At Your Service: March 18, 2009

Trust is a critical component of service and trust is in short supply these days. The issue of trust is completely revealed in our confrontation, as individuals and as a nation, with concerns relating to health care. It is in the domains of health care that the most intimate aspects of service are expressed; lives hang in the balance and the delicate underbelly is exposed. In no other arena are we required to trust with such abandon.
It has only been a couple of centuries since health care operated completely in the arena of faith. Various spiritual leaders were the early men and women of medicine. As the sciences gained knowledge and expertise, we increasingly turned our health care concerns over to doctors of medicine. While we have now placed most of our faith in the hands of highly trained medical professionals, we have more recently abdicated treatment decisions to insurance companies. With millions of people uninsured, this evolution is yielding mixed results.
Life expectancy for the average person has increased over the last few centuries at a rate of about one year per decade. It is somewhat shocking to realize that, despite significant technological and scientific advances, life expectancy for future generations is on the decline. There are several cultures scattered around the world where the average person surviving childhood can anticipate becoming a centurion; indicating that we have not yet maximized our genetic longevity.
There seems to be agreement that the American health care system is in need of a significant overhaul, but we are far from agreement over what needs to be done to fix what is broken. A first step will be taken when there is agreement over what is broken. While that is debated ad nauseum, I have some observations about the quality of health care service.
Recent familial events have given me a look at the operations of several area health care facilities from the large urban medical centers to more modestly supplied local providers. While on one hand I have found myself frustrated and angered by a system in breakdown, I have many more examples of individual caregivers that renew my faith and give me reasons to believe that it is too soon to give up hope.
Our rural location and its parallel smaller facilities support resident caregivers with limited levels of technology. MMH and other local hospitals can only provide certain types of care; patients with higher need levels must be transferred elsewhere. One of the more critical decisions that must be made is when to execute such a transfer and where each patient should be sent to get their needs met. Patients and their families are dependent upon local professionals to guide them in these choices and in my experience they can be trusted to make these calls with careful deliberation and attention to the needs of the individual.
In treatment for disease, we are at our most vulnerable. While the system may only provide a drawn curtain, the gentle ministrations and sensitivity of a direct caregiver enables people to get through these moments with dignity. While insurance coverage may limit the amount or type of treatment an individual receives, the compassionate caregiver finds ways to help them deal with the consequences of those limitations.
As efforts are made to address the various issues surrounding health care, we can begin by remembering the most basic medical tenet: first, do no harm. It is not only the place to begin, it is the source of trust that would do well being spread from the caregivers to their system.