As the health care reform dialog speeds up and the possibility of a single payer system wanes, I find myself more fascinated by the subtle back-story than the predictable dialog. History informs. The last forty years or so, with the center piece of the end of the Cold War, we relegated the communist threat to pockets about the globe while the triumph of capitalism flourished. We had a great need to show that the free enterprise system, both politically and economically, was triumphant. We in the United States often called this democracy.

One expression of that process was the insistence that health care could be a commodity, a product one could market and sell, a service that would enter the hurly burly of competition and that this would make it a better product. Somewhat like lemmings to the sea, we in health care complied, introducing corporate refinements to our system of operations and governance, calling patients consumers and ourselves providers. We attempted to create appropriate metrics to demonstrate our engagement in the models of industrialized businesses. We got aboard.

Every few years I have an opportunity to seek health care services, happily for nothing life threatening, nonetheless experiences that take me into the “consumer” role of health care agencies, one who is purchasing a “product”. My most recent one was instructive. I was scheduled for an MRI and an MRA at a brand new community-sited imaging center.

I parked in a nearby parking lot, hence had no need of the valet service provided by the young man listening to his I-Pod who seemed to not even notice my arrival. I was greeted by three lovely young women receptionists discussing last nights entertainment, who took my name, asked my birth date, and told me to take a seat. A young woman, my “client concierge” called my name, the last time I would hear my name in the three hours I spent there. She asked me my birth date and led me to a dressing room where she provided me with a scrub suit about 3 sizes too small, gave me a 8 page single-spaced document inviting me to participate in their research, told me to change first before I read the document, and left. I did not sign the consent form since I did not have time to read it, yet felt strangely like I might be in the study nonetheless.

A nurse came in to start an IV, and I questioned her plan, since I had no information on their intention to introduce a contrast medium. She was flustered by my questions, assuring me that I needed the IV. She then drew blood and I again asked why. She told me that they needed to run a lab test; I pointed out that I had had the same last test one week ago. A flurry of trying to get the lab to check the results ensued, ending with failure to reach the lab, and hence a second lab test was run, though I am quite sure that the results were not used since the troublesome delay led to rushing me into the procedure. It was evident that I was slowing up the flow of the use of the machinery. The clock was ticking and now we needed to make up for lost time.

During hurried preparations for the procedure every question I asked was ignored, evoking only an assurance that they had the best process anywhere and it was much better than the one I would get at the hospital. I was hurried into the marvelous machine, never told I could interrupt the procedure if I needed to do so, never told how long it would take, never addressed by name. As is perhaps to be expected, all parties did however ask me my birth date.

I have no doubt that the procedure itself was conducted technically in a responsible fashion. I have no doubt that the subsequent report was accurate. I had just purchased a product and it was a very fine product. I was neither a person nor an individual with distinct needs while making my purchase. I was a customer buying a product and my inappropriate questions simply required those providing the service to signal me that my questions were unwelcome and to assure me that I was getting a very fine product indeed.

The impersonality, indeed the depersonalizing impact of this experience was stunning. I was an object in for testing, perhaps indicating a need for further services, a tune up of some kind. We can call this many things, but “care” is not one of them. I have had more humane exchanges with the man who fixes my car.

As the health care reform dialog speeds up and the possibility of a single payer system wanes, I find myself more fascinated by the subtle back-story than the predictable dialog. History informs. Now that we are appropriately embedded in the frenetic process of proving that we too can use the GE model of corporate cleverness and competition, attention to the simple humanity of those we serve is quickly disappearing. The industry leaders are at the table, engaged in the dialog, and intent on ensuring that corporate free enterprise capitalism will continue to write the story of health care in the United States. They have products to sell and profits to protect.

This entry was posted on Tuesday, May 26th, 2009 at 9:58 am and is filed under Patients. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.