Regional
(2008-07-14)
Listen Now:
GREELEY, CO
(KUNC) -
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The serenity prayer challenges us to know the difference between the things that we have the power to change and the things we cannot. KUNC commentator Dr. Marc Ringel has found some parallels between the prayer and his job.
One of the tough things about being a doctor is knowing where my job ends. If I take seriously my duty to alleviate suffering, should I offer: a ride to a patient who otherwise could not get to a specialist for an appointment? money to buy drugs that I've prescribed to someone who can't afford them? a place to stay if my patient is homeless?
The answer to all of the above, at least for me, is no. There have to be some boundaries between my personal life and my professional life. Everyone in a service profession, with the possible exception of Mother Teresa, has had to draw the line somewhere. But it's tough. Assuming you keep your compassion intact, people whom you could help if you just had the resources, are always a challenge, both practically and emotionally.
When the revolution in healthcare finally happens and every American does have insurance and maybe even access to pretty good care, we physicians will still bump up against the limitations of our positions, no matter how great the resources we command from the apex of the healthcare pyramid. Too much of health and illness will always depend on social and economic conditions that are beyond our reach.
An article published last year in the Journal of Hospital Medicine underscores the limits of medical practice. The study examined factors related to hospital readmission.
If everything is done right during a hospital stay and then all discharge medications and follow-up appointments and instructions are on the mark, the reasoning goes that a patient should be able to stay out of the hospital for a reasonable period of time. Readmission rate is one of the prime measures of the quality of inpatient care. One in four patients lands back in the hospital within ninety days. Quality gurus have claimed that poorly-executed discharges are the predominant reason for readmission.
For this project the scientists interviewed twenty-one patients at Boston Medical Center who had been re-admitted within six months of a prior discharge. The authors of the study found that quality of discharge planning had little to do with winding up back in the hospital. For the most part these patients, when they came back and were readmitted, could list the medications and repeat the instructions they'd received on discharge, all of which were appropriate.
It was social factors, mostly related to poverty, that put the patients back in hospital beds. For example, poor single mothers may have been told to rest after a delivery, but there was nobody there to take care of the other kids. Poor diabetics and alcoholics may have been instructed to change their eating and drinking habits, but, given the situations they lived in, the chances that they would or could follow through with such recommendations were slim to none.
So, what are a hospital and doctor and everybody else to do? Certainly, let's not abandon the drive to rebuild our healthcare non-system into an institution that really does serve everybody. We also should keep in mind our overall responsibility as citizens to work for a just society. This season we can start by figuring out which political candidates are most likely to address poverty, the root cause of so much suffering, including ill-health, then work for and vote for these candidates.
Still, of course, it never hurts to keep the Serenity Prayer in mind.
© Copyright 2012, KUNC
