Healthcare needs to be more accessible and more accountable to everyone.
Not long ago my brother-in-law, Tom Coffey, decided to take advantage of a light workday by spending some time on his elliptical machine. Events must have happened quickly because it does not take Tom long to work up a sweat. He was a big bear of a man. About 2 PM, my niece, his daughter who is an NP, noted that her Dad’s car was still in the driveway and went into the garage to see what was up. The machine was running. His body was on the floor with no evidence of trauma. He was taken before he could begin to perspire or turn off the machine.
Tom was a former athlete of distinction and a man with a handshake that could make strong men yell “uncle”. His greatest physical asset was a smile that he had carried on his freckled Scots-Irish/German face since his childhood on a 6-generation family farm at the foot of the Blue Ridge in the “valley of Virginia.” He still as smiling during a heavy daily grind as a package delivery contractor driving in the jungle of Atlanta’s traffic.
Tom left little behind him except warm memories for his family and friends. As I sat on the front row of his funeral along with other members of his family, I realized how wrong our score-keeping system is in life. Tom was poor in the things that have no enduring value. He was the richest man I ever knew in terms of the things which are earned only by living a life centered in the needs of others. Tom is the only person who ever randomly called me several times a year to ask how the world was treating me and to tell me a funny story just because he had suddenly thought of me. Turns out that hundreds of people shared my experience. Who knew?– until we all got together to celebrate his life.
Healthcare failed Tom. It did not call him up to ask how he was doing. He was motivated. He gave up smoking years ago and was constantly starting diets and exercise programs in the midst of coaching kids teams, giving time to his church, and helping everybody who looked like they could use a hand. He had three businesses fail for a variety of external reasons and never had steady access to healthcare. Just recently he did get onto my sister’s plan from her job at a local hospital and had a screening physical that revealed all the risk factors for coronary disease that his heredity would have predicted. He was too busy to sit for hours in a doctor’s office, even if he could have gotten an appointment to check out the vague fatigue that he reported to a few friends over the last two weeks of his life.
Access is a problem even if you have a PCP. Tom was not the guy who would complain, and the idea of going to an emergency room to check out a little fatigue was not his style. A harsh system would hold him accountable for his human frailties. The kind of system we need if we are ever to achieve the triple aim is one that would be accountable to find Tom, identify him as a person who needed help and make that help accessible. It would be a system that operated the same way that Tom operated. The system would always be looking for people to help and making itself accessible to them no matter the time of day. Tom did not get what he so freely gave to others.
