Notes From a Veteran in Retail Health
This is my third year working in a retail clinic. And considering that the concept is new, I feel like a veteran.
And as a veteran retail clinician, I have learned a few things about myself and
about healthcare in the United States and about working for a for-profit
corporation.
I will begin with myself since I am a person
in a society that generally considers "me" before anything else. And believe me
I am a member of that society. There are many good things for me as a NP in a
retail setting. Generally, our patients are not in life-threatening situations.
Their physical problems are mainly minor and what I mainly do is a lot of just
listening. Since I am good at this, I generally enjoy this part of seeing
patients. I don't enjoy the people who come in with the attitude that I am
being paid to give them an instant cure, generally an antibiotic. On my good
days I am able to educate and satisfy them without the magic pill. I like the episodic nature of the business.
In my last job, I had many chronically ill patients and while I learned to know
them, I was often frustrated dealing with chronic issues. I have "frequent
fliers" in the retail setting but for now, we don't deal in chronic care.
I like having days off during the
week. I guess most nurses have learned to enjoy weekdays off, since nursing is
generally not a Monday through Friday situation. I am having a lot of
difficulty with the long hours. I am not as young as I used to be and when I
work two 10-hour shifts back to back, I feel it. In a period of 48 hours, I am
awake, driving and working at the minimum 24 of those hours. And when I have to
stay late, as I have constantly had to do, I am eating, drinking and not
sleeping 28 of those 48 hours. For me, it is an exhaustion problem. For my
patients it could be a safely concern. I
wonder how many automobile accidents occur with retail clinicians, and others,
on day 2 of a two-day shift? Sounds like a good research idea. And of all my
complaints, and I love to complain, this may be the one that forces me to another
job search. I have come to dread leaving home when I know I have a marathon to
endure.
I could continue on and on about me
and I probably will since what I have to talk about next is my life as a nurse
in a retail setting in the state of health care in the United States. For over
40 years now, I have been in the healthcare profession. And I don't count
the years since I was four and I lived in the nursing home my mother owned. I
know the state of healthcare as well as anyone does. I have lived it. And it
is not a good or a fair state. Nothing in life is free and we all bear
responsibility for ourselves. But, as human beings we have a responsibility to
others as well. And I will not apologize
or do the liberal dance-about, this is just my opinion. If you don't care about
what happens to the sick, children and animals, in my book you don't deserve to
be called a human being and certainly not an American.
In healthcare today we
are schizophrenic in the old sense of the word. Split. One part of ourselves
feels that each person has the responsibility to care for their own health
needs and the other part refuses to let the sick child or the human being lying
in the road stay there. Both are good and moral ideals. But because of this
split, we all pay for poor healthcare at rising costs. And until we either
care for all or don't care for those who can't pay, healthcare costs will
continue to rise and healthcare will continue to be sick care. I don't know of
anyone who will admit to letting a bleeding person without money (i.e.
insurance) bleed to death. Societies, in
the past, have allowed this, as well as beggars in the streets and animals
sacrificed to angry gods. We call them barbarians or uncivilized. Funny how we
judge others and can't see ourselves. End of sermon. I come by this honestly,
since I graduated from Seminary and have been an ordained minister along the
way. So what does this have to do with retail healthcare? In the three years
I have worked there I have said and I am sure others say it: "I'm sorry, we don't
take your insurance" or "Our price for a visit is X" and watch people walk away.
Hopefully, these people have minor illnesses. But that does not mean much to a
mother whose child is in pain and whose only hope for stopping her child's pain
is either to give up about a weeks pay or sit all night in a hospital ER. It is
not right, it is not fair and it is not civilized. And being in retail healthcare brings it home to me.
Now, what I have learned about
corporations providing for-profit healthcare? First, I have to say I have
worked for corporations big and small, profit and nonprofit, religious and
nonreligious. And in my opinion, some of the least ethical have been the religious and non-profit. So, I do not have anything against making money.
And of all the institutions to come along, I think retail clinics are the most
honest about the for-profit motive of their being. We talk about convenience
and cost effectiveness and meeting the patients' needs. But we are up front that we
cost money. What worries me is when a corporation in retail clinics mixes up
the meaning of the word retail. By this I mean seeing retail as a definition
not a setting. And as our prices rise to "meet the market" and our companies
grow and the investors look for more profit and less investing, I am afraid of
the consequences. I fear that our companies will go the way of many hospitals
and forget about the health care in its effort to be more profitable.
Yesterday, I cried with a lady who was sick with no insurance since her
husband just lost his job. She didn't
have the money to see me. I gave her the number for a free clinic and the health department of
her county. She had already checked the Health Department out; no help. A stupid
name for something with no help, health department, sure. I told her if the
referral did not work out that the ER "had to see her." She tried to make ME feel better: "You have to be tough," "Things will get better." For 40 years
things have gotten worse. When are they going to get better?
This seems like the longest blog I
have written. And I think it is certainly the most personal. These are my
concerns, my feelings and my frustrations. It is not all of what working in a
retail setting is about. For a nurse/PA this can be a fulfilling and great
career. And retail clinics are proving that we have a place in caring for
people. If you are a research person,
look at the studies that have been done so far. And look at our statistics. But in any endeavor there are conflicts and personalities,
frustrations and paths to recognize and choose.
These are my quirky personality's observations of a growing and
changing entity in the context of a contentious period in healthcare. My
liberal dance begins and ends here.