:.V
'¦
*V*i"; .I?.'-'iS^- ';^.~^;f ^>2?-:v
Love and common humanity could save health care dollars By Diane Wilson hospital bed across from the patient I was visiting was a 78-year-old woman. She'd had a stroke 4 months previously but was coming along nicely. She dressed and undressed herself, helped the nurse, fetched water for other patients. She didn't really need to be in a general hospital. But she was there, waiting for space in a nursing home. Of her 10 children, only one came to visit. A son. They seemed to spend a lot of time arguing, she saying she didn't really want to go to a nursing home, he telling her she couldn't live with them. There was another patient, a 68year-old woman. She, too, had had a stroke. Two weeks after leaving the ICU she couldn't walk unaided. But her family took her home. And in the 2 weeks, they provided a lot of the care that the hospital just didn't have the resources to give. Not that the nurses didn't try. They were cheerful and kind, when they arIn the
but they had so many patients, rived much to do, that they were 10 to 15 minutes behind on their calls all the time. So in our second example, the family just ensured there was somebody there most of the day; they walked the patient around, fed her, did her hair. The doctor apparently thought it made a lot of difference. The first case I mention probably spent up to 6 months in a hospital or nursing home say 5 months longer than case number 2. But, of course, what members of the family did in case number 2 they did for the love of their mother not to save the gov¬ ernment $5000. That was, to them, incidental. Nevertheless, there are those who read this journal to whom saving $5000 a patient is not incidental; it is very much their business and their duty. If a warm human emotion named love can be mobilized to save money, then it's their business to study this strange phenomenon, maybe even promote it so
R LAWSON TRAVEL A world of difference Offices across Canada.
in association with
BELAIR TRAVEL 1238 CMA JOURNAL/MAY 17, 1975/VOL. 112
little. Even the Toronto convention bureau believes love is good business, according to its advertising. Possibly we should reveal to our health adminis¬ trators the existence of this potentially profitable departure from logic of the human mind. Let's look again at our examples. Our first instance may have been one of those cases where there just wasn't the space or the money to look after the old woman. It's difficult to imagine a family of that size could be com¬ pletely unable to find some way of looking after her but obviously there are cases where a small family cannot find the resources. If a husband and wife are both working, one cannot stay at home to give care. And the province is willing to shell out up to $40 a day anyway to place old, unwanted people in extended care homes. So it's easy for an active couple to rationalize to themselves a situation in which they hand over the old folk to an institution. continued on page 1264 a
INTERNATIONAL DOCTORS IN ALCOHOLICS ANONYMOUS, July 31-Aug. 3, Palm Beach, FL. Info: Dr. Lewis K. Reed, 1950 Volney Rd., Youngtown, OH U511. VII world congress, WORLD FEDERATION OF THE DEAF, July 31-Aug. 8, Washington, DC. Info: WFD. World Congress Housing Bureau, 1129 20th St. NW, Washington, DC 20036.
Annual meeting. CANADIAN CARDIOVASCULAR SOCIETY, Oct. 23-25, Montrdal. Abstracts In English or French (4 copIes) as soon as possible to Secretary, Canadian Cardiovascular Society, 2100 Marlow Ave., Montreal H4A 316.
AMERICAN ORTHOPAEDIC SOCIETY FOR SPORTS MEDICINE, July 27-30, New Orleans, LA. Info: Dr. LeslIe M. Boduar, 328 N Michigan St., South Bend, IN 46601.
CONSUMER VIEWPOINT continued from page 1238 "They'll be happier there," "She'll get proper care there." "There are lots of people her own age there." Never: "We don't want the old pest." Much of this attitude is the result of government welfare that, I believe, has gone too far. There used to be a closeness about families that hardly exists any more. Certainly family circumstances differ, and what would be a burden for some, either from their own selfishness or for more valid reasons, would be welcomed by others. So the public purse finds itself paying out considerable sums of money for extended care, where people need 2 or more hours of nursing care daily. There is no government machinery whereby a family that would like to look after an aged parent, but genuinely cannot afford to, can get assistance. Yet to design a scheme under which a working daughter or son could be enabled to stay at home and give love and care to a sick parent would pay a triple dividend: in money saved to the public purse (because such a subsidy would surely be less than the cost of a home), in greater happiness for the family, and in the promotion of a greater belief in humanity. "But that's not possible," one can
hear the bureaucrats saying. "We have no control over this. People would be getting our money for looking after their own families. They would be untrained as nurses. They might not be getting the proper care... Bureaucratic control? They had it for Hamilton harbour and the Bonaventure refit and all the other host of lesser incidents that auditor general turns up every year. And it's true that abuse of old people is as much a problem in general as child abuse. But adoption agencies for children have long since learned to evaluate those who would give care to the very young (and as yet there's no bureaucratic control over who shall have babies and nurse them). Cannot the skills so learned be applied to the care of old people? Cannot individual people be encouraged to look after old folks - instead of going on welfare, perhaps? There could even be a scheme under which old people can be formally adopted - with some extra financial help given the families in cases where they are bedridden. There are all kinds of possibilities to make life happier for a few people and perhaps save a little public money. What it will take is new, flexible and creative thinking along the lines of common humanity.E
NHS SETTLEMENTS continued from page 1233 to scrap a new contract she proposed at the end of last year and return to negotiations based on the old NHS contract. Now the HCSA is holding a ballot of its members to see what they think. Privately, however, most doctors are saying that the hospital services, with consultants' working up to 70 h weekly, will never return to what they were before. Frankly, the consultants enjoy a normal working week (of about 40 h) and found, too, that they were able to offer their patients (those who were seen) a much higher standard of medical care. So what will be the ultimate outcome of Castle's dangerous clash with the medical profession? Crucial to the issue is the undeniable fact that Castle, backed by the National Health Service trade unions, seems quite determined to ban private practice in National Health Service hospitals. She has persisted with this theme although reminded that her leftwing colleague, the
late Aneurin Bevan (often described as chief architect of the National Health Service), specifically promised doctors that such private practice would be permitted. It was this promise, in fact, which finally persuaded the profession to accept the NHS proposals. Now many doctors are talking about the final state takeover of medicine about which previous opponents of nationalized health care had warned. One group of London hospital consultants said in a recent letter to The Times: "The abolition of private practice is the expressed intention of several members of the present government and many officials of the trade unions which are becoming a dominant power in our country. "It is therefore desirable that all people should realize that the primary responsibility of the full-time doctor employed by the state is not to the patient, but to the state. "Those of us who have served as doctors in the armed services in war and peace have experienced the reality of the conflict of loyalties which this
can cause. If the state is the sole employer of doctors, the strength of their loyalties to the state rather than to their patient must become much more marked. Then, the only alternatives for a doctor refusing to acquiesce to the directives of state officials which conflict with the interests of a patient are, at best, for the doctor to leave medicine or leave the country." The letter's signatories (headed by Dr. John Seale, a consultant at the Middlesex Hospital, London) added that they believed the trend towards state monopoly in medicine must be resisted and accordingly they were setting up a charitable foundation, associated with a clinic or series of clinics, to provide medical services of the highest quality privately. The clinics would be run like the famous Mayo and Cleveland clinics and patients would pay, usually through insurance. "A good medical service at some direct cost is preferable to a poor service which is free," the letter concluded. It was signed by 12 distinguished London teaching hospital consultants.E
Symposium, UNDERWATER PHYSIOLOGY, July 610, San Diego, CA. Info: Secretariat, 6th symposium on underwater physiology, 9650 Rockviiie Pike, Bethesda, MD 20014. BRITISH MEDICAL Leeds, Yorkshire.
ASSOCIATION,
Juiy
6-18,
BIOLOGICAL PHOTOGRAPHIC ASSOCIATION, July 13-19, Scottsdale, AZ. Info: Larry K. Repp, Medical communications, St. Joseph's Hospital, Phoenix, AZ 85013. International congress of CHEMOTHERAPY, July 13, England. Info: Conference services, The Conference centre, 43 Charles St., Mayfair, London, England WiX 7P HEALTH PHYSICS SOCIETY, July 13-17, Buffalo, NY. Info: R.J. Burk, 4211 39th St. NW, Washington, DC 20016. Jubilee congress of MEDICAL ASSOCIATION OF SOUTH AFRICA, July 14-18, Johannesburg. Info: Dr. C. Abrahams, Organizing secretary, P0 Box 10102, Johannesburg, 2000 South Africa. AUDIO-VESTIBULAR SYSTEM AND FACIAL NERVE, July 16-18, Amsterdam, the Netherlands. info: Emmy Jacobius, Academia Books Exhibits, Alexandrastrasse le, D-6200 Wiesbaden, Germany. International symposium, HEPARIN, July 18-19, Europe. Info: V.V. Kakkar, Dept. of surgery, Kings College Hospital. Denmark Hill, London, England SES 8RX. 4th British academic conference In OTOLARYN. GOLOGY, July 20-25, London, England. Info: Andrew Morrison, FRCS, 38 Devonshire St., London, Wi England. VI International congress, PHARMACOLOGY, July 20-25, Helsinki, Finland. INTERNATIONAL SOCIETY ON THROMBOSIS AND HAEMOSTASIS, July 21-26, Paris, France. Info: Dr. J.M. Stengie, National Blood Resource Program, National Heart and Lung Institute, Bethesda, MD 20014. 14th congress of the INTERNATIONAL SOCIETY OF BLOOD TRANSFUSION, July 27-Aug. 1, Helsinki, Finland. Info: 14th congress, ISBT, Kivlhaante 7, SF-00310, Helsinki 31, Finland.
1264 CMA JOURNAL/MAY 17, 1975/VOL. 112
Deadline
'¦
*V*i"; .I?.'-'iS^- ';^.~^;f ^>2?-:v
Love and common humanity could save health care dollars By Diane Wilson hospital bed across from the patient I was visiting was a 78-year-old woman. She'd had a stroke 4 months previously but was coming along nicely. She dressed and undressed herself, helped the nurse, fetched water for other patients. She didn't really need to be in a general hospital. But she was there, waiting for space in a nursing home. Of her 10 children, only one came to visit. A son. They seemed to spend a lot of time arguing, she saying she didn't really want to go to a nursing home, he telling her she couldn't live with them. There was another patient, a 68year-old woman. She, too, had had a stroke. Two weeks after leaving the ICU she couldn't walk unaided. But her family took her home. And in the 2 weeks, they provided a lot of the care that the hospital just didn't have the resources to give. Not that the nurses didn't try. They were cheerful and kind, when they arIn the
but they had so many patients, rived much to do, that they were 10 to 15 minutes behind on their calls all the time. So in our second example, the family just ensured there was somebody there most of the day; they walked the patient around, fed her, did her hair. The doctor apparently thought it made a lot of difference. The first case I mention probably spent up to 6 months in a hospital or nursing home say 5 months longer than case number 2. But, of course, what members of the family did in case number 2 they did for the love of their mother not to save the gov¬ ernment $5000. That was, to them, incidental. Nevertheless, there are those who read this journal to whom saving $5000 a patient is not incidental; it is very much their business and their duty. If a warm human emotion named love can be mobilized to save money, then it's their business to study this strange phenomenon, maybe even promote it so
R LAWSON TRAVEL A world of difference Offices across Canada.
in association with
BELAIR TRAVEL 1238 CMA JOURNAL/MAY 17, 1975/VOL. 112
little. Even the Toronto convention bureau believes love is good business, according to its advertising. Possibly we should reveal to our health adminis¬ trators the existence of this potentially profitable departure from logic of the human mind. Let's look again at our examples. Our first instance may have been one of those cases where there just wasn't the space or the money to look after the old woman. It's difficult to imagine a family of that size could be com¬ pletely unable to find some way of looking after her but obviously there are cases where a small family cannot find the resources. If a husband and wife are both working, one cannot stay at home to give care. And the province is willing to shell out up to $40 a day anyway to place old, unwanted people in extended care homes. So it's easy for an active couple to rationalize to themselves a situation in which they hand over the old folk to an institution. continued on page 1264 a
INTERNATIONAL DOCTORS IN ALCOHOLICS ANONYMOUS, July 31-Aug. 3, Palm Beach, FL. Info: Dr. Lewis K. Reed, 1950 Volney Rd., Youngtown, OH U511. VII world congress, WORLD FEDERATION OF THE DEAF, July 31-Aug. 8, Washington, DC. Info: WFD. World Congress Housing Bureau, 1129 20th St. NW, Washington, DC 20036.
Annual meeting. CANADIAN CARDIOVASCULAR SOCIETY, Oct. 23-25, Montrdal. Abstracts In English or French (4 copIes) as soon as possible to Secretary, Canadian Cardiovascular Society, 2100 Marlow Ave., Montreal H4A 316.
AMERICAN ORTHOPAEDIC SOCIETY FOR SPORTS MEDICINE, July 27-30, New Orleans, LA. Info: Dr. LeslIe M. Boduar, 328 N Michigan St., South Bend, IN 46601.
CONSUMER VIEWPOINT continued from page 1238 "They'll be happier there," "She'll get proper care there." "There are lots of people her own age there." Never: "We don't want the old pest." Much of this attitude is the result of government welfare that, I believe, has gone too far. There used to be a closeness about families that hardly exists any more. Certainly family circumstances differ, and what would be a burden for some, either from their own selfishness or for more valid reasons, would be welcomed by others. So the public purse finds itself paying out considerable sums of money for extended care, where people need 2 or more hours of nursing care daily. There is no government machinery whereby a family that would like to look after an aged parent, but genuinely cannot afford to, can get assistance. Yet to design a scheme under which a working daughter or son could be enabled to stay at home and give love and care to a sick parent would pay a triple dividend: in money saved to the public purse (because such a subsidy would surely be less than the cost of a home), in greater happiness for the family, and in the promotion of a greater belief in humanity. "But that's not possible," one can
hear the bureaucrats saying. "We have no control over this. People would be getting our money for looking after their own families. They would be untrained as nurses. They might not be getting the proper care... Bureaucratic control? They had it for Hamilton harbour and the Bonaventure refit and all the other host of lesser incidents that auditor general turns up every year. And it's true that abuse of old people is as much a problem in general as child abuse. But adoption agencies for children have long since learned to evaluate those who would give care to the very young (and as yet there's no bureaucratic control over who shall have babies and nurse them). Cannot the skills so learned be applied to the care of old people? Cannot individual people be encouraged to look after old folks - instead of going on welfare, perhaps? There could even be a scheme under which old people can be formally adopted - with some extra financial help given the families in cases where they are bedridden. There are all kinds of possibilities to make life happier for a few people and perhaps save a little public money. What it will take is new, flexible and creative thinking along the lines of common humanity.E
NHS SETTLEMENTS continued from page 1233 to scrap a new contract she proposed at the end of last year and return to negotiations based on the old NHS contract. Now the HCSA is holding a ballot of its members to see what they think. Privately, however, most doctors are saying that the hospital services, with consultants' working up to 70 h weekly, will never return to what they were before. Frankly, the consultants enjoy a normal working week (of about 40 h) and found, too, that they were able to offer their patients (those who were seen) a much higher standard of medical care. So what will be the ultimate outcome of Castle's dangerous clash with the medical profession? Crucial to the issue is the undeniable fact that Castle, backed by the National Health Service trade unions, seems quite determined to ban private practice in National Health Service hospitals. She has persisted with this theme although reminded that her leftwing colleague, the
late Aneurin Bevan (often described as chief architect of the National Health Service), specifically promised doctors that such private practice would be permitted. It was this promise, in fact, which finally persuaded the profession to accept the NHS proposals. Now many doctors are talking about the final state takeover of medicine about which previous opponents of nationalized health care had warned. One group of London hospital consultants said in a recent letter to The Times: "The abolition of private practice is the expressed intention of several members of the present government and many officials of the trade unions which are becoming a dominant power in our country. "It is therefore desirable that all people should realize that the primary responsibility of the full-time doctor employed by the state is not to the patient, but to the state. "Those of us who have served as doctors in the armed services in war and peace have experienced the reality of the conflict of loyalties which this
can cause. If the state is the sole employer of doctors, the strength of their loyalties to the state rather than to their patient must become much more marked. Then, the only alternatives for a doctor refusing to acquiesce to the directives of state officials which conflict with the interests of a patient are, at best, for the doctor to leave medicine or leave the country." The letter's signatories (headed by Dr. John Seale, a consultant at the Middlesex Hospital, London) added that they believed the trend towards state monopoly in medicine must be resisted and accordingly they were setting up a charitable foundation, associated with a clinic or series of clinics, to provide medical services of the highest quality privately. The clinics would be run like the famous Mayo and Cleveland clinics and patients would pay, usually through insurance. "A good medical service at some direct cost is preferable to a poor service which is free," the letter concluded. It was signed by 12 distinguished London teaching hospital consultants.E
Symposium, UNDERWATER PHYSIOLOGY, July 610, San Diego, CA. Info: Secretariat, 6th symposium on underwater physiology, 9650 Rockviiie Pike, Bethesda, MD 20014. BRITISH MEDICAL Leeds, Yorkshire.
ASSOCIATION,
Juiy
6-18,
BIOLOGICAL PHOTOGRAPHIC ASSOCIATION, July 13-19, Scottsdale, AZ. Info: Larry K. Repp, Medical communications, St. Joseph's Hospital, Phoenix, AZ 85013. International congress of CHEMOTHERAPY, July 13, England. Info: Conference services, The Conference centre, 43 Charles St., Mayfair, London, England WiX 7P HEALTH PHYSICS SOCIETY, July 13-17, Buffalo, NY. Info: R.J. Burk, 4211 39th St. NW, Washington, DC 20016. Jubilee congress of MEDICAL ASSOCIATION OF SOUTH AFRICA, July 14-18, Johannesburg. Info: Dr. C. Abrahams, Organizing secretary, P0 Box 10102, Johannesburg, 2000 South Africa. AUDIO-VESTIBULAR SYSTEM AND FACIAL NERVE, July 16-18, Amsterdam, the Netherlands. info: Emmy Jacobius, Academia Books Exhibits, Alexandrastrasse le, D-6200 Wiesbaden, Germany. International symposium, HEPARIN, July 18-19, Europe. Info: V.V. Kakkar, Dept. of surgery, Kings College Hospital. Denmark Hill, London, England SES 8RX. 4th British academic conference In OTOLARYN. GOLOGY, July 20-25, London, England. Info: Andrew Morrison, FRCS, 38 Devonshire St., London, Wi England. VI International congress, PHARMACOLOGY, July 20-25, Helsinki, Finland. INTERNATIONAL SOCIETY ON THROMBOSIS AND HAEMOSTASIS, July 21-26, Paris, France. Info: Dr. J.M. Stengie, National Blood Resource Program, National Heart and Lung Institute, Bethesda, MD 20014. 14th congress of the INTERNATIONAL SOCIETY OF BLOOD TRANSFUSION, July 27-Aug. 1, Helsinki, Finland. Info: 14th congress, ISBT, Kivlhaante 7, SF-00310, Helsinki 31, Finland.
1264 CMA JOURNAL/MAY 17, 1975/VOL. 112
Deadline
