Tag Archives: Quality

Melanie Phillips explains how feminism impacted the nursing profession

Dina sent me this article by Melanie Phillips from the UK Daily Mail.

Excerpt:

Last week, a devastating report detailing what can only be described as the widespread collapse of the ethic of nursing was produced by the Care Quality Commission.

This revealed that more than half of all hospitals in England do not meet standards for the dignity and nutrition of elderly people. One in five hospitals were found to be failing the elderly so badly that they were breaking the law.

In hospitals where essential standards were not met, inspectors found that patients’ call bells had been placed out of reach or were not responded to quickly enough, or staff were talking to patients in a condescending or dismissive way.

In one hospital, inspectors witnessed a patient being made to go to the lavatory in full view of the rest of the ward. In another, doctors had to prescribe water to make sure that patients did not  become dehydrated.

These horrifying revelations do not signify merely incompetence nor — that perennial excuse — the effect of ‘the cuts’.

No, they illustrate instead something infinitely grimmer: the replacement of altruism by indifference, and compassion by cruelty.

[…]Nursing was effectively created by that 19th-century feminist pioneer, Florence Nightingale. To her, nursing was in essence a moral act. In her book Notes On Nursing, published in 1860, she wrote that ‘the greater part of nursing consists in preserving cleanliness’.

That wasn’t just because hygiene was essential for recovery and health. It was because keeping both hospital and patients clean meant the nurse needed to be motivated by the most high-minded concern for the care and dignity of the patient.

Accordingly, lowly functions such as washing, dressing and administering bedpans were functions that were invested with the highest possible significance.

[…][D]uring the Eighties, nursing underwent a revolution. Under the influence of feminist thinking, its leaders decided that ‘caring’ was demeaning because it meant that nurses — who were overwhelmingly women — were treated like skivvies by doctors, who were mostly men.

To achieve equality, therefore, nursing had to gain the same status as medicine. This directly contradicted an explicit warning given by Florence Nightingale that nurses should steer clear of the ‘jargon’ about the ‘rights’ of women ‘which urges women to do all that men do, including the medical and other professions, merely because men do it, and without regard to whether this is the best that women can do’.

That prescient warning has been ignored by the modern nursing establishment. To achieve professional equality with doctors, nurse training was taken away from the hospitals and turned into an academic university subject.

Since caring for patients was demeaning to women, it could no longer be the cardinal principle of nursing. Instead, the primary goal became to realise the potential of the nurse to achieve equality with men. (The great irony is that more women than men are now training to be doctors in British medical schools, thus making this ideology out of date.)

In an important book on the nursing profession, Ann Bradshaw, a specialist in palliative care, described how this agenda removed caring, kindness, compassion and dedication from nurse training.

Student nurses now studied sociology, politics, psychology, microbiology and management, and were assessed for their communication, management and analytical skills. ‘Specific clinical nursing skills were not mentioned,’ she wrote.

In short, nursing ditched its core vocation to care. Bedbaths and feeding those who are helpless are tasks vital to the care of patients — but are now considered beneath the dignity of too many nurses.

Dame Joan Bakewell, the former government-appointed Voice of Older People, has suggested nurses be given ‘empathy training’. But, of course, you can’t train people in compassion.

Dame Joan was much nearer the mark when she observed that the decline in kindness and sympathy was linked to the decline in religious observance. In other words, the crisis in nursing is part of a far broader and deeper spiritual malaise.

Duty to others and respect for the innate humanity of every person have been eroded by the ‘me society’ of ruthless,  self-centred individualism.

This is something I have often thought about… what it would be like to go to a hospital filled with non-Christians who had no rational basis for morality and virtue. Especially in a single-payer system, where you couldn’t withhold payment if care was not of a good enough quality. When you put together secularism (removes the rational basis for acts of self-sactifice and the dignity of the individual) together with socialism (where the individual pays mandatory taxes and must seek products and services from a politicized, unionized government monopoly) then it becomes a scary situation indeed.

Feminism affects nurses in other ways, too

I think I’ll just paste some more about these British nurses here, from Theodore Dalrymple’s book “Life at the Bottom” – even though it’s a little off topic.

All the more surprising is it to me, therefore, that the nurses perceive things differently. They do not see a man’s violence in his face, his gestures, his deportment, and his bodily adornments, even though they have the same experience of the patients as I. They hear the same stories, they see the same signs, but they do not make the same judgments. What’s more, they seem never to learn; for experience—like chance, in the famous dictum of Louis Pasteur—favors only the mind prepared. And when I guess at a glance that a man is an inveterate wife beater (I use the term “wife” loosely), they are appalled at the harshness of my judgment, even when it proves right once more.

This is not a matter of merely theoretical interest to the nurses, for many of them in their private lives have themselves been the compliant victims of violent men. For example, the lover of one of the senior nurses, an attractive and lively young woman, recently held her at gunpoint and threatened her with death, after having repeatedly blacked her eye during the previous months. I met him once when he came looking for her in the hospital: he was just the kind of ferocious young egotist to whom I would give a wide berth in the broadest daylight.

Why are the nurses so reluctant to come to the most inescapable of conclusions? Their training tells them, quite rightly, that it is their duty to care for everyone without regard for personal merit or deserts; but for them, there is no difference between suspending judgment for certain restricted purposes and making no judgment at all in any circumstances whatsoever. It is as if they were more afraid of passing an adverse verdict on someone than of getting a punch in the face—a likely enough consequence, incidentally, of their failure of discernment. Since it is scarcely possible to recognize a wife beater without inwardly condemning him, it is safer not to recognize him as one in the first place.

This failure of recognition is almost universal among my violently abused women patients, but its function for them is somewhat different from what it is for the nurses. The nurses need to retain a certain positive regard for their patients in order to do their job. But for the abused women, the failure to perceive in advance the violence of their chosen men serves to absolve them of all responsibility for whatever happens thereafter, allowing them to think of themselves as victims alone rather than the victims and accomplices they are. Moreover, it licenses them to obey their impulses and whims, allowing them to suppose that sexual attractiveness is the measure of all things and that prudence in the selection of a male companion is neither possible nor desirable.

Often, their imprudence would be laughable, were it not tragic: many times in my ward I’ve watched liaisons form between an abused female patient and an abusing male patient within half an hour of their striking up an acquaintance. By now, I can often predict the formation of such a liaison—and predict that it will as certainly end in violence as that the sun will rise tomorrow.

At first, of course, my female patients deny that the violence of their men was foreseeable. But when I ask them whether they think I would have recognized it in advance, the great majority—nine out of ten—reply, yes, of course. And when asked howthey think I would have done so, they enumerate precisely the factors that would have led me to that conclusion. So their blindness is willful.

You see, feminism also has the effects of telling women that there are no special roles that men are meant to perform, like provider, protector, moral leaders, spiritual leader. And when more and more women grow up in fatherless homes where money comes in from the government, and morality and spirituality are taught in public schools, it becomes harder and harder for women to have the wisdom to choose good men. Instead, they end up choosing men who are attractive and entertaining, using the 180-second rule.

You can read the entire Dalrymple book on moral relativism online. I posted links to the full text of Theodore Dalrymple’s “Life at the Bottom”.

Indiana voucher program offers hope to low-income students

From the Courier Press, news of the latest success for Republicans in their long war against public sector teacher unions.

Excerpt:

Kristy Wentworth of Evansville said she was never dissatisfied with public education, and her three children, who attended schools in the Evansville Vanderburgh School Corp., were making good grades.

But when friends told her about Indiana’s new private school voucher program, she was intrigued.

After some discussion, Wentworth enrolled her children this year at Evansville Lutheran School, which is near her home. It didn’t take the single mother long to decide her choice was correct. Her children — who are in grades 7, 6 and 4 — are thriving at Evansville Lutheran. Wentworth noted the school’s small class sizes, and she marveled at the frequent communication she receives from her teachers.

“They come home from school excited, they leave for school excited. They can’t wait to get there,” Wentworth said. “(The school) encouraged them to sign up for Boy Scouts and volleyball, and on the first night they made the kids feel so welcome.”

Wentworth recently lost her job, and she said she couldn’t have afforded a private school without the voucher program, which proponents say helps overall educational achievement and closes achievement gaps along socioeconomic lines.

And these private schools help children to perform better in testing.

Can greater competition among schools help? That’s what state education officials are banking on. While scars from the lengthy spring debate over vouchers heal, they are encouraging local school districts to embrace the new environment.

Local nonpublic schools have courted voucher students. As of Friday, 114 were awarded to students in the EVSC district — the fourth highest number in the state.

Officials with the EVSC, meanwhile, point to recent academic progress, its network of community partnerships aimed at meeting students’ most fundamental needs and classroom innovations.

Delaware Elementary School, which is in the same neighborhood as Evansville Lutheran, has made strides in several areas in a short period of time, said Heather Ottilie, parent of a Delaware third-grader.

Delaware is in its second year as an EVSC “equity school.” Along with two other schools of similar socioeconomic demographics — McGary Middle School and Evans School — Delaware is free to have longer school days and longer school years and has more leeway in curriculum and rules. The three equity schools all showed gains on the spring ISTEP.

Ottilie said Delaware has placed heavy emphasis on independent reading. Other innovations include the use of netbook computers and iPod Touches in classrooms, world language instruction and new learning programs such as LEGO robotics, which emphasize problem-solving skills.

“I love it,” Ottilie said. “Everything is hands-on … the kids aren’t just doing worksheets.”

What is the conservative plan to help the poor? Is it wealth redistribution? Does that even work? Or is there a way to produce better results for the poor through free market capitalism? Those who advocate big government never bother to ask these questions. For those who take the time to study economics, the answer is clear – what works to reduce costs and raise quality is choice and competition.

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New survey finds that Canadian health care system quality is declining

Map of Canada
Map of Canada

A story about a recent survey on Canada’s universal health care system, from the National Post.

Excerpt:

A new survey on attitudes about the health-care system reveals some interesting responses, confirming that Canadians have widespread misgivings about the system, even while not fully understanding how it works. They also favour using tax incentives to encourage healthier living and eating.

The survey of 2,300 Canadians carried out in April by the consulting firm Deloitte was part of a larger poll covering 12 countries. It is considered accurate to within two percentage points, 95% of the time.

Some of the highlights include:

– Just 5% of respondents gave the system an A grade; 45% giving it a B, 36% a C, 10% a D, and 4% a failing F.

– 33% of Canadians said they understood how the system works, down from 39% in 2009 when Deloitte did a similar survey.

– 69% feel that the system has not improved in the last two years, while there were slightly more who thought it had deteriorated, as opposed to improved, in that period.

– 36% believe that half the money spent on health care is wasted; interestingly, half of those skeptics blame the waste on people failing to take responsibility for their own health.

– 13% reported that they are caring for another person, up from 10% in 2009, a possible sign of the increasing personal burden posed by the aging population. In a third of those cases, the individual is caring for a spouse.

– 55% rated their health as excellent or very good … even though 52% report having been diagnosed with one or more chronic diseases.

– 63% favour some kind of tax-based incentive to encourage more healthy diets and lifestyles.

– About 80% favour expanding medical-school enrollments to increase the supply of doctors.

You can find some more videos describing horror stories in the Canadian system in this previous post.

Everyone agrees that the American health care system is too expensive, but do we at least get better quality outcomes? Let’s see.

How good is the American health care system?

Consider this article from the Hoover Institute at Stanford University.

Medical care in the United States is derided as miserable compared to health care systems in the rest of the developed world. Economists, government officials, insurers, and academics beat the drum for a far larger government role in health care. Much of the public assumes that their arguments are sound because the calls for change are so ubiquitous and the topic so complex. Before we turn to government as the solution, however, we should consider some unheralded facts about America’s health care system.

1. Americans have better survival rates than Europeans for common cancers. Breast cancer mortality is 52 percent higher in Germany than in the United States and 88 percent higher in the United Kingdom. Prostate cancer mortality is 604 percent higher in the United Kingdom and 457 percent higher in Norway. The mortality rate for colorectal cancer among British men and women is about 40 percent higher.

2. Americans have lower cancer mortality rates than Canadians. Breast cancer mortality in Canada is 9 percent higher than in the United States, prostate cancer is 184 percent higher, and colon cancer among men is about 10 percent higher.

3. Americans have better access to treatment for chronic diseases than patients in other developed countries. Some 56 percent of Americans who could benefit from statin drugs, which reduce cholesterol and protect against heart disease, are taking them. By comparison, of those patients who could benefit from these drugs, only 36 percent of the Dutch, 29 percent of the Swiss, 26 percent of Germans, 23 percent of Britons, and 17 percent of Italians receive them.

4. Americans have better access to preventive cancer screening than Canadians. Take the proportion of the appropriate-age population groups who have received recommended tests for breast, cervical, prostate, and colon cancer:

  • Nine out of ten middle-aged American women (89 percent) have had a mammogram, compared to fewer than three-fourths of Canadians (72 percent).
  • Nearly all American women (96 percent) have had a Pap smear, compared to fewer than 90 percent of Canadians.
  • More than half of American men (54 percent) have had a prostatespecific antigen (PSA) test, compared to fewer than one in six Canadians (16 percent).
  • Nearly one-third of Americans (30 percent) have had a colonoscopy, compared with fewer than one in twenty Canadians (5 percent).

5. Lower-income Americans are in better health than comparable Canadians. Twice as many American seniors with below-median incomes self-report “excellent” health (11.7 percent) compared to Canadian seniors (5.8 percent). Conversely, white, young Canadian adults with below-median incomes are 20 percent more likely than lower-income Americans to describe their health as “fair or poor.”

6. Americans spend less time waiting for care than patients in Canada and the United Kingdom. Canadian and British patients wait about twice as long—sometimes more than a year—to see a specialist, have elective surgery such as hip replacements, or get radiation treatment for cancer. All told, 827,429 people are waiting for some type of procedure in Canada. In Britain, nearly 1.8 million people are waiting for a hospital admission or outpatient treatment.

7. People in countries with more government control of health care are highly dissatisfied and believe reform is needed. More than 70 percent of German, Canadian, Australian, New Zealand, and British adults say their health system needs either “fundamental change” or “complete rebuilding.”

8. Americans are more satisfied with the care they receive than Canadians. When asked about their own health care instead of the “health care system,” more than half of Americans (51.3 percent) are very satisfied with their health care services, compared with only 41.5 percent of Canadians; a lower proportion of Americans are dissatisfied (6.8 percent) than Canadians (8.5 percent).

9. Americans have better access to important new technologies such as medical imaging than do patients in Canada or Britain. An overwhelming majority of leading American physicians identify computerized tomography (CT) and magnetic resonance imaging (MRI) as the most important medical innovations for improving patient care during the previous decade—even as economists and policy makers unfamiliar with actual medical practice decry these techniques as wasteful. The United States has thirty-four CT scanners per million Americans, compared to twelve in Canada and eight in Britain. The United States has almost twenty-seven MRI machines per million people compared to about six per million in Canada and Britain.

10. Americans are responsible for the vast majority of all health care innovations. The top five U.S. hospitals conduct more clinical trials than all the hospitals in any other developed country. Since the mid- 1970s, the Nobel Prize in medicine or physiology has gone to U.S. residents more often than recipients from all other countries combined. In only five of the past thirty-four years did a scientist living in the United States not win or share in the prize. Most important recent medical innovations were developed in the United States.

Despite serious challenges, such as escalating costs and care for the uninsured, the U.S. health care system compares favorably to those in other developed countries.

The author of that article is a senior fellow at the Hoover Institution and a professor of radiology and chief of neuroradiology at Stanford University Medical School.

So, we saw that the quality of the U.S. health care system is good, but how can we lower the costs? Is government controlled rationing (like Canada) the answer, or is there another way?

Choice and competition in health care

The Center for Freedom and prosperity seems to have found another way: choice and competition.

Excerpt:

In many ways, America’s health care system is the best in the world. It has state-of-the-art technology and highly-skilled medical professionals. America is also home to most of the cutting-edge medical research in the world. However, there are also important problems, such as the “third-party payer” model where consumers rarely pay the full cost of their own health care. This creates an incentive for both excessive and expensive use of health care, a problem that would be exacerbated by current proposals for greater government control of the health care system.

But the third-party payer problem is not the only reason that health care costs are high. State governments impose health insurance coverage mandates, often for “gold-plated” coverage, that drive up the cost of insurance. These regulations, which are unique to each state, are imposed at the behest of interest groups seeking to increase demand for their services. Combined with protectionist barriers that prevent consumers from buying policies from providers in other states, these mandates have severe unintended consequences:

  • They limit competition in the health insurance market by preventing insurance buyers from shopping across state lines, creating monopolistic and oligopolistic situations in many states;
  • They impose coverage mandates that force health insurance buyers to purchase coverage that they either do not want or cannot afford;
  • They force insurers to use community rating instead of experience rating, which means healthy people are forced to subsidize unhealthy people – to the effect that insurance premiums rise for many buyers and healthy people are driven out of the market.

The symptoms of a dysfunctional health insurance market – foremost the significant number of uninsured, but also rising costs – are recognized by many legislators. But the problem cannot be solved, as some suggest, by means of increased government regulation. Indeed, government regulation is the cause of most problems in the health insurance market, not the solution.

Restoring a free market health care system would be a daunting task, one that would involve, 1) sweeping reforms to the 45 percent of health care directly financed by government programs, and 2) a complete rewrite of the tax code to remove the distortions that exist in employer-provided health insurance. This paper focuses on the so-called third leg of the stool – policies to remove government barriers and restore competition to the market for individual health insurance.

Reforming the government-financed programs is definitely necessary because there is so much fraud and waste, as there always is with government, when compared to the private sector. Private sector businesses have to turn a profit, so they actually try to prevent fraud and waste.

Here’s a documentary featuring John Stossel that explains the health insurance problem. (And featuring Regina Hertzlinger, too)

Part 1 of 5:

Part 2 of 5:

Part 3 of 5:

Part 4 of 5:

Part 5 of 5:

Choice and competition govern the way we buy things that we want normally, especially when we buy things online. I am pretty happy buying things from online retailers, because I have so many stores to choose from, with lots of product reviews and retailer ratings. I usually like what I buy, because I know that I am buying a good product from a good seller. And if I don’t get a good outcome, I can leave a review of the product, service or seller as a warning for the next person. That helps to encourage producers to make quality products and services Seller rating helps to make sellers care for customers, and to accept returns on items that don’t perform. Maybe we should do that with health care, and just leave health insurance for catastrophic care – like car insurance is for accidents, but not for oil changes.