(119) Health Care: Compassionate Apostolate or Impersonal Business?........Revisited Thirty Years Later

AMDG

     Below is an article of mine published in the September 1, 1983 issue of Crisis Magazine (click on http://www.crisismagazine.com/1983/health-care-compassionate-apostolate-or-business).  Today 30 years later, is this article still relevant?  How much have things changed since then in regard to total healing or wholistic medicine, tender loving care, etc.?  Will the coercive "Affordable Health Care Act", commonly known as Obamacare, make health care and medical insurance even more bureaucratic, more impersonal, and less compassionate while forcing Catholic institutions to violate basic Church teaching?  In other words, is the crisis at least manageable now or getting worse?

    Since then, I have been a Eucharistic Minister to the sick for the last few years and in 2009 had a hand in starting up and running a free clinic for the uninsured of Gallia County, Ohio (see my blogs # 90 and 91 (Click on http://paulrsebastianphd.blogspot.com/2012/08/french-five-hundred-free-clinic.html). 

 

     Before Health Insurance and After. Historically (prior to 1960 or so), many hospitals were founded and run by nuns to serve the people, especially the poor.  Many others were not-for-profit to serve the community, doing a lot of charity work and keeping their prices low.  Doctors made house calls, lived modestly, and charged modestly because they knew that many patients could not pay much.  True, the cost of medical school was much less, malpractice lawsuits were rare, technology was in the beginning stages, and medicine was less advanced.  Nursing homes were almost unheard of.  Families took care of their own.  There were homes for the aged and longevity was much less. 

       With the advent of health insurance, Medicare, and Medicaid, a new industry came into being…….for profit and non-profit Nursing Homes began to proliferate throughout our society.  Medicaid will cover long term care in a nursing home after the patient’s assets are depleted and no longer has any assets.  But that requirement is often met if the patient turns over his/her assets to his/her children and sometimes all assets are not declared.

       

         Once company health insurance benefits became common in the late 1960s, prices ballooned and are continuing to do so.  My own mother, a dentist who graduated during the Great Depression, could not bear to charge the going rate to the people of her town.  Until the day she died in 2006 at the age of 97, she lamented the prices that today's dentists charge.  But once the local steel mill of U.S. Steel Corporation introduced health insurance, she also charged the going rate which shot up even more.

      Today, the United States has the most expensive medical care in the world.  Health insurance premiums are by far the highest personnel cost after the salary itself and will often wipe out the profits of a small business that provides it.  Some companies, especially small businesses, prefer to pay overtime rather than hire another person or hire part-time help to avoid the payment of additional health insurance.  This is certainly counterproductive for the economy as a whole, causing greater unemployment in the former case and underemployment in the latter. 

 

        The cost of health insurance for an individual or family is often unaffordable and being without health insurance exposes one to bankruptcy if a catastrophic illness or accident should occur.  The for-profit health insurance industry has layers of administration and marketing that further increase the cost. A health insurance company has specialists who determine whether a procedure is covered and whether there is a preexisting condition that would not be covered.  Other specialists contest charges, put pressure on hospitals to charge less, and negotiate lower payments. 

 

Thus, as reported by the Associated Press on June 25, an uninsured patient often must pay more than an insurance company would pay for the same treatment.  In one case a patient was billed $79,000 for a hip replacement, but finally his health insurance company settled it by paying $44,000.  According to one doctor, many insurance companies use Medicare payments as a starting point (80% of billing or what Medicare determines to be standard).  According to one community non-profit medical center financial VP, the hospital typically has to settle for 40% of billing with Medicare patients (Medicaid is about half that) while commercial insurers typically pay about 70% of billing.  

 At the same time, many hospitals and clinics typically give the uninsured cash paying patient a 30% discount which would then be roughly equivalent to what an insurer would pay.  This conforms to the recommendation of the American Hospital Association. 

 

Some patients travel to foreign countries for treatment.  My wife did that for some expensive dental work.  According to a National Public Radio report, an insurance company’s refusal to cover a hip replacement forced one person to obtain the same quality hip replacement in Belgium for $13,660 including plane fare and rehab instead of staying home and paying from $100,000 to as much as $130,000 depending upon the provider.  The price is often determined by whatever the market will bear to maximize profits.  Joint manufacturers will often ask hospitals to keep the terms of the deal in confidence which violates the transparency essential for our free enterprise system to work as it is supposed to. 

 

       Unnecessary procedures, tests, and medicines are often given to patients, thus driving up medical costs.  It can be due to the profit motive.  More often it’s a PYA mentality to protect the doctor against malpractice lawsuits, just in case, just to be sure, etc. even if the probability of need is minimal or remote.  The frequent overuse of antibiotics is producing strains of bacteria that are immune to certain antibiotics.  As long as they are insured, people tend to be somewhat indifferent to medical costs unless there is a high copay and will more likely opt for an unnecessary treatment.

 

       In fairness we should understand that doctors must pay inordinate five and even six figure premiums for malpractice insurance in our litigation happy society because of huge settlements…….it may be $40,000 for a pediatrician, $100,000 for an obstetrician, and even more for some surgeons.  We end up paying it in higher medical bills and/or health insurance premiums.  Doctors complain about the inordinate amount of time they must spend filling health insurance, Medicare, and Medicaid forms as well as required charts.  Some doctors must do some of this paperwork at home after a long day of seeing as many as 60 patients in a community clinic in assembly line fashion.  Bus drivers and pilots can only be on the job for so many hours in order to avoid serious errors due to stress and fatigue.  Shouldn’t there be similar requirements for doctors and interns who also have lives in their hands?  In disgust more than one doctor has abandoned his/her profession and some say it will be worse once Obamacare is fully implemented.  

        Overall, a doctor only receives about 5 to 20% of what the patient is billed after expenses for the receptionist, secretary, nurses, technicians, overhead, charity work, malpractice insurance, etc. are deducted.  The cost of medical education has also increased greatly and young doctors have enormous loans to pay back.  At the same time, some doctors prefer to have an affluent life style now and invest now, preferring to take years to pay off low interest government subsidized loans.

      Whatever happened to the original Hippocratic Oath?   One of the points of the translation from the ancient Greek clearly states:  “I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art” (Bulletin of the History of Medicine. no. 1 1943 or click on  http://www.pbs.org/wgbh/nova/doctors/oath_classical.html).  Despite being pre-Christian, this ancient wisdom is timeless, an application of the Natural Law.  Perhaps the Holy Spirit had something to do with it.  At one time all medical school graduates took this oath. 

         Of course in liberal circles, the oath has been “modernized” (watered down), with parts omitted and ignored as seen at http://www.pbs.org/wgbh/nova/doctors/oath_modern.html.  Many medical schools no longer require the Hippocratic Oath to be taken by its graduates.

       Now we are coping with the evils of the abortion industry and abortifacients (the pill) in the pharmaceutical industry.  There is a body of evidence that shows a link between abortion and breast cancer (www.abortionbreastcancer.com)‎ and a similar link between the pill and breast cancer (http://www.lifeissues.net/writers/kah/kah_19breastcancerpill.html).  The pro-abortion camp either ignores it, denies it, or criticizes this research as being flawed, a typical way of “poopooing” research that contradicts one’s beliefs.  The ideal of dispassionate objectivity taught to PhD students to draw conclusions that may contradict previous beliefs or political correctness goes by the boards.  Even some Catholic physicians are unaware of this research. The same thing occurred with the link between smoking and lung cancer until the research evidence became overwhelming.

         Euthanasia (so called “mercy killing”) or patient assisted suicide are becoming more and more accepted.  The latter is being legalized by one state after another.  There is a danger that euthanasia  will be common in order to cut costs and keep Medicaid afloat which will be greatly expanded under the so called "Affordable Health Care Act" (Obamacare).  Will “death panels” become common in hospitals to determine whether the patient is now a burden upon society and no longer has a sufficient quality of life worth living?

 

       In Holland the elderly often fear going to the hospital because doctors commonly solve the problem by giving the patient a lethal dose.  Since euthanasia is legal there, Holland has the highest rate in the world.  Twenty years down the road, can the people of the United States expect a similar culture of death if committees have the power to refuse treatment or even euthanize because “quality of life is gone” and the hospital does not have the resources, the patient cannot afford it,  or treatment would be too expensive?  We are already well on our way to a culture of death. 

        Playing God.  A caregiver I know placed her 102 year old friend in the hospital to help him.  Since he was that old and dying, they didn’t even bother to give him palliative care…….no food or care to speak of for five days, a clear case of neglect.  His assigned doctor merely peeked into the room and went on her way…….leaving her patient to die.  Regardless of age or condition an admitted patient deserves at least palliative care (intravenous food and water along with comfort care) according to his dignity as a human being.  After all, the hospital charged the same for his stay as anybody else.

       In another case a hospital refused to give an unconscious patient a life-saving feeding tube because his daughter previously never thought of asking her father to give her power of attorney to take responsibility. Later she complained, “The hospital killed my father”.  Bureaucratic rules sometimes take precedence over life.
 

       One doctor I interviewed was not surprised about these two incidents in our culture of death, commenting that it is starting to become common for doctors to play God and unilaterally determine that it is not worth aggressively treating a patient whose quality of life is deficient by his standards.  His/her professor in medical school taught this sort of thing as good practice.  S/he had to threaten to report his/her professor/supervisor, who preferred to let the patient die instead of informing the patient’s wife regarding options that could help him recover.  The next of kin should make that decision with the doctor or follow any living will left by the patient. 

 

        Of course, the Church does not require extraordinary measures that would only prolong suffering when the patient is terminal and close to death.  But even then the Church teaches that palliative care should always be given……intravenous food and water as well as comfort care.  Do medical doctors really know whether the comatose patient suffers when intravenous feeding is withdrawn as in the infamous case of Sarah Palin?

        Spiritualizing Suffering.  Patients who can spiritualize their sufferings, see meaning in it, and have faith in God do better.  Some doctors and nurses pray with their patients when they have the freedom to do so.  In many if not most hospitals, a nurse can do so as long as the patient desires prayer and it is not imposed.  In other places a nurse who prays with her patients is risking her job.  That’s sad!  Perhaps the nurse could at least whisper in the patient’s ear, saying something like “You know, you can be extremely valuable just by uniting your cross with the Lord’s cross and offer it up as a dynamic prayer for the Church, the missions, a better world, and for your loved ones”.  If the patient is Catholic, she can add “for the poor souls in purgatory”.  “All this can make a saint out of you.”  If the patient is receptive, the nurse can do more.  If not receptive, then back off.

          Considerable research does show that patients, who spiritualize suffering, do better.  Click on: http://www.recoveryconnections.ca/understanding-the-healing-power-of-prayers.html

http://www.webmd.com/balance/features/can-prayer-heal

http://health.howstuffworks.com/wellness/natural-medicine/alternative/prayer-healing.htm

           God permits suffering for a reason.  Soon to be St. John Paul II was aware of this and insisted upon being Pontiff until the end in order to teach us how to suffer.  During his recovery from the assassination attempt in 1981, he was inspired to write an Apostolic Letter on the Theology of Suffering on February 11, 1984.  That is “Salvifici Doloris: On the Christian Meaning of Human Suffering” (click on

 http://www.vatican.va/holy_father/john_paul_ii/apost_letters/documents/hf_jp-ii_apl_11021984_salvifici-doloris_en.html).

         The practice of euthanasia and patient assisted suicide do not consider that the patient with an apparently diminished quality of life still has a tremendous value and dignity, created by God in His image and likeness.  Who knows how God uses that time to help the patient grow spiritually and prepare him/her for eternity? The time can also be productively used to help others by being an inspiration to family and friends and by offering one’s suffering for the Church, the missions, a better world, and for his/her loved ones.  Suffering, an inevitable part of the human condition,  endured in a positive way, can make a person a saint.  Every canonized saint without exception has had to suffer. 

           Crucial is TLC, which is often missing……Tender Loving Care or LOVE in recovery.  It can be decisive in healing.  All health professionals including administrators must aspire to follow in the footsteps of the Great Healer even though health care is full of technology and the harried nurse is under pressure to take care of so many patients.  At the same time, TLC helps the caregiver to grow spiritually and in virtue.  Mother Theresa once said that when binding the wounds of a poor dying person in the streets, she feels as though she is “binding the wounds of Christ Himself”.  That person would die knowing that s/he is loved and somebody cares.

  

HEALTH CARE: COMPASSIONATE APOSTOLATE OR BUSINESS?

by Paul R. Sebastian (Crisis Magazine; September 1, 1983)

       Who receives better care, an American in a hospital in the U.S. or a poor Indian in a mission clinic in the jungles or high Andes of Peru?

       Patients in American hospitals are exposed to the most advanced medical technology, modern analytical laboratories, computerization, all the comforts possible, a big impersonal administrative bureaucracy, of tubes, wires, and dials that may terrify more than soothe.

       A poor Indian in a mission clinic will get none of these, but he does receive a lot of love, care, concern, understanding, compassion, and kind individual attention. At times, these qualities have a more healing power than the highly trained specialist and the miracle drugs since they give the will to live and meaning to life.

      The patient feels valued and loved; the mental state is critical in relation to recovery. Thus, the patient’s family and friends can participate in the healing process which involves body, mind, and soul as technology, nature, psychology and theology meet. One doctor referred to this as TLC or tender loving care. Often these intangibles make the difference between life and death, compensating for many shortcomings of the mission clinic which has little, but ingeniously makes the most of what it has.

       The missionary doctor arid nurse see themselves as collaborating with the Great Healer and following in His footsteps. They consider it a privilege to serve. They not only love, but communicate Christian love through touch, sympathetic listening, an affectionate word, kind attention, gentle care, a nice smile, sincere concern, and greeting the patient by name in a friendly manner.

        They believe that poor Indian is much more than another case, another statistic, or a few more holes in an IBM card, but a person with Christ in him created to God’s image. No wonder Mother Teresa could say, “When I clean the wounds of an abandoned dying person, I feel as though I am cleaning the wounds of Christ himself.” She certainly can teach our mercantilistic medical professionals a few things about health care.

       We cannot expect our doctors and nurses to be dedicated selfless saints. But we can hope that they have something of the spirit of the missionary. Money can still be an important motivation, while human service and personal commitment are the predominant considerations. Then health care becomes an apostolate. If money has to be number one, can service be at least a close second?

         Some health workers border on the cynical. A most competent specialist candidly admitted, “I became a doctor because I like it and want a high life style.” To serve and to relieve suffering were not important to him. According to a survey at Loyola of Chicago in 1957, 100% of the premed students chose medicine for the money.

         What happened to the Hippocratic Oath and the Promise of Florence Nightingale? What happened to the traditional ideals of the young doctor just out of medical school? Does a student studying medicine today aspire to relieve human suffering and serve mankind or to be a millionaire by the age of 40?

       Should hospitals simply become impersonal machine shops or instrumentation labs to fix damaged organs? Social work and medicine are dehumanized when there is a mentality of giving without love and care without compassion. This mercantilistic mechanization of health care — among the noblest of professions — reduces the doctor to a technician, as the cost of medical care goes into orbit. The situation would be even worse were it not for the volunteers and the dedicated few who do perceive their professions as a healing apostolate.

           Medicare is being milked to its destruction, killing the goose that lays the golden eggs. Once a doctor realizes the patient has health insurance, his fees increase 20% or more. One hospitalized patient had blurred vision due to an adverse drug reaction. For a three minute consultation, a few eye drops, the ophthalmologist netted fifty dollars. He can rationalize that the patient isn’t paying. We all pay, through galloping inflation, higher taxes, and exorbitant health insurance premiums.

          Too often carelessness overcomes conscientiousness. Classic is the case of the interchanged oxygen and anesthesia tubes. The mistakes of doctors and nurses often are found in tombs: dead men don’t talk. How much suffering and death find their cause in violations of elementary principles? So what? Nothing will happen. Good enough. There’s no time. It is the little things that make the difference between excellence and mediocrity.

           A few occasionally neglect to wash their hands between patients. To dispense the wrong medicine is inexcusable. When under pressure, a health worker may not pay attention to the complaints of a patient until it is too late. In one case, the patient was bleeding. Some complaints are imaginary, but to the patient the pain and discomfort are real.

          Some degreed nurses consider it beneath their dignity to bathe patients and change bed sheets. Contact with the patient is not only for the practical nurse. No job is too low when one has the privilege of serving. The great value of life should never be forgotten, even after years of seeing the most horrid accidents. Even the most wretched have dignity.

          Medicine must treat the whole person, including his fears, the psychological aspects and, in collaboration with the chaplain, his spiritual welfare. Medicine does not simply treat a defective part of a machine, but an organ that is part of an ingeniously planned system capable of functioning for a century instead of the few years of an auto or machine. The body of course also needs preventive care. Man will never completely understand parts of this system, especially that great unknown frontier, the brain.

         Many a doctor’s office has problems similar to the hospital. One waiting room is so full each patient receives a number, as at a bakery counter. Naturally, the doctor’s work becomes a routine assembly line with only a few minutes to spend with each patient as he prescribes a medicine and sends him on his way. How can he get to know each patient well enough to give integral care and be aware of any psychological influence on his illness?

          Under these conditions there is no way the doctor can maintain top quality care. Here a paramedic, a nurse practitioner, or even better, another doctor, could make the office visit more personal with more time for each patient. When America must import M.D.’s from the Third World, where they are in shortage, obviously more medical schools are needed.

       Communication must be improved between the doctor and the patient together with all the family. Since an operation or serious illness is often a traumatic experience, they deserve a briefing as to what is going on, but the doctor is often “too busy.” If the patient is near death, at least the family should be informed in order to comfort him in his last hours. Then he can die with dignity. Too often the family is taken by surprise with a curt telephone call.

       Is there still a place for the family doctor and the house call? Knowing the family, its problems and medical history could be the key to preventive medicine, keeping people healthy and saving millions of dollars in the process. Health care could again be personal, especially if each family could have access to a neighborhood doctor’s office or clinic.

      In poor inner city areas, a nearby clinic could be staffed by a team of a social worker, nurse, and paramedic supervised by a doctor who would only attend to the more serious cases. Part of their job would be health and nutrition education, immunization campaigns, and preventive medicine, the most important aspect of the health professions. A paramedic or nurse practitioner, supervised by the family doctor, could make house calls that the doctor cannot make.

         According to Dr. Harold Wise in Prevention Magazine, the whole family system must be treated since family problems may make one more vulnerable to disease. “If people feel supported and loved, they seem to heal better. The immune system seems to work better.” Getting the family united “is important for the healing of the family itself.” This is supported by studies of the traditional Japanese culture which emphasizes strong community ties and support of the individual by the people around him. In Peru, the entire family, including relatives, comes to the hospital every day to visit its sick member.

         Certainly we should understand the doctor’s side. A specialist must struggle through the pressure of college, medical school, internship, military service, residency, and continuing education. He must accept physical, mental and economic sacrifice before he finally can get started around the age of 30. He must possess extraordinary dexterity, intellectual ability and emotional stability. Then he must cope with life and death decisions, the risk of an exorbitant malpractice suit, a tight schedule, and other pressures.

          In many public health centers, the case loads increase as the staff size and funds decrease. Senile, neurotic and abusive patients may stretch the endurance and temper of health workers to the breaking point. The public has a tendency to condemn all for the sins of a few, forgetting the dedicated work of the majority. We cannot expect miracle workers. After all, health workers are human with their own personal problems, faults and weaknesses. But some criticism is necessary in order to reconstruct, to locate problems, correct them, make reforms and improve medical care.

          The problems pointed out here are not general but still common enough to merit reflection by every person who has to do with health care. All have great responsibility and every job is important. Every profession has its share of problems, small and large, but with health care lives are at stake. We must all examine our methods, attitudes, preparation, mentality and organization. Human dignity deserves it and compassion demands it. Let’s put love and compassion into health care and make it human, and Christian, again.

The views expressed by the authors and editorial staff are not necessarily the views of

Sophia Institute, Holy Spirit College, or the Thomas More College of Liberal Arts.