THE VIRGINIAN-PILOT
Copyright (c) 1994, Landmark Communications, Inc.
DATE: Sunday, August 28, 1994 TAG: 9408300384
SECTION: COMMENTARY PAGE: J3 EDITION: FINAL
TYPE: Book Review
LENGTH: Medium: 83 lines
I grasp that medical costs are up and insurance coverage is down.
I grasp that I can't afford to be sick.
I don't grasp what to do about it.
The American health care crisis is so big, and my layman's brain is so small. The pundits and the Ph.Ds can't seem to clarify the issues in ways I can understand, much less point me in the direction of solutions. Certainly the business administration types haven't been real helpful in making me see that the medical industry in this country is much interested in anything beyond the lengthening bottom line.
Until now. Susan Garrett, 50, a Charlottesville resident, has held management positions in small and large medical facilities. She ran York Hospital in Maine for six years. And Garrett has written Taking Care of Our Own: A Year in the Life of a Small Hospital (Dutton, 177 pp., $19.95), a clear, candid look at that 79-bed community operation, ``voluntary, not for profit, independent, governed by a local board of trustees.''
It's a smashing book about a microcosm of American health care seen from the inside. The little situation illuminates the larger one. Garrett puts a distinctly human face on a great, shambling, amorphous problem.
``I am a tall woman with a quiet approach to management,'' she begins, and would that more administrators were like this one. She is humble; she cares less about institutions than about people. And if those qualities aren't rare enough in themselves, she is also able to articulate them.
There is no jargon in this book, no soft focus of abstraction to beautify the facts. An anesthesiologist attempts suicide. A physician succumbs to drug addiction.
A ``system'' smells of fear, in the emergency room and outside it.
``The cost of hospital care has been rising by 8 percent a year, faster than other parts of the economy,'' Garrett writes. ``The consumer price index itself stays close to a yearly 3 percent increase.
``Where do we cut our cost? Much of it is in salaries, wages, benefits. What should we do? Reduce staff to the minimum? People here expect their hospital to stand by, ready at all times to handle the unexpected. Send nurses home without pay when the hospital census falls? ``Then find them cheerfully ready to return to work when the census rises? A risk. We do not welcome risk.''
Fix me, Doc; do it now.
Make a mistake and I'll sue.
Doctors know dread, even surgical prima donnas. They participate in a dramatic ritual that implies they are in charge and pays them as if they were. But the most introspective of them, in their most self-aware moments, know what Garrett knows:
That they don't know.
``Not absolutely sure of what they are looking for, fearful that their diagnostic route will take a wrong turn, and, most of all, deeply desirous of a good result, physicians are weighed down by uncertainty, and beyond that, they believe that if outsiders are permitted to see this, medicine will lose its political power.''
That comes from the ``system,'' which is a big fat bureaucratic myth.
``There is no standard for community health,'' maintains Garrett, ``no measure of how a hospital looks beyond its walls.
``We are no more a health care system in this country than we are a confederacy of magicians,'' Garrett reports.
``The double messages,'' she adds, ``are intolerable: Be charitable and competitive; be innovative and regulated; be compassionate and efficient; reduce your costs, provide access to everyone, give quality care. No wonder health care is in chaos.''
Meanwhile, homeless Tim Bailey marches into the emergency room every Christmas, and the doctor on duty admits him, and Tim has a bed and meals and friendly faces. Vacationing Bud Grosholtz goes under observation after a ``minor'' heart attack (if it's yours, it's not minor). Big Scotty the lobsterman is brought back from the brink of death by drowning.
Taking Care of Our Own is a ``narrative based on fact and memory,'' and most of the characters are composites, but it is not fiction. It is a record of one hospital that typifies all hospitals. It is compassionate but uncompromising in presenting the strengths and weaknesses we need to understand health care today.
So we can do something about it. MEMO: Bill Ruehlmann is a mass communication professor at Virginia Wesleyan
College. by CNB