Thursday, May 05, 2005

A Good Place to Die?

The hospital block, Rievaulx Abbey, Yorkshire - things are in a bad way with the UK National Heath Service right now

The world is already close to overflowing with Bean Counters and is getting fuller by the minute. Armies of serious wee people equipped with clipboards swarm around us asking stupid questions, observing, counting and documenting every area of human activity. Did you know the average person farts thirteen times each day? Yes somebody has counted. QED.

Once the information gathering is done, the data is passed to managers whose task is to collate and present the information. Now these people revel in job titles that include the word "manager" but collating and presenting information is the traditional skill of the clerk. And a clerk by any other name etc.

Nowhere are the Bean Counters more apparent than in hospitals where although there are several fewer processes to count than in a commercial operation they need more people to count that which is countable.

Perhaps this is just a warped perception because one does not expect to encounter Bean Counter in hospitals. In a commercial enterprise where profit is the goal, counting things many times is an essential act, as is (or was before the advent of computers) the copying of numbers from one piece of paper to another. Nobody ever looked at any of these pieces of paper of course, a thing cannot be of the slightest importance if somebody has time to write it down on a piece of paper. But the fact that there were lots of pieces of paper with numbers on made investors feel safe and comfortable. After all without pieces of paper to keep them in line the R & D geeks would spend all the revenue on gadgets, pizza and acne treatments.

Hospitals have a different culture however (or lots of different cultures if you look in the laboratory.) Bacteria do not follow any business process, road accidents have no regard for budgetary constraints.

A serious wee person with a clipboard saying "and where is the cost benefit in treating this patient" should not be part of our experience of an organisation whose function is to preserve life and alleviate suffering; when we are ill we need to be surrounded by angels in white uniforms applying unguents to suppurating sores, mopping fevered brows, stitching gaping gashes and administering tea and sympathy (no British person would ever under estimate the therapeutic properties of a nice cup of tea.) The last thing you want to see is a bunch of suits holding a meeting to assess the feasibility of reattaching your severed arm and ensuring your "clinical incident" does not consume more than its fair share of resources.

Hospitals now are goal driven profit centres, thus the goals are short term, do a quick fix and give out some happy pills, document that the patients condition has improved and send them home before they can relapse or worse still die. "For God's sake never let anyone die, it will impact on our targets," scream the Bean Counters.

Call me old fashioned if you like but I cannot see what is wrong with dying in hospital. I am prepared to take it on trust that the doctors and nurses do their very best and genuine cases of malpractice where somebody goes in with a broken toe and ends up missing a healthy kidney are rare. That said, it is a hospitals job to take in sick people. And sick people have a very inconvenient tendency to die. Everybody dies sometime.

Doctors have given the bloody minded a stick with which to beat them of course by chirruping self - righteously "our job is to save lives." As soon as a patient dies some opportunistic relative is bound to say "you failed to do your job. I'm going to sue!"

But all reasonable people understand that preserving life is not always possible so over the entrance to any hospital there should be a health warning "entering hospitals may well result in death." Hey presto, they are covered.

Instead, a few years ago some managers decided to eliminate death and start talking instead of negative patient outcome. Well I want to make it clear, I will never willingly be a negative patient outcome. There is nothing negative about dying in fact it is our very last positive act before we shuffle off this mortal coil.
To the clipboard wielding bureaucrats of course, the ultra - conformist enforcers of conformity death ought to be the great vindication, proof that in the end even the most committed anarchist must in the end conform and do as everybody else does. This is a double edged sword maybe, because to the existentialist anarchist death is the final pointless act and proves the pointlessness of life. Bureaucrats never see the big picture though.

In the final analysis I have to say I would rather begin my journey to the "unexplored land from whose bourne no traveller returns" from a hospital bed and surrounded by caring people standing by, ready to administer pain killers, a word of comfort and a final cup of tea than wait alone in some shabby senior-citizens-dwelling-unit for a cowled figure with a scythe over its shoulder to approach and say far too cheerily, "time to go matey - boy but cheer up, look at it this way; at least you have helped some junior bean counter deliver his targets.