Discussions we need to have

On July 23, 2010 Senator Webb wrote an Op Ed Piece for the Wall Street Journal, "Diversity and the Myth of White Privilege" that inspired me to write a Letter to the Editor. I was pleased that it was published today (July 28, 2010) as it provided a different framework for understanding why so many of us do the work that we do.

Senator Webb seems fixated only on slivers of history of his home state of Virginia and not the realities of the nation. He ignores that Spanish settlers were on the continent before Jamestown or Plymouth Rock were settled. But the issue goes beyond who was here first.

What is most damaging about his commentary is that it suggests that the only reason we should help African Americans is because of past injustices; and, that no other community has suffered. There are thousands of incidents from the past and the present that depict a different reality. In health those realities get played out in how patients get information, the decisions we make about treatment, and so much more.

We need to understand our beliefs about others if we are going to get past them and provide quality care to all. To save health care resources you need to provide a patient with the care that is needed and not one which is based on false assumptions.

Field Research 101

It is Valentines’s Day, Chinese New Year, and the beginning of a new decade so there is much to celebrate. Last year was more difficult as those I love spent too much time in hospitals. As I was with them it was an opportunity to watch up close and experience the many facets of our health care system. I found that I had to find the place in myself where I could be calm when all I wanted to do was scream, “Do you hear what the patient is saying?”
It became very clear that the clinical nuances of the individual patient seem to get lost when health care providers focus on their clinical guidelines and not on the specifics of the person in front of them. I watched as very caring and smart providers were rushed and wanted to take the path that was most familiar to them.
Fortunately, on my IPhone I have Epocrates™ and I used it to show how the patient may have a negative response to the medicine they were going to give him. I made the health care provider take extra time and double check. They took the time and checked their system and the medicine was not given.
What would have happened if I had not been there? “Medical Error” may have had another person to claim. Our systems can be brilliant but they can also blunder. The difference between one and the other is usually the act of one human being.
We need health insurance reform for certain. We also need to change the way our health system functions. That would be something we could all celebrate.

The Need for Plain English and Page Limits

Since we are hitting the reset button on health insurance reform, Congress should also commit to voting out a bill of reasonable length and in straight forward language. After all the U.S. Constitution is an eloquent 4,400 words. Surely Congress can commit to writing a health insurance reform bill that is of a length and language that would allow all Americans to understand the bill. The new process should be that at the outset all legislation had to be written in plain English and with a page limit for the document. A maximum length of 50 pages would be read by most. I have been informed by those whom I trust that laws are necessarily long because they have to cite all the other laws that are being changed. My response to that necessity is to add those as footnotes. Having a long document means that it is only read by a limited set of people (i.e. lobbyists). Of greater concern is that the longer the document the more it becomes burdened by special inclusions and carve outs.

The legislation on health insurance reform should be something that we all can read and understand. It should be concise and understandable by those folks who are most clearly impacted by it; that means most of us. To have real insurance reform can be simply put: we all must have it, exclusions or rates based on pre-existing conditions, gender, or age will no longer be allowed, and because we are a responsible society there will be programs to make sure that persons of modest means can buy into a plan. With that said, that leaves 49+ pages for more details.