It's summer and very hot. Really, really hot. And humid, as only the Midwest can be hot and humid in July. My brain feels soggy and uninspired. Now is the time of the year I like to read, not write. Alas, it is not to be, I must write. Stacked on one side of the desk are some magazines, set aside over the year for the good reading they provided. I'm not a regular reader of these magazines, I'm a sampler. I enjoy in-depth articles by investigative reporters about topics outside my personal box. I peruse the magazine racks in book stores, mostly in airports, searching for something intriguing enough to focus my attention away from flying. Not that I'm squeamish about flying; it's just that flying these days is, hummm, not what it used to be. From my sampler, here are some recommendations clinical nurse specialists may find thought provoking, all available online through the respective magazine's Web site.
A must-read is the Time Magazine article by Steven Brill, "Bitter Pill: Why Medical Bills Are Killing Us," about the high cost of healthcare. It's a stunning look at the process used for determining charges for healthcare services. Charges, it turns out, have little relationship to costs. Brill builds the story around actual patients in differing circumstances to illustrate the impact of charging practices on people's lives. Somewhere high over Nebraska I recalled how, as a new nurse, I was instructed in the fine art of cost shifting by the older, wiser nurses' aids who, using the unit's addressograph machine, stamped charge slips for uninsured patients with the name plates of insured patients. The article offers a more contemporary look at charging practices, but the game is pretty much the same. Be prepared to spend some time on this one; it's over 24,000 words. Ever heard of the charge master? No? Then download this article.
What if hospitals operated like the Cheese Cake Factory? The restaurant chain serves thousands of people, offers a wide selection of menu items, and maintains consistent quality from coast to coast. A deluxe burger in Baltimore will be identical to the deluxe burger in San Francisco right down to placement of parsley on the plate. Now contemplate what hospitals might learn about service and quality from the restaurant industry. To find out, read Atul Gawande's article, "Big Med," in the New Yorker. It's a thought-provoking piece for anyone trying to implement evidence-based best practices. And hey, many of our healthcare systems are beginning to mimic the restaurant chain in size and scope. Before you say "no way," give this article some considered thought. Be forewarned; eat before you read to stave off cravings caused by descriptions of menu items.
This next recommendation is a story about a person we in healthcare might call a complex patient, but the story is not about healthcare or a patient. It's about a person who happened to have health problems and got caught up in the government's Immigration and Customs Enforcement's deportation system. As I read, I thought about the many times healthcare providers have brief encounters with patients, in a clinic or emergency room, where we offer treatment and advice with no insight into the larger context of his/her life. Check out William Finnegan's article, "The Deportation Machine" in The New Yorker. There are many different points where the subject of the story interfaced with the healthcare system. How little we really know about our patients.
The photos caused me to read the next article; they were of abandoned mental health hospitals, asylums, part of a project called "American Asylums: Moral Architecture of the 19th Century" by Jeremy Harris. Reminders of my student nurse days working in the state mental hospital, the memory brings a shudder. The photos and the article, "Schizophrenic. Killer. My Cousin," by Mac McClelland, were in Mother Jones magazine. This one is a must-read for anyone who has been paying little to no attention to mental healthcare in America. The mentally ill are no longer placed in giant, sprawling, secluded mental asylums; they are in giant, sprawling, secluded prisons. Big cost, little care. Where does normal end and crazy begin? For an in-depth look at that question, read "A Loaded Gun' by Patrick Radden Keefe in The New Yorker, the story of Amy Bishop, a neurobiology professor who shot 6 fellow faculty members, killing 3 of them. News reports made it sound as if she suddenly snapped. Well, maybe not.
For a change of pace, try some archeology. "Evolution of Creativity: The Rise of the Innovative Mind" by Heather Pringle can be found in Scientific American. It too comes with photos, but these are of artifacts from millions of years ago, early examples of technologic and artistic inventiveness. It's an uplifting reminder that we have within us the ability to invent our future, not so much because we are brilliant, but because we are well connected. Better together than alone. A message for all time.
Read. Read. Read. It can be a great travel distraction, and it can spark some out-of-the-box thinking.