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Listen to the patients

Theresa BrownDecember 6, 2009 -- Over the last year, Theresa Brown has posted some powerful items on the New York Times' prominent "Well" blog about her experiences as a new oncology nurse. These have included posts on the emotional dynamics of shaving the heads of cancer patients when they've lost a lot of hair; the pointless and even harmful things the medical community sometimes does to preserve life that cannot be preserved for long; and the negative effects that the current health insurance system can have on patients. But today Brown published an op-ed in her local newspaper, the Pittsburgh Post-Gazette, that makes a persuasive case for health insurance reform. The op-ed uses the examples of three specific patients confronting a health insurance system that does not seem to be designed to meet their needs, to say the least. Brown's piece is a good example of patient advocacy. But the op-ed is also helpful advocacy for nursing--though she says nothing directly about the profession--because it presents nurses themselves as articulate professionals looking carefully at the big picture and trying to improve health care financing structures that seem to threaten patients' lives.

The headlines for Brown's op-ed read:

Dear senators: Listen to the patients
Nurses hear health-care horror stories day in and day out
America can do better than this, says R.N. Theresa Brown

Brown briefly told the stories of three patients. The first was a man in his thirties with metastatic cancer. Brown explained that the man had good insurance coverage, but because he had recently moved back from out-of-state to be with his parents, the status of his coverage was unclear. Brown described the patient's mother "hiding in his bathroom, yelling into her cellphone, trying to get answers from his insurance company." Apparently, the mother spent three hours in "combative conversation" with the insurer, all of which her desperately ill son overheard.

The second patient apparently had no insurance coverage, at least for some drugs she needed. The patient had paid $300 out-of-pocket for IV antibiotics she would need at home, though she could not afford that. However, Brown explained, physicians had now prescribed at-home injections of a blood thinner that would cost the patient $1,300, and there was no way she could pay for it, even though it would be unsafe to go home without it. A friend asked Brown if there was some way the patient could be discharged with the injections. Brown's response: "Not officially. ... Not to say it couldn't be done." Brown noted that she was not actually the one who ultimately discharged the patient, which she said "spared me from having to decide how much I was willing to risk to get this incredibly kind woman the drugs she needed to stay alive."

The last patient was Brown's own 10-year-old daughter, who had recently hurt her wrist. Brown called her daughter's pediatrician to ask advice about whether to go to the emergency room. But before Brown could even describe the problem, the pediatrician's answering service

asked me not just if I had health insurance, but if I had "Company X" insurance. Their on-call triage center also had to confirm that my insurance was with "Company X." Our family does have "Company X" health insurance, but what if we didn't? I'm a nurse; at work I navigate the maze of modern health care on behalf of my patients, but that day, calling from home, I felt my anger rising. Since when was I required to verify my specific insurance coverage before I could leave a message for a doctor?

These experiences made Brown wonder "if this is really the world we want to live in." In her op-ed, she urged the opponents of reform to "listen to the stories patients have to tell," to compare the perspectives of friends who have private and public insurance (such as through Medicare or the VA), and then to consider whether "our piece-meal system of private insurance is really working as it should for everyone." Should people in the richest nation in the world "depend on the uncertain mercy of the health-insurance market"? Brown concludes:

A great nation has the courage to embrace decency, to do what is right. Our current health-care system is broken. Maybe if we listen to patients we will find our way to fixing it.

Whatever one's views of different proposed changes to the current U.S. health care financing system, Brown's op-ed is a lucid and persuasive plea to consider ways to improve that flawed system. But every piece of media created by a nurse also tells the public something about nursing. This op-ed shows that nurses are articulate patient advocates, professionals who help patients not just at the bedside, but also in public health communications with the potential to influence decision-makers. Nurses spend more time with patients than any other health professionals, and it is vital--for patients and for nursing--that nurses provide their unique perspective on health care issues to the rest of society, as Brown regularly does.

We commend Theresa Brown and the Pittsburgh Post-Gazette for this helpful op-ed.

See Theresa Brown's op-ed "Dear senators: Listen to the patients: Nurses hear health-care horror stories day in and day out. America can do better than this, says R.N. Theresa Brown" published December 6, 2009 in the Pittsburgh Post Gazette.

Also see Theresa Brown's posts on the New York Times "Well" blog.


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