Transparency : Can we talk openly about the abysmal disconnect?

The continuing error/saga of  management’s  cost cutting over service provision in  a public hospital. The  mainstream media reported latest CCDHB action.

“Dr Jimenez left Wellington blaming hospital management as one of the main reasons for resigning.He also said the  Capital & Coast DHB,  management “lacked vision” and prioritised cost-cutting.District health boards and the Ministry of Health had been “irresponsible” in not stepping up their attempts to keep &  train more Kiwi doctors in specialist fields.

There IS an “abysmal disconnect” between clinicians and management.

“Doctors are not empowered to make changes or grow services, as the decision-makers are more interested in cost savings over service delivery.””Stuff.co.nz

This story is repeated each time an intelligent reputable  specialist gets imported (at great cost) and upon assessment wants to improve unsafe and unsatisfactory areas of his/her health care.

If the problem is management, training more NZ drs as specialists (is good but) is not the solution. Management is the problem. In my other blog I posted the point drs have  exact same problem with management in the USA, they say hospital management are un receptive, they dictate and make medical decisions as funding  decisions leaving the dr to obey/mop up.

Hospital management in NZ  dictate  denial of  services for cost cutting  in the USA management  dictate more than needed services to make more money. Both USA & NZ hospital management systems are about profit$ for some shareholders.

I say a good start to the solution of disconnect is to get rid of the unresponsive  dictators  that are “hospital management” decision makers  that do not care about or support the provision of gold standard health services they just care about money and profit .

Unfortunately in the  health system the same disconnect  exists between Doctors  &  patients.  The dr /patient relationship holds the same dysfunctional disconnection pattern  we can see in the management/doctors relationship .

The next thing would be to allow transparency for the patients who  are ultimately the real ( but currently dis-empowered) funders.


“Rehabiliation” or Rehabilitation

NZ rehabilitation crew had a meeting to decide (amongst themselves) that  they should be the ones that continue to set the rehab goals for the patient.

Power and control were the key words used .

Goal setting is not a receptive or co operative process it is done by the “health provider”.

The rehab staff do not make funding decisions and what the funder will fund determines the “goal” that is set. I.E if the funder will not pay for someone to be washed (when they really need help) then the goal set will be to make the person wash themselves.If the patient does not meet the goal set by the funder/provider then often the provider will lie about the patients abilities and functioning.

If you want to empower anyone you do not dictate your  goals.


What battle?

I  had read to me a  story about a man in the UK who had a severe TBI  http://www.mirror.co.uk/news/real-life-stories/jack-martindale-lay-coma-30-4489462  .Summary: this man  got medical care,   treatments,  and a year of inpatient TBI rehab,  found he had hypergraphia (triggered by his temporal lobe DIA)  and so   wrote a  book about his ” battle with TBI” . There is and can be no battle with TBI   it is an injury to the brain. How can you battle an injury to the brain ?

*Unfortunately in New Zealand needed  medical care, treatments and rehab for most people who have a severe TBI  remains an unmet need. And the NZ medical system’s negative&  ignorant  thinking/views about  the  TBI patient being a burden are often taken on by a family (while they are in shock).

The title of his book must reflect his the battle within. Perhaps  he was identifying with  then fighting  his newly created egocentric self  .  Many people, following a severe TBI,  do not regain memory/bodily  functions cannot go back to school and graduate (thus be seen as “socially successful”). In that the book sends the message, if you can do what you did before the TBI , then you will be viewed by the world as “successful”  then with those conditions of “normalcy” will you have won the  battle with TBI.  If you look to the world to define success for you  and tell you what success is you will always be disappointed and always feel incomplete(unsuccessful).

Where does the meme of the book  leave the rest of us with severe TBI  are we  to be judged “unsuccessful ”  in wheelchairs or lurching across the sidewalk like a drunken sailor, unable to feed ourselves or remember things that happened a few minutes ago , but we are here now  -teaching compassion for any that have eyes to see.

In a TBI physical and mental  abilities are either gone, are relearned fully or partially if consciousness allows for access to memory function(gamma waves in the field of energy).  You cannot “battle” memory loss.  The brain as like a radio it  picks up frequencies and  the more negative( lower range) you are “the worse your tuning  is”.

Fact: Memory is not stored in the  brain.

Most neurologists have been taught and believe many theories about the brain(  theory of memory, theory of how the neurons communicate  & theory of  no “plasticity”   which have been proved incorrect) they  cannot answer the big questions . No answers as to how  it possible that a person can destroy the  brain’s (so called)  “language centers  Broca’s area  and  Wernickes  area “and yet still retain the memory (ability)to  speak.?How is it that  that people born without a  cerebellum ( a region of the  brain that is said to play an important role in motor control )have motor control  function as though they have one?. Why did that person with a TBI  start speaking a different language, one that they did not know before the TBI ?