Health Care's Elusive Simplicity
By Craig B. Garner
Founder
Garner Health Law Corporation
Original Publish Date: October 4, 2022
“Out of intense complexities, intense simplicities emerge.” -- Winston Leonard Spencer Churchill
The How And Why
The thermometer remains the preeminent device to measure temperature, and specifically for health care practitioners to identify the existence of fever. Evolving over 17 centuries, today the thermometer comports with the International Temperature Scale of 1990 (ITS-90), the standard set by the International Committee of Weights and Measures, superseding the International Practical Temperature Scale of 1968, as amended, although altered ever-so-slightly by the Provisional Low Temperature Scale of 2000 (PLTS-2000). This basic diagnostic test, whether directed toward oral, rectal, tympanic, temporal artery or axillary, is typically digital, replacing glass and mercury from the past.
Measuring the pressure of circulating blood against the walls of blood vessels is also common to ascertain the efficacy of any cardiac cycle, calculated by the maximum pressure during an individual heartbeat (systolic) as well as the minimum pressure between two heartbeats (diastolic). Temperature and blood pressure, combined with the rate at which breathing occurs (respiratory rate), the frequency of the heartbeat over the course of 60 seconds (heart or pulse rate), and the concentration of oxygen dissolved in a particular medium (oxygen saturation), provide necessary and fundamental information at the beginning of most hospital stays.
From humble origins, the hospital institution deploys basic diagnostic procedures through a handful of health care practitioners, the combination of which serves as the fulcrum for treating practically any illness or injury. Indeed, the simplicity of health care explains, in part, why for much of the population life begins and ends inside the four walls of a hospital. Today the practice of medicine even transcends science fiction through advances in technology, including surgical instruments attached to robotic arms or the removal of part of the skull so that computers and radiological modules can reach precise locations within the brain. Still, health care appropriately remains myopic, focusing on matters of life and death.
The Now
What could be more important than matters of life and death? Depending upon the part of the nation, and to a greater extent the world, from which this question originates, apparently quite a lot.
Clean water remains an integral part of health care, although such a connection was not made until 1848 when a Hungarian doctor working at Vienna General Hospital tried to reduce the number of maternal deaths. Forgoing the leading theory that miasma (bad smells) spread disease, Ignaz Semmelweis ordered doctors to wash their hands and instruments in a special chemical solution to reduce high mortality rates. As a result of these hand hygiene practices, the mortality rate for new mothers dropped from 18 percent to 1 percent, although it took another forty years before health care overall embraced such forward thinking.
Dr. George Holtzapple first used oxygen for medicinal purposes in 1885 to treat pneumonia. While the use of oxygen in health care increased during the first half of the twentieth century, portable oxygen made its debut in the 1950’s in ambulances and on location at medical emergencies. Medical grade oxygen has been the standard since the 1970’s.
Water and oxygen, however, can be precious commodities on occasion in the United States, while an estimated two billion people around the world lack access to clean water at hospitals. In August 2022, 150,000 residents of Jackson, Mississippi could no longer access drinkable water when flooding damaged a critical pump at the city’s main treatment facility. Following years of unresolved concern, in January 2016 the Governor of Michigan, followed by President Obama two weeks later, declared a state of emergency in Genesee County due to the lead in Flint’s drinking water. COVID-19 exposed world-wide cracks in the deployment of oxygen as demand spiked exponentially, rendering the chemical element also known as atomic number 8 a precious commodity in certain countries and the United States.
The Disconnect
Historical knowledge does not always translate into institutional practice, and the same applies to maintaining a sufficient number of health care practitioners within the hospital. On April 1, 1964, the parliament of the Kingdom of Belgium announced to the country that physicians had started a “total and unlimited strike” that sent its health care system into a state of shock. Well-coordinated and widespread, the organizers of the Belgian physician strike had both the foresight and compassion to maintain a section of physician “guards” whose job it was to remain on active duty at all hospitals in the event of a medical emergency. A few years before and several thousand miles away, doctors in the Canadian province of Saskatchewan went on strike for 23 days, having first given the government plenty of advance warning to bring in doctors from other countries as well as other Canadian provinces. The United States narrowly avoided a similar fate in 1965 by passing a handful of statutes that expanded over the past 57 years to become modern day Medicare.
The shortage of registered nurses in California puts patient care and hospital solvency at risk even before taking into consideration state-mandated patent/nurse ratios. Recognizing the collateral damage caused by COVID-19 on the national health care workforce, neither side of the debate over nursing unions, much less those in favor of, or against, the practices of the California Board of Registered Nursing, have an immediate solution to the estimated 41,000 registered nurses needed statewide.
Wants v. Needs
The notion that inherent needs within an industry fail to connect with industry wants is not unique to health care. Likewise, the magical properties of historical hindsight can cast a spotlight on successes and failures in almost any topic of discussion. Perhaps one of health care’s greater challenges is the ability to observe its functionality in the context of a long enough timeline, the blame for which cannot be attributed to COVID-19’s “brain fog”.
The patient “needs” in health care no longer match provider and practitioner “wants”, and the practical implications of this impasse appear to be incomprehensible. Catastrophic institutional failure in health care seems just as unlikely as a hospital without clean water, oxygen and health care practitioners. Partisan politics bears at least some blame for pulling attention away from the delivery of health care and diverting it in the direction of separate yet inextricable issues such as minimum wage directives and construction-related requirements. At the same time, anyone who has been in the past, or potentially can be in the future, a hospital patient shares culpability by not understanding the very system on which he or she may come to depend as it relates to matters of life and death.
The idea of access to health care should be a simple concept, although the enigma in which health care leaders are befuddled is dangerously close to entangling patients as well. Previously sacrosanct, the stability and safety of hospitals is no longer a societal assumption. Somewhere within the great unknown may still exist a different way to deploy health care services without the hospital institution at the center, as well as the possibility of a hospital meeting the needs of its community with depleted resources such as water, air and practitioners. Such discussions, however, will only occur once society accepts that health care may be just as vulnerable as its patients. For now at least, health care remains incredibly simple: When sick, go to the doctor. When very sick, go to the hospital.
Craig Garner is the founder of Garner Health Law Corporation, as well as a healthcare consultant specializing in issues pertaining to modern American healthcare. Craig is also an adjunct professor of law at Pepperdine University School of Law. He can be reached at craig@garnerhealth.com.