Hospitals and Health Care: The Ecotopian Way PDF

HOSPITALS AND HEALTH CARE: THE ECOTOPIAN WAY San Francisco, June 15. An unfortunate accident has given me the chance to observe Ecotopian hospital procedures first hand. I have been recuperating, the past few days, from a nasty gash. But I am mending well, and expect to be out of the hospital tomorr...

HOSPITALS AND HEALTH CARE: THE ECOTOPIAN WAY San Francisco, June 15. An unfortunate accident has given me the chance to observe Ecotopian hospital procedures first hand. I have been recuperating, the past few days, from a nasty gash. But I am mending well, and expect to be out of the hospital tomorrow, though I will have to take it a bit easy for a while. =. The greatest difference between Ecotopian hospitals and ours is in scale. Though the medical care I have received seems to be at the highest level of sophistication, from the atmosphere here I might be in a tiny country hospital. There are only about 30 patients all together, and we are practically outnumbered by the nursing staff (who, by the way, work much longer hours than ours, but in compensation spend as much time on vacation as they do on the job). X-ray, surgery, anesthesia, and other services seem to be fully as competent as ours, though the physical appearance of the hospital might strike an American as a bit rustic: the walls are not tile, and I missed the smell of disinfectant which I've always associated with hospitals. On the other hand everything seems clean and well cared for, and the doctors, though clearly unfamiliar with the expectations of American patients, are alert and seem well trained. In one respect the Ecotopians have taken a profoundly different direction than our modern hospitals. They do not employ electronic observation to enable a central nurses' station to observe many patients at once. The theory, as I have gathered it, is that the personal presence and care of the nurse is what is essential; and the only electronic gadget used is a small radio call set that can retrieve your nurse from anywhere on the hospital premises without bothering anybody else. The nurses are highly trained in a number of specialties unknown to ours, particularly massage, which they regard as important for stimulating the body's recuperative powers. Ecotopians are covered by a type of cradle-to-the-grave medical insurance which has had drastic effects on the medical system. Instead of control by the profession itself, the clinics and hospitals are responsible to the communities---normally to the minicity units of about 10,000 people. Thus the power of the physician to set his own fees has evaporated, though a doctor can always bargain between the salary offers of one community and another, and in fact doctors are reputed to have among the highest incomes despite the fact that they are much more numerous than with us. Doctors perform many duties that nurses or technicians perform in our more specialized system; on the other hand, nurses and technicians also perform a good many of the services that our doctors reserve for themselves. I have noticed that conversations among doctors, staff, and patients are a good deal livelier than in our hospitals; evidently the moral and scientific authority of the doctor has been diluted. Conditions can't be too miserable for the doctors, however, or more of them would leave the country; as far as I can tell, only a few hundred left at the beginning (mostly very high-income specialists) and none at all have left in recent times. Ecotopia does not import foreign-trained doctors to staff its hospitals, as we are still forced to do, because its medical schools were almost doubled in capacity immediately after Independence. My strength has not permitted me to do much investigating while hospitalized. However, the gravest problem of Ecotopian medicine would seem to be a dearth of really top-notch specialists. Specialists do exist, and are consulted on many occasions, but they are required to do general practice as well. This wasteful system is justified by the argument that it keeps them in touch with the medical needs of the people as a whole; but it clearly represents a serious reduction in the best utilization of specialist training and abilities. In fact some specialties have died out entirely. For instance, babies are usually delivered at home by nurse-midwives except in a few cases that present complications, and the hospitals have neither maternity wards nor obstetricians. Intensive-care units are also not developed as highly as in our hospitals. This clearly involves a certain hard-heartedness toward terminally ill or very critically ill patients, who cannot be kept alive by the incredibly ingenious technology American hospitals have. This may be partly an economic necessity, but also Ecotopians have a curiously fatalistic attitude toward death. They prefer to die at home, and elderly Ecotopians spend a good deal of time and energy preparing themselves for death. It is even said that, like American Indians, they can select the day of their death, and almost will themselves to die. At any rate, when they feel their time has come, they let it come, comforting themselves with their ecological religion: they too will now be recycled. On the other hand, the Ecotopian medical system has a strong emphasis on preventive care. The many neighborhood clinics provide regular check-ups for all citizens, and are within easy reach for minor problems that might develop into major ones. No Ecotopian avoids getting medical care because of the expense or the inaccessibility of health facilities. All Ecotopian doctors receive what we would call psychiatric training, though psychology and psychiatry no longer constitute separate fields. My doctor, thus, paid considerable attention to my psychic state as well as to my medical injuries. It is claimed that mental illness has shown a decline since Independence, but it would be extremely difficult to evaluate such claims because of the drastically altered circumstances. I can confirm, however, that Ecotopian streets are not enlivened by the numerous and obvious crazies we are familiar with in our cities. On the other hand, the security and confidence achieved by the Ecotopians with their dense, highly personalized style of neighborhood and extended-family living are bought at a substantial price in anonymity and freedom. Ecotopians have the feeling, I was told by one doctor, of "never being alone." The commonest psychiatric symptom for which people visit doctors, he told me, is having fantasies about solitude and about committing violent crimes. (It is a strange tribute to the ritual war games that it is mainly older people and women, who do not take part in the games, who are troubled by such violent impulses.) Some people find it helpful to take wilderness hiking trips by themselves, where they can be totally alone for weeks at a time. Still, it is doubtful if Ecotopians are happier than Americans. It seems likely that different ways of life always involve losses that balance the gains, and gains that balance the losses. Perhaps it is only that Ecotopians are happy, and miserable, in different ways from ourselves.