Monday, September 10, 2012

We are what we aspire to

Providence Portland Medical Center, the healthcare provider to which I’ve entrusted my cancer care, should not be mistaken for a Christian charity. It’s part of a sprawling not-for-profit organization with more than 32 acute-care hospitals and 64,000 employees in five states. It must compete ferociously to survive, and is thus subject to impersonal market forces that can be as dehumanizing as they are pervasive.

That’s not to say that Providence doesn’t have a heart. Started by the Catholic Sisters of Providence in the late 19th century, there are traces of its original healing ministry that can still be discerned—if you know where to look. I first saw them displayed on stylish posters several months ago on a visit to my oncologist. They were five “aspirational statements” of the Providence system set in attractive type, framed and hung in an otherwise drab hallway on the sixth floor of the cancer center in northeast Portland.
The statements and the Bible verses to which they were referenced are as follows:

Respect: So God created mankind in his own image, in the image of God he created them; male and female he created them. (Genesis 1:27)
Stewardship: The earth is the Lord’s, and everything in it,
the world, and all who live in it. (Psalm 24:1)

Justice: And what does the Lord require of you? To act justly and to love mercy and to walk humbly with your God. (Micah 6:8)
Excellence: From everyone who has been given much, much will be required; and to whom they entrusted much, of him they will ask all the more. (Luke 12:48)

Compassion: And they brought to him all who were ill, those suffering with various diseases and pains, and he healed them. (Matthew 4:24)
The best time to assess the moral character of a team of doctors and nurses that has rescued you from a bleeding tumor inside your head may not be while you’re zoned out in the ICU. Yet that, oddly enough, is where I happened to recall seeing these posters. It was the kindness and professionalism of a particular ICU nurse that brought them to mind. Kenneth was exceptional. At one of the most vulnerable moments of my life, he found the words and actions to both comfort my body and bring me peace of mind.

Mine was not a charity case; in fact, Providence billed my insurance company more than $64,000 for the three days I was in their hands. That’s a shocking figure, and is further evidence of the unsustainability of cancer care practices in this country. This sum is typical for the kind of intensive care I required, however, which included more than five hours of OR time with all of its attendant expenses.
What distinguished Providence was the quality of patient care I received throughout my stay. I was treated with respect and compassion, which was not the case during a less serious hospitalization at OHSU four years ago. It was not what I expected. The neurosurgeons, in particular, personified excellence in their craft. They performed delicate surgery on an especially dangerous tumor without causing permanently disabling side-effects. They were stellar.

Did they and rest of the Providence medical staff steward their resources as well as they could? Well, they kept me alive and I am now well enough to drive and run again. I leave it to a health economist to determine how that $64,000 bill could have been reduced for an episode of care with an outcome as positive as mine.
I’m inclined to give Providence the benefit of the doubt on this matter. What I observed of its institutional culture during my stay impressed me. Almost everyone with whom I interacted—nurses, doctors, technologists, therapists, the chaplain, etc.—seemed to know what they were doing and were responsive to my needs. I was well cared for.

There’s nothing that softens one’s opinion about the relative value of high-tech, high-cost healthcare faster than to survive a health crisis like mine. I can now say, for example, that I did not seriously consider an alternative to the $2000 ambulance ride from Corvallis to Portland while my tumor was bleeding into my brain, crushing it against the skull. I just wanted to get there--stat.

This doesn’t make me less the critic, but I would prefer to be alive than totally consistent about some of the harsh opinions I’ve previously expressed about American healthcare. Our system remains desperately in need of reform. The cost of cancer care alone could eventually bankrupt not only thousands of patients but also Medicare and possibly even our nation. It’s because cost is seldom a consideration when our lives are on the line that we dare not ignore the opinion of patients in attempting to find our way through the morass of healthcare reform.
A system that integrates some version of Providence’s aspirational statements into the timely, efficient and affordable delivery of proven medical practices might be a good place to start. There is not yet an obvious model for how to do this, but we are an inventive, resourceful people and I believe we’ll eventually strike the right balance. Our success or failure in that effort will be a measure of our humanity. I would hope not to have to stake my life on a system that makes the interests of patients any less central than the one I’m counting on right now.

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