This commentary is by Nat Mulkey, a psychiatry resident at the University of Vermont Medical Center.
I am a psychiatry resident at UVM Medical Center, with plans to go into child and adolescent work. Prior to this I went to school in Arkansas and then Boston.
Oklahoma, Arkansas, Boston, Vermont. I am hard pressed to find more dissimilar places for health care in this country.
Coming to New England was in some ways a culture shock — everyone generally has access to health insurance, the health of the population seems better, and wow, are there some wealthy white people. Now that I am here, I make it a point to learn the local health care system because I intend to make Vermont my forever home.
A necessary evil of this quest? News. I tune in as much as I can to the updates on all platforms and what local government and journalism have to say. In doing so, I have learned a lot from high-quality pieces. I have also felt crushed.
It has taken me some time to figure out why my reaction to health care coverage has been abject sadness. Defensiveness, seeing critiques of a system I am a part of? Sure. But my discomfort is complex, with part of it being an intense need to say: We care!
Maybe I am the only one who makes it a hobby to peruse Google reviews of hospital systems. To spare you the time, I will summarize: It’s dismal. Boston Medical Center, 3.2 stars. Oklahoma University Medical Center, 2.6 stars. University of Vermont Medical Center, 2.6 stars. University of Maryland Baltimore-Washington Medical Center, 2.2. Maine Medical Center, 2.9 stars. Massachusetts General Hospital, 3.9. Mayo Clinic, 3.5.
Obviously this is not scientific, and is always in flux. But for comparison, every one of the local Hannafords nearby has at least four stars.
Hospitals, Hannaford’s — both have staffing issues, both are experiencing inflation, but maybe more importantly, both are in customer service. Maybe it is part of the territory.
There is something affronting and morally wrong about a long wait time for a medical procedure vs. in the checkout line. I jest, but only slightly. Customer service is an aspect of being a physician I have only recently come to understand. But things are different now, and some of our customers (OK, now I am regretting this analogy because to me they are patients), some of our patients don’t know that, maybe forget that, and are suffering because of it.
Imagine you work at a restaurant. But a two-year-long crippling traumatic event waved through customers and staff alike, killing many of them and ravaging any excess resource available.
I’ll put it like this. If your meal at a restaurant takes a while, and by the time you get it, it is cold and not what you ordered. What happens? You’re angry, hungry and unsatisfied. If you go to the emergency room with intense, scary, what you think may be life-threatening pain, and it takes a while and ultimately what is able to be delivered is not what you hoped for — what happens? Well, this is my health we are talking about, not a silly meal. It’s a big deal! Rightfully so.
So how could something like this happen when the most important thing is on the line, health? And in the United States no less! What breaks my heart is the number of people jumping to the conclusion that it must mean the people working just do not care.
I had a lecture recently with a fantastic couples and families psychologist, Dr. Diane Gottlieb, who said to us: People are people; problems are problems. I scoff at first — now, who do you think is creating the problems? Eventually, I think I understand her point: Problems do not have to totally define or describe people.
There are things, big, varied and uncontrollable, that affect everyone’s ability to do the ideal. That is one thing I know we can all agree on. Because we care, we know this is not ideal. And we are sorry; we wish it were different.
It is nearing 6 p.m. and as I leave I see the case manager still working at her desk, worried about an insurance review the next day. This patient needs more help and should stay in the hospital. The insurance company, states away, who has never met them, thinks otherwise. My attending fights them hard, but ultimately their insurance lapses. The nurse commiserates with the patient at their bedside while I start to order their discharge.
What’s painful to reconcile is the hurt and suffering patients have with the devoted and intense compassion the people who work in health care have. Lucky is an understatement to describe how I feel surrounded by my colleagues of all types — RNs, LCSWs, MDs, DOs, PAs, the whole alphabet soup — who strive every day in a pinched system to do the best thing for the patient. And often not hearing a single thank you along the way. And tomorrow we will do it all again. We wouldn’t if we didn’t care.
