“We’ve established the most enormous medical entity ever conceived…and people are sicker than ever. We ‘cure’ nothing! We ‘heal’ nothing!”
– George C. Scott as ‘Dr. Bock’, from The Hospital (screenplay by Paddy Chayefsky)
There are two questions that get asked again and again throughout Peter Nicks’ film, The Waiting Room: “Do you have a regular doctor?” and “Do you carry health insurance?” And the answer that you hear over and over to both questions is a simple “no.” After watching this extraordinary documentary (which somehow manages to be at once disheartening and life-affirming) I had to ask myself a question: “Does this country have a completely fucked-up health care system?” To which I answer with a simple “yes.” Not that Nicks has set out to make a self-consciously polemical statement on the health care crisis. Quite simply, he allows the pure objectivity of a filmed record to speak for itself.
The premise is straightforward: document a “typical” 24 hour period in the life of a bustling public ER (in this case, at Oakland’s Highland Hospital) and compress it into a 90-minute film. And as you would expect, all forms of human misery are on display, in a microcosm of Everything That Can Go Wrong with these ridiculously fragile shells we inhabit for “…eighty years, with luck-or even less” (if I may quote my favorite Pink Floyd song). A sweet little girl with a severe case of strep struggles to communicate as her loving parents take turns at her bedside. An uninsured 20-something couple (a man who has just learned he has a tumor, and his concerned wife) desperately confab with hapless and over-taxed attending physicians about how he’s supposed to arrange the “emergency” surgery recommended by a private hospital that has palmed him off on Highland’s ER.
Every time a trauma case arrives, there’s a ripple effect on the pecking order for the huddled (and understandably frustrated) masses in the waiting room proper; for obvious reasons nearly all available ER staff have to pitch in and focus on stabilizing the patient. When these efforts prove to be for naught, it’s heartbreaking to watch (in the film’s most emotionally wrenching sequence, a 15-year old gunshot victim is pronounced DOA after attempts to resuscitate fail). However, not all situations are life and death. Some of the patients are “regulars” who use the ER as a primary care facility. One of the “regulars” is an obviously troubled homeless man (initially brought in for breathing problems) who has ongoing issues with drug and alcohol abuse. He apparently has become too much of a handful for the shelter he has been staying at; his attending physician is told over the phone that they don’t want to take him back anymore. Now the doctor has to decide whether to let the pleading patient stay the night (and take up precious space that may be needed for more medically needy patients) or in essence toss him out into the streets. “Sometimes,” the frazzled but noticeably compassionate doctor confides to the off-camera director with a resigned sigh, “I have to admit people…for societal reasons.” And then, he delivers the film’s money quote: “This (the ER) is the institution of last resort.”
The filmmaker can’t be faulted for not asking the million dollar question that arises from that statement, because any viewer who has a heart and a functional brain will begin to ponder over why emergency rooms have become “the institution of last resort” for America’s uninsured. Why are already overextended medical personnel who staff these facilities getting saddled with responsibilities more appropriate to PCPs, social workers and mental health professionals? And why is this even up for debate? How and when did the fundamental right to receive decent health care transmogrify into a political football?
Of course, we can wring our hands and debate health care issues until the cows come home, but in the meantime there are sick people who need help yesterday and who certainly don’t have time to hang around waiting for an act of Congress in order to get it. For their sakes (and for yours and mine when the time comes, and that time will come) all I can say is thank the gods for the tireless and dedicated men and women who staff these facilities. That’s the crucial takeaway I got from this film (and it accounts for that “life-affirming” part I mentioned earlier in the review). Nicks, whose utilization of the observational mode recalls the work of the great documentarian Frederick Wiseman, has fashioned a narrative that is wholly intimate, yet completely unobtrusive. I never once got the impression that anyone was playing to the camera; consequently there is a great deal of humanity shining through, from doctors and patients. And the next time a family member or co-worker starts ranting about the “tyranny” of universal health coverage, don’t argue. Calmly take their pulse, ask if they’ve been eating right, exercising and getting regular check-ups. Then, invite ‘em out for dinner and a flick-preferably this one.
Apropos of this post, I thought I’d just add this cheery little note:
Most physicians have a pessimistic outlook on the future of medicine, citing eroding autonomy and falling income, a survey of more than 600 doctors found. Six in 10 physicians (62 percent) said it is likely many of their colleagues will retire earlier than planned in the next 1 to 3 years, a survey from Deloitte Center for Health Solutions found.
That perception is uniform across age, gender, and specialty, it said. “Physicians recognize ‘the new normal’ will necessitate major changes in the profession that require them to practice in different settings as part of a larger organization that uses technologies and team-based models for consumer (patient) care,” the survey’s findings stated. About two-thirds of the survey responders said they believe physicians and hospitals will become more integrated in coming years. In the last 2 years, 31 percent moved into a larger practice, results found. Nearly eight in 10 believe midlevel providers will play a larger role in directing primary care.
Four in 10 doctors reported their take-home pay decreased from 2011 to 2012, and more than half said the pay cut was 10 percent or less, according to Deloitte. Among physicians reporting a pay cut, four in 10 blame the Affordable Care Act (ACA), and 48 percent of all doctors believed their income would drop again in 2012 as a result of the health reform law.
The ACA hasn’t taken effect yet and I’m willlng to bet that the doctors who took the time to fill out this questionnaire might be the types who are politically inclined to hate it. Still, that’s a pretty pessimistic view coming from the medical profession.
On the other hand, maybe there are a bunch of younger doctors coming up who are willing to try something new. Let’s hope so.
