March 22, 2009

As I sat in the chemo room yesterday receiving my court-ordered toxins, I took some time to really reflect on the inner working of my oncologist’s office, from a business point of view. Here’s one scene that I observed, which I found of particular interest. Let me know how you feel about this?

Chemo Day #???? (I’ve had treatments on & off now for 9 years. I’ve long since stopped counting.)

As most of you have heard, Michigan, and Southeast Michigan in particular, is not a financially thriving locale these days. And that economic implosion has now made its way into our healthcare. Given our high rate of unemployment here, there are more people without healthcare. That means the uninsured-unemployed often have to default on large medical bills that they owe by filing for Chapter 7 Bankruptcy protection. As a consequence, even the largest hospital systems, like Beaumont, are having to slash overhead to help stem the losses of billings.

Shortly after entering Dr. Jeff’s office yesterday, I realized that there had been significant cuts in the number of his office staff. A frightened shiver cascaded down the back of my neck. I’ve seen what happens when doctors are forced to significantly under staff a medical office.

I sat in the lab area waiting for my blood to be drawn and vitals to be taken. I noticed one of the head nurses, Clare, was coming over towards me. Since labs are normally staffed by lower-cost “Medical Assistants,” I was surprised to see Clare working in this area of the practice. I asked her about it and she replied, “Yeah, we’re really short-staffed so I have to help out over here for a while.” I smiled while processing what she just said. But just then, my “Chemo Brain” kicked in and I simply forgot what we were talking about. Now there was nothing I could do but skip past to the end of the conversation. Embarrassing when that happens, isn’t it? (Fast-forwarding 30 minutes of my actual appointment time yesterday…)

Now waiting for my chemo in the “Infusion Lounge,” I noticed that Ramona, the top nurse in this area, was scrambling around trying to figure out the orders that Dr. Jeff had written for me. It seems they have a new assistant who acts as a physical liaison between the lab, doctor and the treatment nurses. And she was seriously dropping the ball under the pressure. She was getting treatment orders wrong, which is simply not allowed in an oncologist’s office.

After about 20 minutes of waiting to get new orders signed by Dr. Jeff, Ramona herself came over to me to start my chemo. This was very surprising. She was usually involved in more complicated matters, such as mixing the chemo cocktails for each patient, which demands significant specialized knowledge and experience. A bad job done in this area could literally kill someone. She’s a little over-qualified to be administering an IV, if you want my opinion.

Wondering how the staff shortage was affecting the treatment area, I asked her, “Seems a little strained in here today, has it been busy?” “No….,”, pauses Ramona. “…steady….but a good kind of steady. The kind that gives us extra time to show a little T.L.C. to our patients.”

Wow! I was simply blown away by my next thought!!! ‘These nurses are so over-worked that they can’t take care of their patients and show the compassion they feel on the inside. This is because everyone in the practice must scramble in order to produce enough billings to make just a small profit in this Managed Care world. (I have a love/hate relationship with Managed Care. But that’s an entirely different blog)

It’s now evident to me that the pace of the modern day doctor’s office is such that our nurses are not getting the “self-rekindling expression of their emotions” that they need.

I ask you all to ponder: Where would medicine be today without managed care? How do we free ourselves from this insidious relationship we have with them? How do we return to a better era of medicine? How can we let nurses be nurses again?

We wanna hear what you have to say. Thousands of cancer patients read my blog and the comments that are left by others. Let’s start a dialog that could end up making a difference!