The literary journal for the School of Medicine finally came out, in which I submitted an entry entitled, "A New Perspective" about my trip to a hospital in the Dominican Republic last summer. I'll include an excerpt so you can see where my thinking was going:
My next patient, in the orthopedic unit, was a man with a broken leg from a motorcycle injury. He needed surgery, but was waiting on his family to bring back a surgical screw from Santo Domingo. In the meantime, he was lying in bed with two gallons of water hanging from his foot—makeshift traction. He was not sure when he would be able to have surgery, but in the meantime he appeared comfortable and seemed to enjoy the company of other patients in the large, multi-bed room with him. [...] Although many of my classmates were gawking at the substandard level of care, I was able to see the truth: If these patients came to the United States, they wouldn’t receive care at all, except maybe in the Emergency Room after waiting several hours, and even then being looked down upon by hospital staff and hurried through the system to be thrust back to the curb. Maybe the Dominican Republic doesn’t have everything right in terms of health care, but neither does the United States. No matter where I am, there will be some people I can treat and some I cannot. Sometimes it will work and sometimes it won’t, even when the answer seems clear. But in every case, I have a responsibility to listen, smile, and pray with my patient, treating them as an individual and making their hospital experience seem as much like a home as possible. I am convinced that the Dominicans are much closer to mastering this skill than the best American doctors we have to offer.
As I read my entry again, one thought occurred to me: This is Cooper Green. Cooper Green is Jefferson County's hospital, run by government tax dollars (1% of sales tax, to be exact), to care for citizens with no insurance. Recently, there has been a debate around closing the hospital's inpatient side because funding cuts have been so severe that patients are not getting the care they need. This is true-- A fellow classmate of mine informed me a few weeks ago that they had run out of pillows, and I know they have run out of certain medicines as well. Yes, this is a huge problem, and I do believe that people deserve better care. What strikes me as dangerous, though, is that we are deluding ourselves if we think that this particular population of people will get better care. Sure, from the comfort of our own, middle-class American homes, it seems an abomination for a hospital to exist that can't even give our patients pillows. But what if some patients don't go to the hospital for pillows, or even cutting-edge medical care?
We refuse to accept health care, for ourselves or anyone else, if it is anything less than the best. That is why we produce top-notch doctors, medicines, and equipment here in the United States. But when we resolve to offer nothing less than the best, where does that leave the non-middle-class Americans? The dichotomy for us, when presented with "best" or "just okay", seems an easy decision. But if we come to grips with the fact that we have two dichotomies at war here-- the other being "just okay" or "there's nothing here for me"--does a role for "just okay" suddenly emerge? And if so, how do we define this substandard set of standards, so that we in medicine can maintain our Hippocratic oath of "Do no harm?"
