Did you know that Medicare has parts A to L, each with a different purpose? Did you know that despite being a public hospital, Bellevue still sends a bill to each of its patients? Did you know that 30 million people in this country do not have health insurance? Do you know what the differences are between an HMO, PPO, PSO, and EPO? There is no denying that the US healthcare system is one the of least accessible systems in our country, yet it is still objectively one of the most important. It has been a hot topic in political debates and the news, but I would argue that very few people fully understand these discussions. I am one of the few lucky people to understand the different numbers and acronyms on my health insurance card, but I am by no means an expert. Even my beginner level of proficiency took a college-level class to impart this knowledge, one that is rarely accessible to most of the population.
In all honesty, the woman living in a shelter who was bounced from hospital to hospital needs to know this information more than I do. The man who decided to leave AMA (against medical advice) because he did not want to pay for his care needs to know this more than I do. The elderly gentleman who needs an assisted living home but does not have insurance needs to know this more than I do. I am not discounting the importance of my education, as I think that everyone who wants to go into the healthcare industry needs to know how our healthcare system works.
What about the millions of people who use our healthcare system daily? They have more than just a right to know; they have a right to be educated. I think that health care professionals need to capitalize on their role as educators rather than just providers–teaching patients both when to take their medicine, but also what a co-pay means and how much they are going to get billed for their visit. In reality, however, most physicians know little more than the patients when it comes to our healthcare system. It is seemingly impossible to wade through the layers and layers of bureaucracy, the mountains of paperwork, and the thousands of exceptions to truly understand this system.
How are we supposed to give our healthcare system the facelift it so desperately needs when there is no clear answer? We are stuck in this ever-draining and difficult system of insurance, administration, and government battles all speckled with inefficiencies. Doctors can still treat the patient with high quality medical care and comfort, but the healthcare system and hospital are not set up in a way to benefit the patient.
Watching how the hospital system functions has been one of the hardest things to comprehend this summer, as it does not seem to have the patient’s best interests in mind. I am not discounting the amazing work all of the healthcare providers perform, as the individuals clearly want the best for their patients. In fact, I have met some of the most passionate and empathetic people in this job, and they are the reason I can keep returning to work. But how can I just sit in this hospital and deliver clothes to the man I know I will see shirtless the next day? And when a patient walks in with an infection contracted from their homeless shelter, why is discharging them to same shelter all that the physicians can do?
When I reflect on my experience (which I do a lot), it is not the mysterious sickness or intense trauma that stands out to me; it is the never-ending cycle of abuse from the patients to the hospital and back again. In all honesty, many of these patients know how to work the system. They know what to say to the doctor, they know the rules to qualify for a detox bed, and they know how to ask for the social worker. If this is all the hospital can do for them, they might as well make it part of their routine.
Having been there for over a month now means that I am officially part of their routine, both good and bad. Providing someone with their first hot meal in three days is one of the better moments, even if I know I will see them next week. Treating a patient with benzos (medicine for alcoholism/withdrawal) only to see them intoxicated the next day is one of the worse moments. Our healthcare system is so focused on the short-term it is impossible to see through the presenting symptoms and try to fix the problem at hand. Who is going to spend the time to implement more stable housing initiatives through the hospital when it is so much easier to continue as is?
Again, I do not blame any individual for the way this hospital or this healthcare system is run; it has been built upon years and years of complicated policies and bureaucratic nonsense. But watching how it trickles down all the way to the patients is beyond painful. I am at a point in this internship where I am unsure if I could ever work in a hospital. I am at a point where I feel myself becoming numb to these issues, and that scares me more than anything. At this point, all I can do is continue asking questions, criticizing our systems, and craving answers. You have given me the ammunition to push myself into this system with a critical eye and an open heart, and for that, Bellevue, I thank you.