What the system needs now

By Mark Jaben

In an earlier column, I discussed whether cutting costs should be the underlying motive for our health care system. Unfortunately, there is something even more fundamental that has been cut along the way.


Business tries to control costs by attempting to fix its expenses. This enables a business to predict what revenues and resources it needs to cover these costs and turn a profit. Health care has done the same in an attempt to fix the cost of the professional. A professional is someone who brings a certain attitude to their work. Professionals apply themselves to the task at hand for the sake of their commitment. We don’t expect our caregivers to just show up to work; you expect them to give a little more when they care for you.

But when you treat someone like a commodity, they will respond like a commodity. For instance, guaranteeing specialty care backup in the emergency department is a struggle in many hospitals. In the past doctors took call because this was their professional and community responsibility. Now fewer are willing to endure the late hours, increased malpractice risk, and poor reimbursement that come with this service. When the cost of doing business is greater than the profit to be realized, you get out of the business. Many hospitals now find themselves having to pay doctors to be on call. They are just playing by the rules. Whether you are rich or poor, insured or not, makes no difference any more if you show up to the local emergency department with a badly broken limb and there is no orthopedic coverage. You have to go elsewhere, if there is even an elsewhere to go.

What we have inadvertently lost in our health care system is caring and compassion. Caring and compassion cannot be reduced to a step in the production line. We must realize that those who provide care are not commodities whose cost must be controlled for success. These are people, working in a very difficult environment. It takes people giving of themselves; it takes the time to understand; it takes the time to talk.

Caring and compassion cannot be just turned on and off like a light switch. LIke virtuoso artists and professional athletes, the performance of our caregivers must be nurtured and supported. Successful business executives in the 21st century have figured out that the key people in one’s business must be valued. They know that to attract and retain these key people takes a commitment to provide the necessary resources. Of course, pay is important, but I have yet to meet one nurse or doctor who wouldn’t gladly flock to work in a place that supports their goal of providing excellent care, that creates an environment where the people can concentrate on their goal of helping those in need, that fosters the energy to do the work excellently. Health care administrators who embrace this modern concept will have no problem with the nursing shortage or the doctor shortage or providing the capacity to handle the load. If well supported, the caregivers will deliver on the caring and compassion we need to make health care successful.

Free enterprise has no vocabulary for caring and compassion. Our system must somehow find a way to value caring and compassion, not just assume that it will happen on demand. When caring and compassion appear as a line item on the balance sheet, we might actually realize the potential in our health system.

Interestingly, we may have a model for this. Next time, we will explore whether this model can be applied to healthcare.

(Mark Jaben is a doctor for Haywood Emergency Physicians. He can be reached at jabenmm.aol.com.)

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