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Tag Archives: hospitals

Candid (Granny) Camera

sign

As leaving small children in the care of others has grown in popularity so has the awareness that not all carers are caring. Depending on one’s social circles, it’s not unusual to hear a weekly childcare horror story. Whether the babysitting arrangement is posh or subsidized seems not to matter. Little ones watched in their own home by uniform clad nannies, babies clustered in a neighbor’s living room, or those in daycare centers are equally vulnerable. This reality is not meant to strike fear. There is a fine line between believing in the boogeyman and having some common sense. Quite simply vulnerable people are often vulnerable.

Many parents have addressed their concerns strategically; using hidden cameras or surprise visits. This might seem hovering to some but it most often is not. A small child by definition does not have sophisticated communication skills. A baby is completely helpless. Caring for small children is not easy and can be incredibly frustrating. When doing so is an actual job there is little emotional attachment to pull the carer through the darkness. This doesn’t excuse mistreatment; it only helps to explain it. It can happen, and every parent everywhere knows this. What we don’t often consider is what can happen to our parents if they too are dependent on care.

Elderly people are just as, if not even more susceptible to mistreatment. Often an adult child is arranging the care from a distance, relying upon agencies or institutions to do the right thing. Nursing homes are staffed with the same extreme variations of competency seen in hospitals. Supervision of aides is no more reliable than in any other business sector. People don’t necessarily go into the low-paying and often messy work of health aide due to some sort of calling. It’s a job. Some people are good at it and some people are not. It can be terribly overwhelming to arrange care for a parent. The mixture of relief and guilt of situating a parent can be all consuming. It often is only when there are signs of mistreatment that the concept even occurs to anyone.

Often, like small children, the parent is not a reliable narrator. The parent might not know that possessions are missing or meals have been missed. A person with memory loss may not be able to recall mistreatment. Some bruises or marks may in fact be the result of a combative parent and not abuse. Add to that muddle the fact that the parent might only receive occasional visits from family members, and how is anyone to know what’s really going on? Granny cams. Installing hidden cameras (on live feed to an adult child’s computer) in a parent’s home will tell most of the story. Having every care facility (including senior daycare) outfitted with surveillance will change things dramatically. Those institutions should post signs everywhere informing employees, residents and visitors that; “You Are Being Watched.” Is it an invasion of privacy? Of course. So is having a bevy of doctors and interns gaze upon one’s privates for the benefit of learning. (It’s interesting which invasions of privacy we notice and which we don’t.) The signage will not only deter some misdeeds it also will set a tone. An institution that puts the safety of its patients above all else will attract employees with a compatible ethos. The surveillance will have to be viewed of course, which is not inexpensive. But surely the diminished lawsuits will help to defray those costs.

It’s tempting to wring our hands and bemoan how things have changed for the worse. But it wouldn’t be entirely accurate. Eldercare has risen in popularity because people live longer. Childcare has risen in popularity partly due to more employment opportunity for women. As things grow they often become less wieldy and need to be formalized. There’s nothing graceful or lovely about spying on people but there’s nothing so terribly genteel about burying our heads in the sand either.

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Posted by on November 19, 2013 in Cultural Critique, Well-Being

 

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Wattle Twaddle

turkey

It’s two weeks until Thanksgiving! You know what that means? Any second now the talking heads and “experts” will rise up and moan and rail against retail. Suddenly the plight of the employee and the sanctity of family will take on grave importance. The siren song of the big box store will lure people away from the sacredness of their nuclear hearth! How dire it is to impose commercialism onto such a pure holiday! Never mind the millions of turkey and pilgrim tchotcke festooning tables and mantels. Disregard the families barcalounged in front of football games all. day. long. It is shopping that threatens to erode this holy Norman Rockwell day!

“People shouldn’t have to work on Thanksgiving”; the bobble talking heads will shout. I suppose we should close the hospitals, police force & diners as well. Lots of people work on Thanksgiving. Do we expect the secret service or any branch of the military to lay down their arms and hoist a drumstick? I’m not sure anyone would want pilots, gas station attendants or bus drivers to have the day off. It’s interesting that retail employees are often the concern during this sacred poultry time. Retail workers regularly work evenings and weekends and often quite erratic schedules. Depending upon the shop they can be forced to wear a uniform and carry a see-though bag containing their belongings (the assumption being that they steal.) Retail workers are often on their feet all day long, not allowed to use the same bathroom as the customers and not given their week’s work schedule until the last minute. Throughout most of the year their interests aren’t exactly a priority. Let us just assume the moaners/ranters are just grasping at (cheese) straws and spouting twaddle.

But what of the family?! Whose family exactly? Is there a family so functional and fun loving and their time together so sacred? Is this fictional (if not entirely creepy) family so enamored with each other yet powerless to resist the charms of a doorbuster sale? Many many people do not have a family or one with whom they’d like to be sequestered. To impose some ideal onto every single person is if not callous than surely annoying. Would anyone care if family members went to the movies (spending obscene amounts of money to sit in dark silence together?) What is it about shopping that rankles the pundits? Is it that the shopping in question is for Christmas? Is the melding of holidays the equivalent of “my corn is touching my sweet potatoes!!!!”? If that’s it I suggest they take on the Thanksgiving/Chanukah synchronized celebrating of 2013.

I suspect that at the core of the whining is that any kind of change can make people cranky. Thanksgiving is nothing else if not a holiday revered for its stasis. We eat the same exact foods every year (heaven help the host who changes the stuffing recipe!) We go to or watch the same parade or movies. We take the post-feast walk or nap. There’s nothing wrong with clinging fast to the comfort of tradition. But there are lots of people out there with lots of different needs and desires. The idea that there is only one way to do something is a bit offensive. There’s a reason we serve more than one kind of pie.

 
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Posted by on November 14, 2013 in Holiday, Well-Being

 

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Behind The Scenes Reality

nymed

You can’t make it through a week in New York City with out spotting a Haddad’s dressing room trailer. Movies and television shows are shot continuously throughout the year and throughout the boroughs. Whether the shot is an exterior (there is no substitute for the real city) or interior, the streets are lined with trailers and crews. In certain neighborhoods it’s next to impossible to not be in a background shot. Less elaborate shooting is harder to spot but most likely happens more frequently. Student films, illegal shoots (done without permit and too much attention), news crews, ‘celebrity’ interviews at events (oft times the category of ‘celebrity’ is broad enough to include those recognized only by their extended family), and the creator of ‘celebrity’; reality shows.

In this town, you can not swing a restylane filled cat without hitting a reality show participant or shoot. Cooking, chatting, mating, dieting, contest, gossip & housewife shows are all shot here. In addition there are several more niche shows that go in and out of production. There was a restaurant show, not a sitcom like It’s A Living (that was a nice little show) but a behind the scenes show (like anyone wants their worst fears of what happens in a restaurant kitchen confirmed). Currently a hospital reality show is being shot in NYC. A previous season was shot at a Boston hospital and now it’s our turn. If memory serves; an intern (or two or three) are followed and recorded and we learn a bit of their personal life (or it being a perpetually on-call intern; their lack of a personal life.) I suppose the premise is interesting for anyone contemplating a life in medicine. If it’s an interest in blood & gore one has, there are shows that do that kind of thing better. This series almost poses as eduinfotainment. Almost.

Ignoring for a moment the ethics (or simply good taste) of filming people experiencing a medical emergency (and it’s always a medical emergency being filmed; elective surgery rarely provides drama.) Let us instead consider the reality of this reality show. I was on set (otherwise known as accompanying someone to the E.R.) yesterday and had the opportunity to witness the sausage being made. Upon check-in I noticed a gaunt unnaturally white man clad in scrubs and carrying a handheld television camera like it was a scythe. There he was in Admitting. Oh look who’s that guy in Radiology? Wait didn’t I just see you in the ambulance bay? He’s Waldo sniffing out an ’emergency.’ And like a good made for T.V. movie, his prayers were answered. An elderly woman arrived in the throes of anaphylactic shock. She could speak and she could breathe, but it was serious. It was as if a bomb went off; the floor emptied and every nurse, doctor, and other scrub wearing personnel crammed into the bay. The 10 foot by 10 foot space came to resemble a clown car, with countless people entering and exiting. There was not a single nurse or physician available to the other patients in the E.R. for 45 minutes. The woman was intubated and moved to a room within 15 minutes. So what’s wrong with the math? Why did it take at least a dozen people to intubate a compliant elderly woman? Why did a 15 minute procedure waylay personnel for 45 minutes? Waldo. Not only did each doctor retell the horror and drama directly to the camera, a nurse slowly enacted calling for a room (which was already procured) for the camera. Doctors spoke fervently about the extreme danger and mystery of anaphylaxis and then disappeared back into the bowels of the hospital. The granddaughter of the patient, a weeping shaking teenager was all alone; except for the hospital handler guiding her to speak to the camera. If you’re still reading this, you might want to stop now.

For the next hour the nurses, interns, and attending physicians chatted excitedly about the event. Overheard was; “Oh my god I was like okay we can do this” and “Wow that was wild.” Now if I’m not mistaken an emergency room (in a world famous teaching hospital) sees its fair share of emergencies. Anaphylaxis is dangerous and certainly an emergency but is it rare? Is any emergency rare enough to warrant an OMG from the staff? The chatter, tempo and general ambience was that of a junior high school fire drill. Was it all for the benefit of Waldo? Does the very presence of a camera alter people’s behavior? Usually. Were there personnel that showed up for this particular emergency knowing the footage would make it into the final cut? A quick Google search verified those emergency guests are regulars on the show.

My guess is that this event will make for 10 minutes of footage (5 real minutes and 5 slow motion & recap moments.) What won’t make it onto the show are the patients that we left alone for 30-40 minutes at a time. We’ll never see the elderly incoherent patient never seen by a hospital handler let alone an actual doctor. The camera did not pick up on the man left on a gurney in the hallway for 7 hours while many bays were empty. The camera missed the attending physician checking on a patient without looking at the chart or asking any questions. The audience will never see this doctor making a surreal diagnosis completely unrelated to the presenting issue, answering his cell phone, and rushing out for his one-on-one with Waldo. Maybe I’m darker than most, but I’d watch that show.

 

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A Health Care Reformation Proclamation

doctor

Medical Insurance (or as it’s less accurately known; health insurance) is on its way to reformation. It’s not clear if the results of the reform will render the; coverage, procedures and rights of the users any more decipherable than they are right now. But what is clear is that the more something is examined the more flaws are brought to light.

We can all probably agree that good medical care should be available to all. Whether insurance is the means to that end is highly questionable. But we seem to be stuck with that particular paradigm. Anyone who has ever sought treatment, payment or reimbursement would probably be happy to swear on a big towering stack of bibles that insurance companies seem to be in the business of making money not providing good healthcare. But as we established; we are stuck with this paradigm. In the interest of making lemonade out of the soul crushing demoralizing oligarchy of the paradigm, let’s consider how government involvement might improve things. (There will be no rolling of the eyes.)

The most obvious improvement will be filling gaps in the current usage of medical care. Insured people are presumably less likely to use emergency rooms as their general practitioner. This is good for both continuity of care and preventive efforts. It is also an enormous cost savings. Insured people are more likely to visit doctors before a condition become acute. They are also more likely to take the full dosage of their prescribed (co-pay) medicines, when not compelled to ration. In theory medical insurance for all will lead to medical care for all. Whether it’s ‘good’ medical care is another issue altogether (that was less of an eye roll and more of a ‘whatever’.)

Where things potentially get exciting and sane is the possibility of payment parity. Currently medical insurance is sold in two sizes; individual and family. The individual plan is discreet and self-explanatory. The family-size is an unlimited free for all. There is nothing equitable about this framework. A two-person family is paying the same rate as a ten person family. A parent with one child is in essence subsidizing larger families. Two options of coverage (individual and family) only benefits large families (and no doubt insurance companies.) There is no other insurance plan (of which I’m aware) that operates this way. You don’t buy homeowner insurance for either one home or an unlimited amount of homes. You don’t purchase auto or life insurance in this manner either. You purchase insurance plans for each entity that needs coverage.

I would like to think that as the thinkologists are drawing up this new way of doing medical care business, they will take note of this inequity. (Can’t really see my eye rolling behind these rose colored glasses, can you?) Perhaps when all people (not covered by employers) have to purchase insurance they will balk at the two sizes fits all framework. People probably don’t spend a lot of time scrutinizing each pay-stub and considering their pre-tax contributions. But it’s hard to ignore being overcharged when you are writing the check.

Sometime during the last four decades or so we’ve convinced ourselves that medical insurance is mandatory and good. It is not a coincidence that healthcare costs have skyrocketed as we succumbed to this thinking. There are too many bad medical practices and less than good doctors hiding behind insurance. There is far too much money and time spent trying to keep costs down versus caring for people. Good care that focuses on what’s best for the patient is what we need.¬†We’re on our way to medical insurance for all. Now how about some actual health care reform?

 
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Posted by on January 31, 2013 in Cultural Critique

 

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