Suzanne Gordon; Author, Lecturer and Patient Advocate

The other day I was talking to a woman in the neighborhood and we got on the subject of national health care — or what she automatically dubbed “socialized medicine.”  All those people in Europe, Canada, Australia — pretty much every other industrialized country in the world — are in trouble she said because she was certain they all had to wait unconscionably long times to get to see a primary care doc or specialist.  Here, in the US, however, there are no waits.  You’ve got coverage, you’ve got a doc, when you need him or her.

What planet, I wondered, does this woman — and so many other Americans like her — live on?  No waits in the US?  For whom, Warren Buffet (I’ll get to him on another posting).  Bill Gates?  People who can afford to pay $2000 to $25,000 for concierge care and instant access to their doctor?  Well for the rest of us insured Americans, even well insured Americans, there are waits and very long ones at that.  Let me give you a couple of examples.

A woman in her forties who develops type 1 diabetes.  She was diagnosed by her PCP and he began to treat her.   He prescribed a particular drug.  Nonetheless, he recommended that she see a specialist.  The ones she called could only see her  in four to six months.  Finally, a friend of the family pulled some strings and got her an appointment three weeks later.  And it was a good thing because the PCP was prescribing the wrong med.  If she had continued on this medication  for the six months it would have taken –without string pulling — to see the specialist, could have really hurt her.  Unfortunately, most people don’t have any strings to pull.

I do and it certainly didn’t help me a couple of years ago when I just felt really sick but didn’t know what was wrong.  Thinking I maybe had a UTI, Urinary track infection, I called my PCP and tried to get in to see him.  This was in October and the secretary said maybe he could fit me in in February.  February?  For a UTI?  Couldn’t I just come in and give a urine sample.  I had to fight for that.  Without seeing him at all, they gave me an antibiotic, which didn’t help because five days later when I went to the ER in a hospital in Vermont, I had acute appendicitis which he would have been able to diagnosis by palpating my stomach in the right spot.  But since my appendicitis, like many, didn’t present with lower right quadrant pain, and vomiting, who knew?  I didn’t and therefore didn’t think to press on my right lower abdominal quadrant, which, it happens, was very tender indeed.  I can’t tell you how much it cost me to have surgery in a tiny under-staffed hospital.  The complications still plague me.

A recent article in the Boston Globe enumerated the problem.  In Boston alone the waits for non-urgent appointments for surgeons, dermatologists, OB-GYNs, orthopedic surgeons has grown steadily longer.  Try to get to see an OB and the average wait — and this is for people with good health insurance — is 70 days.  As for primary care docs, well there aren’t enough of them, and it is almost impossible to get to see one.  Here are the facts folks, we actually have fewer doctors per 1000 people than some countries with so-called socialized medicine.  We have way fewer primary care doctors than most other countries and the shortage of primary care docs is getting truly catastrophic. If we had more and they could handle things before they became catastrophic, we wouldn’t need to see speicialists so often.

So please — check out other countries and their wait times before you bemoan the evils of so-called socialized medicine. Yes some do have long wait times.  But in others, things are far better than here.  Several years ago, I had a stomach infection and a colonoscopy to see what might be wrong.  The nurse from the gastroenterologists office called me to tell me that they found a suspicious spot in my gut.  Maybe, at age 57, I had Crohn’s disease, but then again maybe I didn’t.  Freaked out by this I asked a bunch of questions, to which she answered, ” I don’t know, you’ll have to ask the doctor.’  To which I replied, so put me through to him.  No, she said, you’ll have to wait — as in WAIT — for three weeks till your appointment with him.  Needless to say, this was a potentially devastating diagnosis.  Terrified I called a good friend who is a nurse in Australia.  Yes, I woke her up in the middle of the night.  She was horrified.  “You mean the doctor didn’t tell you this in person?” she asked.  “A nurse who couldn’t answer you questions told you this?  You have to wait three weeks to talk to him?”  She was incredulous.  “That would never happen here. You’d be in his office the next day and he would give you the results and talk you through them.”

Hello, It seems apt as Nurses’ Week is coming to an end to share this interview with you. I did the interview with Rob Fraser, a wonderful new nurse whose got a great website called Nursingideas.ca. Rob does interviews with all kinds of people and he did one with me after I did a workshop on how nurses should tell their stories in Toronto last year at the Registered Nurses Association of Ontario — another great group people all over the world should know about. Nurses’ Week is always a flutter of hearts and angels and other symbols that I think trivialize and sentimentalize nurses’ extraordinarily complex work. Just consider the International Council of Nurses’ choice of a symbol for Nurses’ Week this year — a light bulb with instead of a normal filament inside, a lit up heart. Need one say more. So I hope you enjoy this interview and let me know what you think of it.
Thanks and happy Nurses’ Week and thank you all for the educated brains that guide your educated hearts.

,

So once again, Nurses week rolls around.  Only this Nurses’ Week, I gather things aren’t too great.  I’d love people to write in and tell me if their hospitals have cut back on or completely eliminated Nurses’ Week celebrations because of the economic crisis.  Please post and let me know.  I’d also like to know if hospitals are cutting back on nursing positions, laying people off, or not filling vacancies.  I’ve heard that the nursing shortage of just yesterday has miraculously been solved today.  That hospitals don’t have vacancies or openings.  That they can get plenty of nurses. So what I want to know is, how are things at your place of work?  Is the shortage over and how do we measure that?  By the amount of vacancies a hospital posts?  Or by the amount of work a nurse is asked to shoulder?  Is your workload suddenly more manageable on the floors and in the clinics and in home care?  Do you have loads of help from other nurses because suddenly — no shortage — they have more time and can help you?  Are patient falls, UIT’s CVC line infections decreasing because there’s more nursing care available because, after all , there ’s no shortage?  If you’re a manager, do you have three units to manage or one?  If you’re a manager to you have time to actually learn what’s going on on your unit?  This is how we should measure whether or not  the shortage is over.

I think we need to make a distinction between a shortage of nurses and a shortage of nursing care.  With the former, not enough people want to be nurses and not enough will stay in the workplace delivering direct care.  That means if you want to hire more nurses and provide more nursing care, you can’t because there just aren’t enough bodies with educated brains to do the work.  That’s a shortage of nurses.  A shortage of nursing care, on the other hand, means that hospitals could deem that they have hired sufficient nurses but the reality is that those nurses cannot possibly deliver the high quality care each and every patient deserves.  That’s because there are not enough bodies with enough educated brains to deliver the intensity of care patients with skyrocketing acuity need today.  If you make this distinction, you can easily have a situation in which there is no “shortage of nurses,” but there is a “shortage of nursing care.”

I fear this is precisely the situation we are in today and that this shortage of nursing care will soon produce another shortage of nurses.  Why?  Because the babyboomers are poised to hit the hospital bed big time — with not just one disease but mulitple co-morbidities  Then we have a whole cohort of nurses –babyboomers themselves –poised to retire.  These nurses will stop giving care  and  start needing it themselves.  If, however, nurses are being laid off or cannot get hired, well then, guess what, the word gets out and then people don’t enroll in nursing school.  So then, when the patient demand increases, the older nurses  have retired, and the economy has improved and suddenly hospitals and policy makers and politicians rediscover nurses and nursing, well, we won’t have enough students in the pipeline to produce the nurses we need.

The point here is the society has to begin to understand that there is no faucet whose spigot can be turned on to instantly provide a supply of nurses when we need it and turned off when employers and our society deems, sorry we can’t afford it, we don’t need it.  To produce a compentent nurse — and I mean competent not expert, takes at least six to nine years.  To produce an expert nurse takes more.  Wouldn’t it be nice if just for one nurses’ week we celebrated nurses competence and expertise instead of how sweet and kind and compassionate they are?  Wouldn’t it be nice if just for one Nurses’ Week we demonstrated that we understand that kindness and compassion depend not on the heart but actually on the brain and how educated and experienced it is?