The Gilded Age of Healthcare

(Originally published by Hospital Impact)

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Recently my family and I visited a plethora of colleges in Rhode Island as my oldest daughter seeks her life’s path. On our way from Bristol to Newport I shared with my family my days of working for Harvard Community Health Plan in that area and the large disparity between the wealthiest and the poorest in Newport at that time (mid-1990s).

After a brief tête-à-tête, my wife and I agreed to take a slight excursion from the college tours and visit two of “the Mansions” in Newport, the Breakers and Marble House.

As we began the self-guided audio tour, I was again thinking about the wealth disparity back in the 1990s and how large the disparity must have been in the 1880s. Just as I started to process how conceptually things have not changed, I heard in my ears (from the self-guided tour) the words of Mark Twain’s “The Gilded Age.” The gilded age I thought. “The golden gleam of the gilded surface hides the cheapness of the metal underneath.”

I turned to my wife and I shared what I was thinking: “These Mansions–the gilded age–remember that blog post I wrote some months back about “bricks and mortar” and how the construction of these new hospitals and hospital wings and extravagant new medical office buildings serve to ‘represent power, conquest, legacy building, and achievement, and yet are not always in line with what is best for the populace?’ The mansions and their gilded surfaces served the same purpose.”

As I continued to think about the wealth disparity when these mansions were built, my mind drifted to the poor who currently line up outside of the local new and/or expanded hospital hoping for someone to show compassion, to care, to empathize, to help.

I further contemplated Twain’s quote, “the gilded surface hides the cheapness of the metal underneath,” and reflected back on the hospital leaders who built these shiny new palaces of which 69 percent do not deem quality and patient safety as top priorities. An example of Twain’s “underneath”?

I thought about the physicians who are working in these gorgeous new medical office buildings and yet are subjected to intense productivity quotas (like factory workers) and do not have time to know their patients, develop trust with their patients, share empathy with their patients, and co-create patient-specific care plans that address the root-cause of their health challenges.

I considered the financing of healthcare within these dazzling facilities and how overtreatment is rewarded and yet is also placing patients in harm’s way.

My thoughts turned to the gilded “patient-centered” concept being lauded, and I wondered how can care be patient centered if…

…the physician does not have the time to know the patient?
…the bottom line is more important than the patient?
…the system does not care enough to have accurate medical information available to the physician and patient at time of service?

Perhaps all of this patient-centered languaging is the “gild” and the reality of patient-centered care is the “cheapness of the metal underneath.”

Despite wealth disparity, we continue to see these gilded hospital systems and health care practices but witness less and less focus on effectively addressing the needs (physical, mental, emotional, cultural, environmental, financial, etc.) of our most vulnerable populations.

Is it really too quixotic to want the “underneath” in healthcare to match the “gild” in healthcare?

I don’t believe so. We are talking about the health of our friends, our families, and our communities. Beautiful mansions like the stunning new hospitals, spectacular hospital wings, and mighty medical complexes are only as gilded as the hope, the provision, the safety, the outcomes, the care, and the service they provide to patients.

Looking beyond the gild, we have much work to do.

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  1. Hi Tom! Wonderful analogy! I think Clemons said it and your use of it via health care are right on target! Dad

    J. Peter Dahlborg Dianne M. Dahlborg

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