I got a parking ticket today. It was worth every penny. The logistics behind why I was in the wrong spot don’t matter (do they??). What does matter is the fact that I made a conscious decision at 10:30am that I was happy to pay the fee that was going to be coming my way if I didn’t exit the building.
I was able to attend a portion of the Pediatric Bioethics conference entitled “Who’s Responsible for the Children” this morning. I was planning to return to other work after a couple of talks. But I couldn’t pull myself away. In perfect form, bioethics’ discussions draw a feisty and varied crowd. In keeping with this, I sat between a lawyer and a nurse, behind a pediatrician, and in front of a philosopher. For someone who has studied bioethics, this is a little bit of nirvana.
Did you know that recent data finds that 40% of children in the US have Medicaid and/or no health insurance?
I’m left reeling, my head spinning webs of thoughts and streams of information together that make me want to do more, speak out, stand on a table and improve health care for children. I’m somewhat humbled and intimidated by the brilliant thinkers I heard. So until all that settles, there’s one thing that came up, and often does, that I must write about. It seems it’s a theme.
It’s about the division between us. “Us” can mean doctors and patients, patients and doctors, doctors and nurses, patients and parents, policy and patients, or doctors and policy. These divisions don’t deviate far from those that arise between breastfeeding and formula feeding moms, SAHM (stay-at-home-moms) and working moms, or vaccinators and non-vaccinators. It all feels so similar, so partisan. So divided. We are always forgetting our similarities.
“We want health care for all children” — Dr. John Lantos
The morning talks (which you can watch LIVE) twirled around issues related to obligation and duty in the health care space, cost of healthcare, and resource/clinician allocation. Basically, bioethicists discussed their take on how communities, and pediatricians more specifically, are morally obligated to care for and protect children regardless of pay, cost, complexity, or access.
Dr Art Caplan spoke about policies to mandate flu shots for health care workers (to protect hospitalized children) and the reasons he believes our nation’s health care workers are only getting flu shots 50-60% of the time in many hospitals. We need about 90% of all those working in hospital immunized against the flu to protect those vulnerable. Nationally, we’re not meeting the mark. Dr Caplan talked about codes of ethics and oaths and duties to put patients first. When he was asked about vaccine hesitancy in the US and how to mandate flu immunizations across the nation, Dr Caplan responded that we need to clean up our own house first…
But it was after the talk on vaccines and after the talk on our moral duty to care for all children that a panel discussion unfolded. It was opened up to the audience for questions. At one point the conversation we got into health reform in pediatrics, on who would provide preventative care, how to help families get good access to pediatricians and afford it. The idea, many echoed today–and one I’ve heard before–is that we will likely shift our duties in care. In the future, it is likely that nurses will provide well-child care and check-ups while doctors will provide more care to the sick. To that, a bioethicist asked the nurses in the audience if they would want to do so. People nodded. “Yes,” I heard someone cry out in the center of the room. And then a nurse took the mic.
She said that nurses should be providing well-care because nurses work in the realm of compassion. It was clarified after she spoke, that this compassion was in stark contrast to a lack of compassion housed by doctors. Just before this, someone at the mic had said they didn’t think their primary care doctor cared.
At one point the nurse with the mic asserted [I'm paraphrasing] that doctors had too much power in the hospital and that at the end of the day, the doctors had all the influence but that the nurses had done all the work.
I groaned a little. Because this perspective aches of error and misses the true point of quality, efficient, and effective health care. WE WANT PARTNERSHIPS. Partnerships! Between nurses and doctors, nurses and patients, patients and doctors. We don’t want more divisions. I could tell you how many hours I worked yesterday, but that misses the point, too.
It’s ludicrous to think that doctors aren’t compassionate. It’s ludicrous to state that one group in the hospital is more compassionate than another. We’re forgetting our similarities. And our similar goals. The parallel between this discussion and the mommy wars (where we all long for the same outcome: happy, healthy children) rang loudly in my head. There I was sitting in a room where someone was deciding who was more compassionate…
I contend that nearly everyone working in a children’s hospital or a clinic is committed, on some level, to the mission of a hospital. Or I hope so. I believe clinicians, nurses, doctors, therapists, aides, volunteers, receptionists, and cafeteria workers and all the others I haven’t listed here, want to help, want to be compassionate, want to improve lives. Don’t you agree? I work in a clinic. I work for a hospital. I am married to a specialist who does too. We care. We ache. We worry. We work to be as smart, efficient, helpful and compassionate as we can be.
I suppose the discourse today reminded me how far we have to go. The nurse who confidently announced to a room of hundreds of people that doctors don’t have compassion is simply a flare. And it burns brightly in my eyes this afternoon. We have many more miles to go to bring patients and clinicians, and clinicians and patients, back together again. We really do need to regain our similarities first.
What do you think? Were you at the conference? Do you think I misrepresented this?