Suffering in Healthcare When Healthcare is Suffering

People are suffering. Diseases. Chronic illness, including chronic pain. Trauma. Violence. Aging. We continue to demand and expect "the best", especially in our suffering, from an industry whose own suffering threatens us.

There are so many crises in the health care industry.

Everyone wants the best of care, affordable, accessible. Many states are losing quality physicians because of the cost of malpractice. Many companies are dropping insurance benefits because it costs too much. Many employees are dropping insurance benefits because it costs too much. This leads to serious consequences when it comes to health maintenance and often results in more costly health care in emergency rooms

Demand far outweighs capacity: people, facilities, dollars.

Reimbursement diminishes while demand, and the pressures of regulatory agencies (including JCAHO and HIPAA) increase. We are spending more and more on things that detract from patient care.

Managed care is not working. The out of balance market allows some insurers to coercively demand, and receive, discounts significantly below provider costs. As they capture more and more market share, providers are desperately under-reimbursed. Meanwhile, in addition to aging buildings we have aging employees doing more, with less staff support, creating difficulties with recruitment and retention. The employee revolving door is further challenged by the vicious tactics of competition (and not just from competing hospitals) with through-the-roof bonuses and other promises that lure human capital from one place to another.

We anticipate significant nurse shortages (already real in some locations), some say up to 28% in the next 15 years. We are not saying enough about physician shortages, especially in family practice, obstetrics (especially with the malpractice issues) and some specialty areas. Some recent articles have suggested that, not only are many steering away from health care professions, including physician candidates, many face a morale crisis before they leave medical school.

Technology may be great, and each new gadget sells newspapers (and pushes hope often beyond realistic levels), but technology is costly, puts further burdens on tired providers, and heightens ethical concerns. All too often new technology is used redundantly alongside old.

Depression is in the workplace, as are morale issues, family and financial pressures, even the diminishing of the spirit or sacredness of work (especially in health care). Depression costs the U.S. workplace $12 billion annually, and job-related stress costs $300 billion. Chronic disease management has little effect across national populations due to a lack of a participation attributable to depression and denial, while the health care system is seemingly incapable of integrating medical and behavioral care. Many hospitals talk the language of wellness for their patients, but fail to grasp its significance for the workplace and the workers. We save a few dollars by cutting wellness dollars for the workplace (including cutting chaplains) while complaining of the rapid increases in costs that result from this shortsighted thinking.

Pharmaceutical costs are out of control, while Medicare under-funding and growing corporate health plan co-pays and deductibles cause significant numbers of patients to "forego" medications needed to control illnesses or progressive morbidity. Because individuals, the health care industry and society have really never addressed futility, expensive new drugs lure us into unrealistic expectations.

The industry is in trouble and, from conversations with Canadians and folks "across the pond," the conclusion is that their models don't work all that well, either.

These are the best of times in so many ways in health care, and these are times of enormous challenge. As challenging as the issues are for all of us (and this includes the chaplains), there is an enormous opportunity on the horizon if we are willing to rally around our real mission and values, make the tough decisions (including the willingness to risk) and do what we do best ... provide for the patient.

These issues represent minimalization and marginalization. The bullies of the world and of health care are pushing us to the limit. We are running dysfunctionally to hide and escape, if we haven't left the industry altogether. These are real issues and there are no quick solutions. Some argue that there are no solutions at all. We are an industry that long has demanded the highest of standards and from the ashes of today can rise a new health care that truly is who we are and what we are all about. Here are some suggestions .

For all we might lament, the weight of the lament for patients is staggering. Pain. Fear. Loneliness. Dying. People too busy to listen. Yet we who are also marginalized still have much to say about ourselves even when we have little control over the workplace. Chaplains understand something of the theology of "miracles," but it doesn't mean we can "fix" the industry or even selected power brokers in our own workplace. It does mean that, with all of the givens, all of the margins, all of the resistance, we must bring to our workplace the standards of performance that tangibly demonstrate our own values and vocation. That is something WE control. We must move beyond the incessant blame in health care to personal ownership and accountability.

While hospitals with religious affiliations seem are no less infected by these issues, these hospitals may have a unique opportunity, even with all of their baggage, to be a needed prophetic voice (along with the other prophetic voices) to the larger industry. It always must be ... "What is best for the patient?"

We need to make better use of the chaplains who, as guardians of the values of the workplace and the spirit or fabric of the organization, bear the burden of raising the tough questions and calling us all back to our mission and values. Chaplains, especially those properly trained and certified, can serve well to address the systematic issues that present themselves, and bring to the employees (including administrators and the Board) the same quality, holistic, healing presence that long have been brought to the patients. Some argue that chaplains don't produce revenue. That really isn't true. Healthy chaplains can be a very strong marketing component, and given the encouragement to commit to the workplace, can and do make a difference in matters of recruitment, retention and wellness. Chaplains can help reduce the previously mentioned costs of depression in the workplace and the abuse of sick time.

As Jesus responded to the woman who was longsuffering with hemorrhaging and was lost in the system, so must we seek out the lost and welcome them into the community.

The Reverend Richard B. Gilbert, Ph.D., BCC, CT Director of Chaplaincy Services, Sherman Health, Elgin. Executive director, The World Pastoral Care Center. Editor, Healthcare & spirituality.