Repairing Health Care: Building Relationships through Groups

Abstract

Our health care system is broken . . . or is it? "We must fix our health care system this year" is the message from the new administration. Our protocols and methods for providing care are based mostly on tradition rather than evidence. Costs are spiraling out of control; outcomes (at least for maternal- child health) are worse than comparable categories in other developed countries; and our population's general dissatisfaction with health care seems evident. It is hard to find anyone who would not say that the system is badly in need of repair and perhaps a total makeover. FROM EXAM ROOMS TO GROUPS The rapidly growing body of information and technology involved in even routine care means that from every direction there is a need for more patient education. Yet, in the name of productivity and cost containment, office visits are becoming briefer-a system that tries to do more in less time. An episode of I Love Lucy provides a humorous analogy to our health care system. In this episode, Lucy and Ethel get jobs wrapping individual pieces of candy in a candy factory. At first it's all smiles and fun, but then the conveyer belt starts to accelerate. They can't keep up and Lucy starts eating the candy. She soon winds up with a full mouth, full hands, and candy piling up, and she runs out of options. That is the picture of our health care system in many settings. How did we come to accept patient care as an assembly line? For most primary care, individual patients' needs are very similar; perhaps standardization seemed like a good idea. Take prenatal care. Each woman is weighed, has vital signs taken, and is asked, "Is everything the same? Is anything diff erent?" She is put into a room to take off her clothes; then she waits . . . and waits. In comes a busy provider who mostly looks at the chart. "Lie down and let me listen to the baby-sounds good, sounds like a boy, ha-ha." "Looks like everything is going well. Remember, you are only eating for two; your weight gain is a little high. Just watch the extra helpings and skip the sodas. The nurse will give you an ultrasound appointment. I'll see you in 2 weeks." Hand on the door, now looking at the woman, "Do you have any questions?" Two seconds later, "Okay then, take care." The chart joins a growing pile to get back to at the end of the day, or maybe tomorrow. Too bad the provider can't eat them to make the pile smaller, because she missed lunch, too. On the way to her car, the patient remembers that she wanted to ask about having a doula for labor and had some questions about breastfeeding. Oh well, she will ask next time. The same scene is repeated all day, all week, all year. The provider thinks about her next day off , or retirement, and wonders what really got done that day. The patient wonders how the little she got could take 2 hours. When I think of all those wave functions filling space, rich in potentials, accumulating more and more possibilities as they fan out, I wonder why we limit ourselves so quickly to one idea or one structure or one perception, or to the idea that "truth" exists in objective form. Why would we stay locked in our belief that there is one right way to do something, or one correct interpretation to a situation when the universe demands diversity and thrives on a plurality of meaning? Why would we avoid participation and worry only about its risks, when we need more and more eyes to be wise. Why would we resist the powerful visions and futures that emerge when we come together to co-create the world? Why would we ever choose rigidity or predictability when we have been invited to be part of the generative dance of life? ( Wheatley, 2006, p. 73) RELATIONSHIP BUILDING Relationships are the basis of our society. "While we humans observe and count separate selves, and pay a great deal of attention to the diff erences that seem to divide us, in fact we survive only as we learn how to participate in a web of relationships" ( Wheatley, 2006. …