My Letter to Healthcare

Dear Healthcare System,

 I have to admit.  You never dazzled me at the beginning.  Throughout my college career, I was bound and determined to work in a school system with children.  That was my career goal.
 
My hospital externship provided my first insight into that world of not only the healthcare system, but adult therapy.  My beginnings with dysphagia therapy, were quite frankly disgusting and completely unappealing to me.
 

Something changed in that externship and I discovered that the world of adult therapy could be quite rewarding and found that I actually enjoyed it.  A passion and respect grew for that intricate system that is responsible for swallowing solids and liquids.  A system that can be quite fragile.

 

I tried my hand in the school system, however my love for the medical field continued to grow.  I became extremely fascinated by the brain, muscles and cranial nerves.  Medications, lab values, tests, disease processes quickly became the area that I sought to learn as much as I possibly could.

 

Somewhere, dear healthcare system, my passion has dimmed.  I continue to love my patients and have a passion for the swallowing process.  You have failed me with your demands.

 

Productivity feels like a roadblock that I can never conquer.  My value as a therapist should be considered by my outcomes or effort to achieve those outcomes.  Instead, my value is based on my productivity.  It doesn’t matter that I never sat down the entire eight hour day, that I skipped lunch or documented through my session.  The time I spent educating nurses and family members can’t count because the patient wasn’t present.  Designing programs and learning new techniques to improve patient outcomes no longer matters.  What matters?  How many minutes I spent during the day with direct patient care or billable minutes.

 

COTS, RUGS, assessments, therapy caps and G-Codes haunt me.  Patients that aren’t appropriate for 45 minutes of therapy are put on my schedule for 50 minutes.  Patients that require more speech minutes are put on my schedule for 30 minutes and heaven forbid, someone is sick or just doesn’t want to participate in therapy that day.   I shouldn’t go over the given number of minutes because that’s just providing free therapy and we don’t do that.

 

Somewhere along the line we have lost our purpose.  Documentation and reimbursement have shadowed patient rights and needs.

 

We “justify” our therapy through our documentation.

 

I have lost my clinical judgement.  Sometimes, I’m not given permission to discharge a patient who has met their max potential and am probed as to whether I have tried “everything possible” with this person.

 

We are told to document throughout lunch, however we have to clock out for lunch because it is required.  It is suggested that we clock out before completing documentation because we should have documented during the session.

 

I can no longer abide by this human factory of herd the patients in and out, document, document, document.  I want my worth as a Speech Language Pathologist to be measured by the number of patients I help increase quality of life.  I want my worth to be measured by the patients that I help return to their prior level of function.  I don’t want to get called back into the office to talk about how to boost my productivity.

 

So, my dear healthcare system, I will be leaving you.  I am returning to that long forgotten land of school systems, where I may have a large caseload, but my worth is not measured in the number of students I see everyday.  It’s the quality of service I provide those students.  Until healthcare can return to that level and I’m allowed to provide services required by my patients, I bid you a fond farewell and a fond farewell to the dress code (color specific) I detest!

One thought on “My Letter to Healthcare

  1. Brava Tiffani! Well said. I agree 100%. We should never have to choose between ethical treatment of our patients and our own overall health. The two should not be mutually exclusive, but all of the situations you’ve described are far too common. Sadly, you are not alone in your reaction. If social media is any judge, many wonderful SLPs are seeking alternative careers. Thanks for weighing in on this critical issue.

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