Today, I'm tired of writing about eating disorders, (aren't you sick of reading about them?), so I'll focus on another issue, our nation's health care system, my diatribe inspired and fueled by my recent viewing of Sicko, Michael Moore's new flick. If you have any interest in health care, check it out--if nothing else, Moore's acerbic wit is sure to entertain. I actually found myself laughing out loud at a scene in which a woman, who had been in an accident, reported that the payment for her emergency transportation to the hospital was denied because she had failed to have the ambulance ride pre-authorized. It's funny. But it's not.
As both a patient and a provider, I've struggled with managed care. I've found myself wondering what universal health care would look like in the States, why we can't seem to get it right. Applying for Medicaid, which is supposed to insure even the most economically disadvantaged, isn't the easiest process to navigate. And, once you have Medicaid coverage, you don't get much besides the card. Most providers, at least in mental health, don't even accept Medicaid, and at horrendous reimbursement rates, that make a mockery of their advanced degrees, why would they?
Several years ago, I did a brief stint at a city hospital, where most of the patients were covered by Medicaid. My stint was brief because on my first day on the job, I was assigned 103 patients--any idea what a typical therapist's case load is like? Not 103 patients.
The objective was to meet with 10 patients a day, for 30 minutes each. Now, in the managed care and private pay worlds, patients are entitled to a bit more time. Not these folks. And, the frequency of therapy? Because of my 40-hour work week and various administrative demands, I was instructed to see each patient once every three to four weeks. Not the most ethical or medically sound care, given that many of the patients had major mood and/or psychotic disorders. Each patient in my case load required volumes of paperwork--I took to, and I'm embarrassed to say this, completing the paperwork in session, because it was the only way to get it done. For many, I was their third or fourth therapist in the last few months, due to incredibly high turnover rates.
In addition to the clinical overload, the work environment was, to put it mildly, sub-par. It took way too long to get my office up and running. My phone didn't work--not even a dial tone. So, I went downstairs to the telecom department, which was conveniently located next to the morgue, and spoke to Ms. Telecom about the problem. "My phone doesn't work. No dial tone, " I said. She handed me a slip of paper. "Here, call this number."
My computer, as luck would have it, didn't work, either. I went to I.T. They also gave me a number to call. Or, if I'd rather, they mentioned, I could log on to their trouble-shooting site. Every exchange, every moment at this hosptial, felt just like this.
Pretty soon into my stay, knowing that I would leave shortly, I visited the H.R. department to inquire about health insurance coverage. "I'm curious how long you have to work here in order for you to qualify for COBRA?", I asked. And, the director of benefits, housed in the hospital's H.R. department responded, "What's COBRA?" He also engaged me in a casual conversation regarding his recent vacation and his concern that there had been some Arab travelers aboard his flight. "You should be suspicious of the Arabs," he said. I quickly thought, "You should be suspicious of those who tell you to be suspicious of the Arabs."
So, who would work at facility with dysfunctional technology (and office clerks), dusty, likely asbestos-rich walls, and racist, incompetent H.R. staff? Let me tell you about my colleagues, each caricatures of a sort: One of the psychiatrists seemed to have some trouble reading social cues. Whenever he spoke to me, he never made eye contact, and I was always left wondering if he was talking to me or himself. One day, he said something to me in passing in the hallway. I had thought we were done, so I continued walking, but he kept talking, unfazed by my departure.
A social worker down the hall wore a white coat to work each day, as if he were an M.D. I asked him about it once, and he reported that many social workers wear white coats. No they don't. That's great, I thought to myself, there's a therapist with a delusional disorder working down the hall.
And our fearless leader? The clinic director, a psychiatrist, stood up at a staff meeting one day and stated how difficult it was for him to be the most intelligent person in the room. I'm not kidding. He's also the person who told me my first week, "If you and I get along, you should have no problems here," who referred to our clerical staff as "stupid" (yes, to their faces!), and encouraged his providers to commit Medicaid fraud. According to information gleaned after my departure, a thick enough H.R. file eventually resulted in the discipline of said psychiatrist. He was only kept on board with the provision that he must always have a third person present for his one-on-one conversations. He was castrated, but still allowed to screw.
Clinical care was substandard, morale was atrocious, and the building was falling apart. Can you see why I left? But, the thing is, this is the care that countless of Americans get. They wait hours and hours for appointments (one patient arrived for his scheduled 11 a.m. appointment at 8:30 am. because he was so accustomed to having to wait) to see providers who are overworked, mistreated, and not provided with the appropriate resources and administrative support they need to do their jobs. . . who then leave, despite their best intentions to make the world, or at least Manhattan, a better place, after just three whirlwind months. I wonder how, if we were to insure every American (and without extraordinary tax hikes), this scenario could be different, where folks who needed medical care could actually get it and not just instigate a paperwork trail that made it look as if they did.
(Apologies for the non-eating-disorder rant. Regularly scheduled programming will resume next week.)