Recently, Emergency Department physician Dr. Robert Martensen was interviewed on NPR’s Fresh Air about his new book, A Life Worth Living. He discusses the complexities of our health care system, particularly with our relationship to life, death, advanced technologies and communication.
14 minutes into the interview, he states, “I can spend an hour and a half talking with the patient and the patient’s family when the patient learns they have a life threatening diagnosis. We can spend 2 hours together which is perfectly appropriate – it’s the way to go I think to find out what matters to them, relevant medical history, do a physical exam, etc. In New York State, Medicaid pays $18 dollars for that service. If, on the other hand, I said with the patient, you have this problem we think, it looks like….today we are going to be doing a lot of tests, spend 15 minutes with the patient, maybe do a procedure myself – that procedure would be well compensated. But my time to listen, that is not compensated and yet that makes all the difference in what people experience as they are navigating this very daunting set of circumstances.”
For many this is no surprise, yet disturbing nonetheless. Last post we talked about the “e” movements. In light of other health care reform initiatives, how have talking and listening become skills that don’t “count” in the medical field?
Communication scholars, Julie Apker, PhD and Susan Eggly, PhD wrote about the dominance of medical socialization and encourage a reform in medical education and medical training as a way to instill more humanistic skills, like talking and listening. What kind of medical professionals are our medical curricula trying to produce? Whose values and objectives are embedded in such curricula and whose aren’t? What is the role of care in such training? What is the role of communication is such education? Clearly, this is a generalizing set of questions about medical education and training, but at the same time, they may help in uncovering some of the things that don’t “count” right now in producing a medical professional.
Of course, we cannot overlook the role of patients and their need to take a more active role in educating themselves about their health, not to mention focusing on ways to improve their interaction with nurses and physicians. But as NY Times Pauline Chen, MD points out, this really demands a high level of literacy from patients, expecting them to go home with diabetes, congestive heart failure or a kidney transplant and just take care of themselves.
The “e” movements are helping – albeit selectively – to re-educate patients through a more accessible vocabulary and forum. Health
care, however, is relational and the very things we are training ourselves in like the importance of talk, listening, participation and collaboration, must “count” in other places, like a patient’s bedside.
Again, Dr. Martensen reminds us that looking at Medicare overall, half the money we spend in this country is on patients in the last 6 months of their lives which underscores our exceptional ability to prolong life. Yet at the same time, this fact calls into question our ways of bringing comfort and a contestation to our practices of what we need to do, rather than what we can do for a patient.
Re-organizing medical education and medical training with more diverse values and perspectives as a way of re-determining what is compensated and what is not may sound ideal or even utopian. Although I think ideals can be useful as models for which to work from, “utopia” literally means “no place.” Therefore, I hope this sounds more like a “eutopia” which refers to building a better place. That is, a better place for medical students, medical staff, physicians, nurses, social workers, and patients that can determine together, what we need to do in order to get there…
Where to begin?
With thanks to cobalt123 and Joe Hatfield for their photos as well as Erica D. for sending me Dr. Martensen’s interview!
Looking forward to your thoughts!
Carey Candrian
