Health Care Themes Explored in Sorrow’s Reward

Utilizing the stories of “The Unit”, the author explores a number of themes related to contemporary health care. A partial list includes:

The importance to patient care of the values and organizational culture of the system in which he/she is receiving their care. In the view of the author, both Canadians and Americans would be benefited by reflecting on the actual values and organizational culture their health care systems demonstrate. At hospital and program levels, it is remarkable how similar Vision and Mission and Values statements sound, and how rarely the organization is genuinely guided by them.

The marked variability in the professionalism of health care providers. Health care providers continue to be held in high esteem by most; however the cracks are beginning to show. In the Globe and Mail, columnist Margaret Wente describes her recent hospitalization, how chaotic it was, and the lack of professionalism of some nurses. The New York Times recently highlighted the change in the practice of Psychiatry, contemporary psychiatrists admitting that it is more efficient to prescribe drugs than to talk with patients. The Internet is aglow with the remarks of bloggers and micro-bloggers related to lack of professionalism.

Related to the above, many describe lack of patient education and poor communication with patients as being major issues that reduce quality of care. Increasingly, patients are turning to the Internet for education related to their disease; unfortunately, information provided there is often both unscientific and entrepreneurial. Some information provided to patients with chronic diseases has been developed by pharmaceutical or other health companies, and is a form of marketing.

The issue of patient accountability is highlighted in this book. Patient accountability is a key determinant of quality care for patients with chronic diseases, but faces many barriers.

If patients, particularly those with chronic diseases, were more accountable themselves, they would demand a more accountable health care system. As it is, patients reside at the bottom of the health care hierarchy; politicians are at the top. This issue is highlighted throughout the book.

Many issues related to quality of clinical care are highlighted in the book. For example, it is not rare for hospital review processes related to physician practice to be weak, with resultant weak physician accountability. There are media reports almost weekly related to the tragic consequences of poor physician review processes. In the system, physicians are a special group; Medicaste, I call it. The book also highlights quality of care issues related to such diverse matters as lack of standardized care, inordinate pressure on administrators and, importantly, lack of focus on disease prevention as opposed to disease treatment. (e.g. see recent Globe & Mail article: Northumberland Hospital CEO balances budget by canceling diabetes complications prevention clinic).

The book, in a number of ways, touches upon the role of health care industries, most notably pharmaceutical companies, in influencing care patterns. Matters related to performance of clinical trials by such companies are also highlighted, including the unethical conduct of such trials in developing countries. This matter has just recently surfaced in the U.S. Congress; a disproportionate number of clinical trials are being conducted in developing countries, with much less stringent documentation.

The death rate amongst the dialysis population is high, permitting the author to explore our society’s attitudes toward death and end-of-life care. It is an important topic. When the U.S. President recently tried to facilitate better end-of-life care by introducing various health care reform measures, he was accused of favouring “death panels”.