Health and medicine: overview and contemporary issues

Health and Medicine

Twenty-Five Years of HealthCare

There have been numerous changes in the field of healthcare over the past twenty-five years. Many of these have occurred behind the scenes in areas such as regulation and documentation requirements. Others are obvious, such as advancement in medicines and technology. All have some degree of impact on the delivery of healthcare to the patient. Most have an impact on the cost of healthcare delivery. What area of change has made the greatest difference in the eyes of a long-term healthcare professional and what does the future have in store?

One healthcare professional, a nurse who is currently working as the Director of Nursing in a skilled nursing facility, thinks that the greatest area of change has been in patient education. Her opinion is that "we used to know it all and patients were simply the recipients of our care." She continued to describe the accepted method of treatment while often referring to the hierarchy of physician and nurse to patient. The patient did not, apparently, have much input in their course of treatment. If a person came into the hospital or the nursing facility, the professional team prescribed the plan of treatment and the path it would take. The nurses and physicians decided what types of medications a patient would take without consulting them as to how they felt about them. If a patient was violent, the nurses restrained them. Much of the time, patients were unaware of the course that their treatment would take. Now there is the patient bill of rights, patient advocates, care plan conferences, and the patient has a direct say in their care. It is no longer a case of wondering what the next test is for and why a patient should take a certain pill, but more, how do you want your care to proceed. This change in patient-doctor communication has had the greatest impact in how healthcare professionals treat their patients and perform their jobs over the last twenty-five years.

Some changes are for the better and some are not. While patient-doctor interaction is much better for the patient, it is not always easier for the physician. One nurse made the point that many patients are not aware of the potential side effects of the treatments they might receive. When they become aware then they decide not to move forward. This, explains the nurse, makes some tasks very difficult -- even life threatening. Full disclosure requires that the treatment a patient receives be error-free. If a physician makes an error, he expects to be held accountable. The degree of regulation has increased exponentially over the past 25 years, according to the D.O.N. Regulations have turned the patient from being a victim to the decision maker in most cases. However, some regulations impede the ability of the healthcare provider to care for a patient. More and More hours have to be devoted to paperwork, which means less and less hours in direct patient care and observation. This means the cost of health care continues to rise.

In a two-tiered system, you have health care for the rich and healthcare for the poor. It is the system presently in operation in the United States. Those that can afford it get everything, and those without the funds must be turned away. Those without extensive healthcare benefits or large amounts of money cannot access high tech treatments that are not covered by welfare plans. The issue with the second largest impact in the past twenty-five years appears to be the cost. In 1979 the cost of one day in our nursing facility, say the Office Manager, was thirty-five dollars -- now it is almost two-hundred. That is an increase of over 700%. The D.O.N said that when she worked as an LPN in an inner-city hospital, most of her patients were welfare patients. They had little or no education concerning healthcare. Some could not understand why they needed to be in the hospital, or how to take medications that were prescribed. The system did not provide them with adequate care.

Finally, the health care industry is changing extremely fast. New technology requires ongoing training for healthcare providers. With change being a constant, healthcare workers find themselves under more and more pressure just to "get it right," said the D.O.N. The downside of new technology is the risk to which it exposes the patient. While ongoing training is essential, time and labor is inconsistent. Constant relearning poses a degree of threat to patients. Ongoing training is destabilizing. When a new nurse finds that his or her nursing supervisor knows less than they in terms of procedural change it is difficult to give the best care. The patient experiences decisions they never had to make before and the staff loses continuity. This brings one full-circle to the argument that full-disclosure and patient involvement has been the change that has had the greatest impact on healthcare and how it is delivered.

What is the future of healthcare? The D.O.N. believes that it is full of promise, but not without some drastic changes. She believes that everyone needs equal access. As long as the best doctors can charge the highest fees and money determines the quality of care, then our healthcare system is broken. A person needs to be either very rich or very poor in this country to receive adequate healthcare. In the facility where she works, there is no difference between the residents on Welfare and the privately paying patients. However, the facility does limit the number of welfare recipients it takes. The poor do not have the same choices as the wealthy. This D.O.N. would also like to see a more holistic approach taken, where the whole person is a priority. Specialization is wonderful but sometimes the whole person falls through the cracks, she says.