Health Care: Compassionate Apostolate or Business?

Who receives better care, an American in a hospital in the U.S. or a poor Indian in a mission clinic in the jungles or high Andes of Peru?

Patients in American hospitals are exposed to the most advanced medical technology, modern analytical laboratories, computerization, all the comforts possible, a big impersonal administrative bureaucracy, of tubes, wires, and dials that may terrify more than soothe.

A poor Indian in a mission clinic will get none of these, but he does receive a lot of love, care, concern, understanding, compassion, and kind individual attention. At times, these qualities have a more healing power than the highly trained specialist and the miracle drugs since they give the will to live and meaning to life.

The patient feels valued and loved; the mental state is critical in relation to recovery. Thus, the patient’s family and friends can participate in the healing process which involves body, mind, and soul as technology, nature, psychology and theology meet. One doctor referred to this as TLC or tender loving care. Often these intangibles make the difference between life and death, compensating for many shortcomings of the mission clinic which has little, but ingeniously makes the most of what it has.

The missionary doctor arid nurse see themselves as collaborating with the Great Healer and following in His footsteps. They consider it a privilege to serve. They not only love, but communicate Christian love through touch, sympathetic listening, an affectionate word, kind attention, gentle care, a nice smile, sincere concern, and greeting the patient by name in a friendly manner.

They believe that poor Indian is much more than another case, another statistic, or a few more holes in an IBM card, but a person with Christ in him created to God’s image. No wonder Mother Teresa could say, “When I clean the wounds of an abandoned dying person, I feel as though I am cleaning the wounds of Christ himself.” She certainly can teach our mercantilistic medical professionals a few things about health care.

We cannot expect our doctors and nurses to be dedicated selfless saints. But we can hope that they have something of the spirit of the missionary. Money can still be an important motivation, while human service and personal commitment are the predominant considerations. Then health care becomes an apostolate. If money has to be number one, can service be at least a close second?

Some health workers border on the cynical. A most competent specialist candidly admitted, “I became a doctor because I like it and want a high life style.” To serve and to relieve suffering were not important to him. According to a survey at Loyola of Chicago in 1957, 100% of the premed students chose medicine for the money.

What happened to the Hippocratic Oath and the Promise of Florence Nightingale? What happened to the traditional ideals of the young doctor just out of medical school? Does a student studying medicine today aspire to relieve human suffering and serve mankind or to be a millionaire by the age of 40?

Should hospitals simply become impersonal machine shops or instrumentation labs to fix damaged organs? Social work and medicine are dehumanized when there is a mentality of giving without love and care without compassion. This mercantilistic mechanization of health care — among the noblest of professions — reduces the doctor to a technician, as the cost of medical care goes into orbit. The situation would be even worse were it not for the volunteers and the dedicated few who do perceive their professions as a healing apostolate.

Medicare is being milked to its destruction, killing the goose that lays the golden eggs. Once a doctor realizes the patient has health insurance, his fees increase 20% or more. One hospitalized patient had blurred vision due to an adverse drug reaction. For a three minute consultation, a few eye drops, the ophthalmologist netted fifty dollars. He can rationalize that the patient isn’t paying. We all pay, through galloping inflation, higher taxes, and exorbitant health insurance premiums.

Too often carelessness overcomes conscientiousness. Classic is the case of the interchanged oxygen and anesthesia tubes. The mistakes of doctors and nurses often are found in tombs: dead men don’t talk. How much suffering and death find their cause in violations of elementary principles? So what? Nothing will happen. Good enough. There’s no time. It is the little things that make the difference between excellence and mediocrity.

A few occasionally neglect to wash their hands between patients. To dispense the wrong medicine is inexcusable. When under pressure, a health worker may not pay attention to the complaints of a patient until it is too late. In one case, the patient was bleeding. Some complaints are imaginary, but to the patient the pain and discomfort are real.

Some degreed nurses consider it beneath their dignity to bathe patients and change bed sheets. Contact with the patient is not only for the practical nurse. No job is too low when one has the privilege of serving. The great value of life should never be forgotten, even after years of seeing the most horrid accidents. Even the most wretched have dignity.

Medicine must treat the whole person, including his fears, the psychological aspects and, in collaboration with the chaplain, his spiritual welfare. Medicine does not simply treat a defective part of a machine, but an organ that is part of an ingeniously planned system capable of functioning for a century instead of the few years of an auto or machine. The body of course also needs preventive care. Man will never completely understand parts of this system, especially that great unknown frontier, the brain.

Many a doctor’s office has problems similar to the hospital. One waiting room is so full each patient receives a number, as at a bakery counter. Naturally, the doctor’s work becomes a routine assembly line with only a few minutes to spend with each patient as he prescribes a medicine and sends him on his way. How can he get to know each patient well enough to give integral care and be aware of any psychological influence on his illness?

Under these conditions there is no way the doctor can maintain top quality care. Here a paramedic, a nurse practitioner, or even better, another doctor, could make the office visit more personal with more time for each patient. When America must import M.D.’s from the Third World, where they are in shortage, obviously more medical schools are needed.

Communication must be improved between the doctor and the patient together with all the family. Since an operation or serious illness is often a traumatic experience, they deserve a briefing as to what is going on, but the doctor is often “too busy.” If the patient is near death, at least the family should be informed in order to comfort him in his last hours. Then he can die with dignity. Too often the family is taken by surprise with a curt telephone call.

Is there still a place for the family doctor and the house call? Knowing the family, its problems and medical history could be the key to preventive medicine, keeping people healthy and saving millions of dollars in the process. Health care could again be personal, especially if each family could have access to a neighborhood doctor’s office or clinic.

In poor inner city areas, a nearby clinic could be staffed by a team of a social worker, nurse, and paramedic supervised by a doctor who would only attend to the more serious cases. Part of their job would be health and nutrition education, immunization campaigns, and preventive medicine, the most important aspect of the health professions. A paramedic or nurse practitioner, supervised by the family doctor, could make house calls that the doctor cannot make.

According to Dr. Harold Wise in Prevention Magazine, the whole family system must be treated since family problems may make one more vulnerable to disease. “If people feel supported and loved, they seem to heal better. The immune system seems to work better.” Getting the family united “is important for the healing of the family itself.” This is supported by studies of the traditional Japanese culture which emphasizes strong community ties and support of the individual by the people around him. In Peru, the entire family, including relatives, comes to the hospital every day to visit its sick member.

Certainly we should understand the doctor’s side. A specialist must struggle through the pressure of college, medical school, internship, military service, residency, and continuing education. He must accept physical, mental and economic sacrifice before he finally can get started around the age of 30. He must possess extraordinary dexterity, intellectual ability and emotional stability. Then he must cope with life and death decisions, the risk of an exorbitant malpractice suit, a tight schedule, and other pressures.

In many public health centers, the case loads increase as the staff size and funds decrease. Senile, neurotic and abusive patients may stretch the endurance and temper of health workers to the breaking point. The public has a tendency to condemn all for the sins of a few, forgetting the dedicated work of the majority. We cannot expect miracle workers. After all, health workers are human with their own personal problems, faults and weaknesses. But some criticism is necessary in order to reconstruct, to locate problems, correct them, make reforms and improve medical care.

The problems pointed out here are not general but still common enough to merit reflection by every person who has to do with health care. All have great responsibility and every job is important. Every profession has its share of problems, small and large, but with health care lives are at stake. We must all examine our methods, attitudes, preparation, mentality and organization. Human dignity deserves it and compassion demands it. Let’s put love and compassion into health care and make it human, and Christian, again.

By

Paul R. Sebastian was a lay missionary in Arequipa, Peru for 14 years. He is a member of the Campus Ministry Board & adviser to the Catholic Newman Club at the University of Rio Grande.

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