Once upon a time, health care was all about healing. It was driven by compassion, faith, and science that combined to meet patients' emotional, spiritual, and physical needs. Hospitals frequently were governed by clergy who focused on mission, not margin...
John Leifer recently drew the attention of the loss of Catholic Health Care in Kansas City as the last bastions of non-profit hospitalization are being sold to for-profit organizations, which are concentrating more and more health institutions into fewer hands. In this Midwestern city, four Catholic hospitals are being sold out as they’ve become too expensive to operate for the Sisters of Charity and Ascension Healthcare.
What Leifer omits to mention is the loss of religious vocations and therefore of highly competent sister-nurses who cost the hospitals only food and shelter. Not all that long ago, Catholic hospitals like St. Mary’s in Kansas City were staffed with women religious.
Leifer, who spent his life working with hospitals of all types, "rued the day when the spirit of caring was sacrificed to purely secular care." Writing in 1998, Leifer worried about the direction health care was heading and issued a challenge to the industry (published by the American Hospital Association):
Once upon a time, health care was all about healing. It was driven by compassion, faith, and science that combined to meet patients' emotional, spiritual, and physical needs. Hospitals frequently were governed by clergy who focused on mission, not margin—and who wouldn't dare think of wearing pinstripe suits. These institutions had a palpable spirit of caring. The field possessed a gentility and grace; it was a time when healing was still viewed as a sacred art.
Today, the industry is moving like a runaway train on a collision course with the profane. There is neither the time nor the inclination to indulge the sacred elements of care. The once-hallowed doctor/patient relationship has been reduced to mere sound bites exchanged during hurried office visits, and therapeutic words of empathy have been replaced with Prozac scrips… Nurses are overworked and patients are undercared for. The only thing that glistens in our modern health care system is its dazzling technology.
Of course it shines. Our hospitals have become altars to the twin gods of technology and science… The relationship between medicine and science may have delivered us from untold suffering, but like any Faustian bargain, it did so at a price. Scientific advances have led to medical reductionism—a tendency to view the patient as little more than the sum of physiological processes. This conviction reduces patients' emotions to mere neurochemical events and holds that the soul is an illusion, in reality nothing more than an electrochemical phenomenon. Hence, a patient is not to be ministered to—a patient's condition is to be cured.
Thanks to science, cure is the only option. God forbid we talk about death. It's not natural, or so the myth goes. After all, death is the failure of science. Hence, heroic measures are used by providers to sustain terminally ill patients--often at great cost to patients' illusory souls. And though the hospice movement has grown dramatically in the past 30 years, most patients still die in hospitals as their doctors engage in a pitched battle against the inevitable.
It's clear that science and technology have exacted a toll on our psyche and soul in exchange for a few more minutes of life. Just as important, they have taken a toll on our pocketbook… Health care has not always been a trillion-dollar industry representing more than 15 percent of our gross domestic product. Hospitals and doctors are both to blame for this inflation. Hospital costs rose from $28 billion in 1970 to $350 billion in 1995, a 1,250 percent increase. Physician services rose from $13.6 billion to $201 billion, a 1,500 percent increase.
The time has come for a resurrection. For health care to undergo such a renewal, a number of things must change, beginning with our definition of healing. If we remove our scientific blinders, however, and begin to view patients as having physical, spiritual, and emotional 'bodies,' then we're forced to view the art of healing in a much broader context. Compassion becomes an essential medicine, and time is allocated for kind words of encouragement. The modification of our lexicon needs to include a redefinition of death, making it an accepted part of the life process. Thirty years ago, Elisabeth Kubler-Ross sought to teach us that death was not to be feared, but ultimately to be embraced as the final stage of life. Our goal as healers is not to prevent death at any cost, but—to paraphrase Ira Byock—to help the dying to die well… A person's passing is then marked by dignity, not horrific pain and nearly insurmountable medical bills."
Fifteen years after this article, Leifer takes up his pen once again and adds two comments from Arnold Relman in his book A Second Opinion:
One careful study in 2002 reviewed all the available published data for U.S. private for-profit and not-for-profit hospitals, pooled the results, and found that the risk of patient death was 2 percent higher in the for-profit hospitals…
An interesting report in 1999 compared Medicare spending in geographic areas in which all acute-care hospitals were for-profit with spending in areas in which all the hospitals were not-for-profit. Adjusted mean per capita Medicare spending on inpatient care, as well as total spending, was much higher in the for-profit area."
Leifer finishes with a blunt statement by George Lundgren, editor of the Journal of American Medicine:
The profession of medicine has been bought out by business, and unless physicians take it back, it will devolve into a business technology in which faceless patients will be treated by faceless technicians."
To these caveats we should add the recent threats coming from ObamaCare, which attacks all medical professionals, doctors and nurses, as well as the patients. And, last but not least, there is also the threat of a successful legislation on the so-called "Reproductive Health Care Act," in Governor Cuomo’s New York State which aims to raise abortion to a "fundamental right." This bill ensures "that abortion is treated as a matter of women’s health, not as a matter of criminal law." Brave New World, indeed!