medical care is a false assumption far too ensconced in the minds of politicians and academics invested in the likes of obamacare. My own experience with the recent loss of my son shows how wrongheaded such ideology is.
Texas is in the midst of setting a new mandatory classification system for NICUs that is tied to reimbursement for caring for premature and sick neonates. In the ongoing deliberations, there is a political faction that has been trying to set up a statewide system that would force critically ill infants to be transferred to a few large academically based hospitals, by making it harder for smaller community hospitals to meet the new statewide requirements, under threat of nonpayment for medical services. The concept being that parents do not care how far their children need to go to get the “best” care, and only large, academic hospitals provide such care. Such ideology may not be a problem in states where people live only an hour away from such large institutions, however in a state the size of Texas, many people live as far as 6 to 8 hours from such facilities. When a family is faced with weeks to months of their child being in an ICU so far away, there are great financial, logistic and emotional burdens to carry. It is not easy to leave your child at such a great distance while having to continue working in your home city or town.
Adding to this, is the lack of compassion seen all too often in large medical facilities trying to care for so many patients. I have worked in hospitals large, medium and small as a physician. There is an almost direct link between the size of a hospital and the propensity to rely on protocol thinking in the delivery of patient care. Protocols are not inherently bad, however the tendency to restrict the practice of the art of medicine, as if individual patients are as interchangeable as machine parts, grows more pronounced as a hospital gets larger. From my almost 2 decades of medical practice, I have seen how the slavish devotion to protocol “cookie cutter” medicine degrades medical treatment through lazy medical thinking.
When I have a patient who is dying despite everything that I try to do to save them, I am honest with their parents, and I stay with them until after their child passes. I make sure to tell them how sorry the nurses and I are that we could not heal their child, and try to help them through the grieving process. We handle each death in a manner that gives the greatest possible compassion for the family, and utmost dignity to their child.
When it became obvious that my son was going to die, the large, academic hospital where he had been on a lung transplant list had the machines, medicines and the protocols to provide his painfree death as we withdrew care. What they absolutely did not have was any sense of human compassion in the process. The attending physician was comfortably at home. In fact, there was no physician, not even a resident, on the floor, much less one who came into the room to speak to us. We had to call the physician at home to request withdrawal of care. The nurse assigned to my son actually told me, knowing that I was a critical care physician, that despite over 6 hours of severe CO2 narcosis in a patient with chronic lung disease on a vent, that we just needed to give him another 12 hours of chemical paralysis (he had already had over 4 hours of such with continued worsening of his blood gasses) to see if he could recover. After he had been taken off the vent as we withdrew care, his heart monitor began alarming as he went into asystole. I turned the monitor off, just as I do when I have a patient dying, since there is no reason to add to a family’s anxiety with noxious alarms as their child is dying. However, in this large academic institution, slavish devotion to protocol-driven medical care led the charge nurse to the highly inappropriate decision to come uncaringly into my son’s room to insist the monitor be turned back on because she had to have 60 seconds of monitor-recorded asystole to pronounce time of death. Her rude, uncompassionate demeanor while arguing with me detracted greatly from my son’s dignity while dying, and showed an unimaginable disregard for our family in our time of grief. Were any doctor or nurse working in my unit ever to display such inhuman callousness, they would be fired on the spot.
I share this story not for the purpose of garnering sympathy, but rather to warn of the danger that such a horrible, uncaring manner of providing so-called care will become the norm if the effort to overcentralize control of medical practice is not stopped. I would not wish my experience on my worst enemy, but that is what the future holds if we do not succeed in halting the misguided effort to turn over control of medicine to large government bureaucratic systems.