Stewardship is a polite way of saying accountability. Attached to accountability must be a system of rewards and punishments which ensure accountability. The rewards and punishments sequester responsibility. Big business does not like this because they have learned that responsibility eats into profits. We can use all the buzz words we want but not much will change until big business is taken out of medicine.
This was excellent. It’s too bad that the one who usually suffers is the one at the bottom of the decision making process. Patients are dependent on their primary care providers for knowing their condition and prescribing the correct treatment plan, working with the patient to see if that is working and making adjustments as needed. I’m a retired home health psychiatric RN. I saw many patients who desperately needed adjustments in their care plans—some ongoing PT or OT at home, maybe some in home visits by a nurses aide to help with bathing, meals on wheels. If pain was an issue, the patient and the pcp would discuss options and assess effectiveness. Often this did not happen. MDs or ANPs were often required to see too many patients per day to have an adequate amount of time for proper assessments. Insurance companies where the treatments were reviewed often not by MDs but by people reading a list of symptoms and diagnoses (this was my experience more times than I care to think about) and often it was quite apparent that the bottom line was the most important thing. Any mental health diagnosis complicated the matter. The idea of shared responsibility in healthcare is a wonderful idea, and the patient’s responsibility is often dependent on the resources available to them and the knowledge of where and how to get them. Until patients are able to access those resources, nurses and doctors are able to have the time to look at the whole person, and insurance companies give their employees adequate training and resources and aren’t so quick to look at their bottom line (this includes the hospital executives too) then shared responsibility remains a distant goal.
Stewardship is a polite way of saying accountability. Attached to accountability must be a system of rewards and punishments which ensure accountability. The rewards and punishments sequester responsibility. Big business does not like this because they have learned that responsibility eats into profits. We can use all the buzz words we want but not much will change until big business is taken out of medicine.
What a concept! Responsibility shared at many levels. Nobody has to bear it alone.
This was excellent. It’s too bad that the one who usually suffers is the one at the bottom of the decision making process. Patients are dependent on their primary care providers for knowing their condition and prescribing the correct treatment plan, working with the patient to see if that is working and making adjustments as needed. I’m a retired home health psychiatric RN. I saw many patients who desperately needed adjustments in their care plans—some ongoing PT or OT at home, maybe some in home visits by a nurses aide to help with bathing, meals on wheels. If pain was an issue, the patient and the pcp would discuss options and assess effectiveness. Often this did not happen. MDs or ANPs were often required to see too many patients per day to have an adequate amount of time for proper assessments. Insurance companies where the treatments were reviewed often not by MDs but by people reading a list of symptoms and diagnoses (this was my experience more times than I care to think about) and often it was quite apparent that the bottom line was the most important thing. Any mental health diagnosis complicated the matter. The idea of shared responsibility in healthcare is a wonderful idea, and the patient’s responsibility is often dependent on the resources available to them and the knowledge of where and how to get them. Until patients are able to access those resources, nurses and doctors are able to have the time to look at the whole person, and insurance companies give their employees adequate training and resources and aren’t so quick to look at their bottom line (this includes the hospital executives too) then shared responsibility remains a distant goal.
Excellent commentary! Shared responsibility! Not a blame game, a real conversation to help care get better👍