Leaving the SiCKO world.

Note: There IS a review of the movie in here.

Thirty years ago in May, I graduated with a Bachelor of Science in Nursing from Widener University in Chester, PA. It didn’t take long to realize that my instructors and the WU curriculum had prepared me well for what was happening in American health care. The incredible growth of techology over the past three decades has changed this industry in ways that are unbelievably good and bad. As always, the capacity for harm is greater than the capacity for good can always fix.

The reality for me about nursing was the calling. The conviction of being able to do something to help a person who could not care for themselves, and returning them to the ability to resume caring for themselves. It meant doing the not so pleasant stuff so they could rest instead of using energy to do it. Making sure they were not in pain, nauseous or otherwise too uncomfortable to rest. Watching for the teachable moments and being ready to give the lessons in short, understandable sessions.

The rewards have mostly made up for the lousy pay and benefits. I have gained a deep respect and love for the people I dubbed decades ago as ‘SACs’; Solid American Citizens. They were the vast majority of my patients. They had their bad sides, illness brings that out. In a career spent mostly at the ends of the continuum, Critical Care and Home Care, I have given care in situations that involve close relationships with both patients and families. That is how you find the good that lies in most people and bring it out. I never thought that leaving direct patient care would be possible. That a job that did not involve my stethescope, my assessment, listening, and communication skills, as well as the knowledge base built on the excellent WU foundation, could be worth cutting off the intangible rewards.

It is not likely to. I am leaving because my health has deteriorated drastically from the stress. Because I am ‘an old fashioned nurse’ who knows that if I don’t spend the time listening to the patient and following up on their comments with focused enquiry, I will miss critical information that could be necessary to getting them well. That if I don’t spend time on discharge teaching, they will be back. They will not become independent in managing their acute illness recovery or the progress of a chronic illness.

Instead of doing those things, I spent a lot of time overdoing the safety precautions. Double documenting and trying to figure out where to document some aspect of assessment or care. Doing someone else’s job because the staffing in that department is ridiculously low for the work load. ‘Working around’ the well intentioned and cumbersome processes that can interfere with commonsense care and documentation. And adding 15 to 30 minutes of ‘unapproved overtime’ to my shifts, despite working through countless meals, answering dozens of questions from less experienced, agency and float RNs. I am ‘disorganized’ (Well, there was only one job I was dubbed ‘the sticky queen’ and only one of the boards of directors I served with who specifically commented on my preparation and organization). I have ADD. If employers can’t work with that and can work with the less competent, compassionate, and consciencious, it is time for me to go.

It is a bitter and sorrowful leavetaking. I have done the kind of case management the new job involves and know that it has it’s rewards. I will also continue what one supervisor wrote as the definition of my nursing practice, patient advocacy, in a different field.

Politics.

I had been behind Universal Health Insurance for decades. When WTC II fell, I immediately thought, ‘There goes the money to bring about the change. We will spend it on the millitary and a war.’ The sign I carried in antiwar marches said ‘RN for health care not warfare’. On 3/15/03 I adopted a puppy and named her ‘Shalom’. She has lived up to that name and provided the little peace in my life since.

My daughter Lauren called yesterday afternoon because her copy of Deathly Hallows had not arrived. She had stayed up until 2 am Saturday morning to finish a paper so she could kick back and read the rest of the weekend. (I am not making this up, she does the school/studying stuff the right way. Unlike most of us, epecially her dad, brother and I.) We decided on dinner and SiCKO to mark this transitional milestone in my career.

Having read a fair number of reviews and followed Moore from his emails, I was appalled at the nitpicking of his statistics, representative cases and ‘distorted’ presentation of health care in other countries. Maybe it is an issue of classifying movies. Documentaries are supposed to provide a lot of substantiated facts with less emphasis on the cultural, ethical and psychological issues behind them.

Perhaps we need to redefine the genre as ‘non-fiction’. SiCKO does exactly what was needed to be done to get this country to pay attention to it’s better values and discuss this topic with, this is not an oxymoron, rational emotions. There simply is no justification or rationalization for the United States of America having a health care system on the brink of implosion . The wait times here are worse than many industrialized countries with universal health care. I have waited two months to see specialists for conditions that needed to be treated – the sooner the better. Neither was life threatening immediately. That both went an additional two months added more stress to my life and accelerated the downward spiral of illness.

‘Choice of physicians’ makes me furious. We get a choice of what physicians the insurance company our employer decides to contract with, decides we can have. That’s two decisions away from choice. And it gets worse. If our company switches to a different insurance company, if the insurance company takes our doctor off their approved provider list, or if we change jobs, the choice is: find a new doctor. I have personal experience with this. It is time consuming, expensive and delays appropriate care.

Moore does an excellent job of outlining how we got to our capitalist system while Canada, England and France, not to mention Cuba, got to Universal Health Insurance. These include but are not limited to: the GOP infatuation with the invisible hand of capitalism, the onerous and unreasonable threats of a slippery slide into socialism then communism, and the horrors Madison Avenue and Congress can do with large (virtually intravenous?) infusions of capital from the pharmaceutical and health insurance corporations. The other countries were focused on the real human need for universal health care access, not the bottom line of corporate profits as the significant vital statistic of a viable health care system.

He interweaves this outline with the basic issues of: Do we care about each other? Do we care about the least among us ? We don’t show it very well. Indeed, the imbalance of ME versus WE ideology is impossible to ignore.

“I think; therefore I am” – Descartes
“I am because we are; and since we are, therefore I am” – John Mbiti (African theologian)

There is another message in Moore’s film that American’s need to contemplate very carefully. It is a broad question actually. What is all this capitalistic focus getting us in our standard of living when we consider those ‘priceless’ moments of our lives (other than deeper in debt to MasterCard)? Do we have the time to relish the moments? To make the memories we will be thankful for? Are we healthy enough to pursue happiness and enjoy the time of our lives?

As I watched the section of the film on France, my mind was having a little argument. There was a subjective idea that I became aware of, and my objective brain tried to point out that of course, I would be predisposed to see and think this. Some years ago one of my sisters relayed the story of a friend who had traveled to Paris. On arriving, she started explaining her difficult situation to the French woman at an information booth. When she stopped talking, the woman responded with “Good Morning, welcome to France.” The traveler took a deep breath, relaxed and expanded her focus.

During dessert and conversation afterwards, Lauren brought up exactly what had struck me. The faces and voices of the French in the movie were absent the now standard American stress and anxiety. The people who were interviewed, including American ex-pats, smiled and laughed easily, often and the stress of being interviewed seemed almost non-existent. Being dyslexic, Lauren has spent a good deal of her 22 years studying facial expressions to better understand what people are saying (and not saying). It’s a skill she has honed to a fine degree. One that I have developed in caring for patients who are all too often reluctant to bring up what is bothering them and listening to what they do say to give them support, focus and develop insight into the problem. Bringing it to the attention of physicians, clergy or social workers when indicated.

This country is stressed out, sleep deprived, and flat out unsatisfied with life. We are still convinced that the nicer house, new car, furnishings, clothes, and toys will bring us the elusive happiness and satisfaction. We are getting fatter, sicker and unhappier with every decade that passes. We have fewer friends, spend less time reading and interacting with our children, at church or in community activities. Too many of us have winning the Lotto as our 401 K plan, which won’t matter for those of us who work until we die. That some (or at least George) consider it fantastic that many of us work two or three jobs to make it here is uniquely American irrationality.

Let’s be perfectly clear: stress and illness are two sides of the same coin.

Moore emphasizes both the French guaranteed 5 weeks of vacation AND their turnouts for political demonstrations, without obviously connecting the dots. He tries to make the point that the French government is afraid of the people rather than the people being afraid of the government. I am not so sure about that. How about the French have elected government officials who are willing to listen to them – and they are not afraid or too hopeless to speak their minds to those officials. In France “I am from the Government and I am here to help.” are nine precious and valued words. The French people, and their government, are not sticking their heads in the sand on the issue of population inversion – too few children being born in industrialized countries due to the cost and sacrifices parents have to make. America has only avoided what Europe is confronting due to: illegal immigrants, who we have room for.

There are several points that Moore could not cover in the film that I want to bring into the discussion.

*The payor system for health care in this country is an accounting nightmare. CPAs who work in other businesses and encounter the system – sometimes because of being sick themselves- are generally flabbergasted. The multitudes of private insurance companies are only ONE form of reimbursement the providers have to deal with. The others include:

Medicare
Medicaid
Worker’s Comp
Millitary
PHS/INS
VA
Energy Employees Occupational Injury Compensation Program.
Railroad workers and Postal workers insurance programs.
Private pay
Charity

Note all but three are existing government programs. There is also the ‘no pay’ group – the unrecoverable debt that the providers have to incorporate into the cost of services to those who have a payor source. This especially includes those that use the system for exacerbations or other diagnosis that could have been caught and treated before they were emergent or life threatening. Some have no insurance, others are underinsured or were denied treatment by their insurance companies. (For the record. The PHS and active duty Millitary health care are essential government functions that should not be contracted. Veterans can be offered the opportunity to go to physicians outside the VA for an interim, which would ease the crush of new vets on the system.)

Lauren works for a DME company that specializes in wheel chairs and other equipment for the disabled. There are five (5) billing employees for every specialist who evaluates the clients and orders equipment.

**Long overdue and still getting inadequate funding from the federal government: a standardized, electronic Personal Health Record (PHR). Many private companies, organizations and universities are working on this, but final coordination is up to Uncle Sam. The electronic PHR system would save:
1) Millions of hours of caregiver time at admission.
2) Millions of dollars in unnecessary tests, either repeated or inappropriate.
3) Missed diagnoses, wasting inappropriate treatment and delaying proper intervention.

***Our focus on technology needs a large reality check. There is art to medicine as well as science. Sometimes low tech trumps high tech – at a fraction of the cost. We need to have more leeway for physicians to use these alternatives. Not unnecessary or overly objective rationing. More reasoning and development of other ways to rule out a diagnosis short of expensive testing. Coupled with more consumer education on what information various tests (MRI, CT scans, etc.) can and cannot provide to make a diagnosis.

SiCKO is a far better film than any review I have read has indicated. It truly needs to be widely seen and used to get this discussion out of the rut it has been dug into for decades.

There is no way to express my deep appreciation to the many patients who provided the wonderful learning experiences, opportunities to care, help and be told that I made a difference, over three decades. I remember some very clearly and will always carry the sense of having achieved my goals in the wonderful world of direct patient care.

Maybe we will meet again in the fight for Universal Health Care in America.

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3 Responses to Leaving the SiCKO world.

  1. Ginny

    Thanks for this great review of Sicko. I hadn’t had much desire to see it yet, although I know I should. May have to wait until the DVD comes out though… I’m continuing my leave as it is for a while longer… because I realized while on my mini-vacation of sorts that I don’t take enough time for me and being over-worked it’s time to take care of me. I may not live in France, but being self-employed shouldn’t mean I can’t take time off.

  2. Darrell Prows says:

    I very seldom see movies, and I’ve never watched anything by Moore. I’m curious about this but will be surprised if I end up going.

    The reviews are not all as well done as this one, but I have no doubt that Sicko is an excellent piece of work. For things like this, though, I usually judge merit on the basis of those who hate it, rather than those who approve. Judging from that, this is a world beater, and hospitals are probably filling up with apoplectic right wingers.

  3. Here’s a couple of Sicko related links I ran across. The first is blog post on MSNBC from the perspective of some one like myself – self-employed and uninsured:
    http://yourbiz.msnbc.msn.com/archive/2007/07/23/284892.aspx

    The 2nd link is Michael Moore on Hardball:
    http://hardblogger.msnbc.msn.com/archive/2007/07/23/286052.aspx