Audio-book Review
By Chet Yarbrough
(Blog:awalkingdelight)
Website: chetyarbrough.blog
The Cost of Care (How Four Nurses Put Patients First in a Profit-Driven System)
Author: Theresa Brown
Narrated by: Donna Jay Fulks
Theresa Brown (PhD, BSN, Rn, Author, American clinical nurse.)
“The Cost of Care” is a somewhat frustrating book to review because it notes human faults that seem to dumb-down the profession of medical care in the United States. Like all products and services in America, cost is rising. Of course, a difference is that medical service is often a necessity rather than a choice. However, like all service organizations, some are managed well; others not.
Childbirth.
The first half of Brown’s book deals with childbirth and the costs and care for young families that choose to have children. Surprisingly, she finds Midwife birthing centers provide better care for pregnant mothers than most hospitals. She highlights Pittsburgh, Pennsylvania, and Portland, Oregon Midwife centers. She notes the counseling and care from “Midwife” birthing centers are less expensive, equally effective, and more comforting for both mothers and newborn than major hospitals. Brown criticizes hospital treatment of pregnancy as emotionally sterile, less patient centered, and less likely to offer the best care for mothers and the newborn. This is an observation by Brown who is educated and licensed as a registered nurse.
A major criticism is Brown’s recognition of what one might call hospital clericalization of health care.
There is a sense of medical treatment becoming a mechanical job by caregivers, including doctors and nursing professionals who show little empathy or expressed concern for their patients. Many who have been treated by doctors, nurses, or hospital admissions employees will recognize some of her criticism. Large organizations, like hospitals, are highly regulated by the States in which they exist. Standardization of service in hospitals is required to mitigate possible mistakes in medical treatment. However, Brown notes that standardization works against the care, comfort, and safe infant delivery offered by mid-wife operations.
The right to choose.
However, what the author ignores is the volitional control a patient or pregnant mother has in choosing a physician. Human beings, whether doctors, nurses, midwifes, or pregnant mothers vary in their attitudes, habits, and beliefs. Both patients and those who provide medical services are human. The best any person can do as a physician, nurse, midwife, or patient is influenced by their education and the life they have lived. A pregnant woman’s choice of service is up to her. Brown argues mid-wife’ deliveries show lower C-section rates, fewer induced births and episiotomies, and higher rates of vaginal births with infant outcomes that are equal or better than hospitals.
Brown suggests care for expectant mothers is diminished by hospitalization.
Few service organizations and their employees perfectly serve the public. If one is not satisfied with a particular physician or medical service, a patient’s options are to choose a different service, live with or self-cure their malady, or try to find another medical treatment service. If the medical facility is the only one in town and has rude or unresponsive employees, a patient’s options are to complain about the medical service to supervisors or owners of the facility. Complaints may or may not change anything but failure to register a complaint will only reinforce poor services of the company.
Aged American citizens.
Brown goes on to discuss medical services for aged American citizens. The majority of Americans cannot afford full-service retirement communities that cover all natural aging maladies of those over 65. Qualification for complete care retirement communities often exceed a net worth requirement of $1,500,000 while most aged Americans’ have net worths of less than $250,000. This economic reality makes ageing in place a necessity rather than a choice for most Americans.
Brown ends “The Cost of Care” with a practical, though ideologically idealized, idea of how to improve medical care in America. She argues for caregivers, particularly nurses, be trained to base their care on human relationship. Brown suggests focusing on a health care change in America. She argues for health care to be reorganized. Her book recommends insurance companies, medical services, and government administrations focus on creating a policy of “Medicare-for-all” that treats all elder and/or ill American citizens equally.
