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This comment is from Daniel Caloras, MD, a resident of Charlestown, New Hampshire, and a former longtime resident of Springfield, Vermont. He has provided primary care to residents of Vermont and New Hampshire for 30 years.
Having been in the healthcare industry as a primary care physician for 30 years, I have seen some changes. Many changes have been for the better and some for the worse.
I come from a time when computers weren’t found in hospital corridors or on office desks. Oh, I long for the days when I could spend another five minutes with a patient and write a note on a paper chart.
The crisis I would like to describe is not directly related to electronic health records or primary versus specialist care. This is a lack of staff. Too few health personnel and too many patients. A supply chain problem that existed before Covid and worsened after the pandemic.
We read that hospitals, home help agencies and health care facilities are understaffed and charged outrageous rates to correct understaffing. Nursing homes are in a similar situation. The hospital cannot take another patient; the nursing home cannot accommodate another resident because there are no more beds.
More often there are many beds and rooms, but not enough staff. And now home health agencies cannot see people in large geographical areas due to lack of staff.
Recruitment elsewhere, often through temporary work agencies, is not sustainable. It’s expensive and not a long-term way to stem the tide of disease.
I think we knew that the elderly population was growing. I wonder how much thought and effort healthcare decision makers have put into correcting this healthcare tsunami.
More doctors, nurses, assistants or therapists can help in the short term. Making it more attractive for healthcare professionals to pursue less desirable places or jobs is one option. Reducing the burden of massive student loans and equalizing pay rates is an often-discussed option.
There is a more pressing issue that many politicians either do not address or openly acknowledge. It is not politically correct to argue about doing too much for too few.
This should not be misunderstood as socialized medicine or euthanasia. As a result of more rules, regulations and requirements to be met, we do more work for every individual. The goal is safer results, fewer errors, liability safeguards, and adequate reimbursement for each activity.
This leads to more work for each activity, burnout, a desire to work fewer hours and work at full capacity when there are still beds in the nursing home, hospital and staff in the geographic areas to see the homebound.
Diseases are no longer complex today, nor were nurses any better in the old days. The demands given to the healthcare professional per patient are higher. Too much documentation per case is an example of the burden.
It is concerning that I have seen many excellent and busy nurses leave home care due to their need to spend as much time typing on a computer as they do seeing their patients, usually late at night after the workday.
Maybe we can free up a nurse and improve access to care if we take away some of the duties. Perhaps it would alleviate burnout by reducing onerous tasks that usually have nothing to do with why people seek health care.
I spend many hours typing stories about why people need wheelchairs, hospital beds, walkers or home healthcare. If I don’t document these accounts, the agencies that pay for these services or items will deny them. I sign hundreds of documents weekly that have little or nothing to do with the well-being of the people I care about. Everyone needs to be paid. Perhaps the time can be better spent seeing more people.
Along with my regular primary care duties, I spent years working for a hospice in a home health care agency. I have also traveled to less developed countries, providing primary care to less fortunate people. I know we can provide great care with fewer resources. Many of our ailments can be healed with care, compassion, a simple nod, a touch, or an extra moment of listening. Handing someone a cane to help them walk or medicine to improve a skin or joint disorder.
I challenge our government agencies, insurance and hospital administrators, and healthcare providers to address systems that are wasteful, inefficient, and time-limiting that lead to overworked staff and create an environment unable to care for more people.
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