Jayma Anne Montgomery
WHY ARE WE STILL TREATING SICKNESS LIKE A BUSINESS?
Updated: Mar 10
Coming across this opinion piece in the New York Times this morning took me right back to the moment I decided that pediatrics was not for me. I was a third-year medical student on clinical rotations in the NICU…an ICU with thirty incubators for thirty impossibly tiny premature babies. Babies with underdeveloped lungs and birth defects and heart failure. Babies who were too weak to eat and many too fragile to be held. I challenge anyone to watch a one-pound baby attached to an impossible tangle of life-sustained tubes and wires, struggling to breathe on a ventilator for thirty seconds and not cry. This was the scene of my first public panic attack…a code blue on a baby born 10 weeks too early that didn’t make it. His parents, who hadn’t left his side for over a month collapsed on the floor and wept when the time of death was called. I knew I could never be the doctor to lead that code, determine when to end it, and then devastate this child’s parents with the news of his death. There are braver men and women out there than me and I thank G-d for it.
The crux of the article is well summarized as follows: “Profit-driven management has eroded pediatric healthcare in America. Healthcare providers make more money treating adults than they do children. As a result, the number of hospitals offering pediatric care has decreased drastically over the past two decades” (Stockton and King, NYT). As a mother who also happens to be a physician lacking in pediatric expertise, this reality is doubly devastating. Just a few months ago, our two-year-old developed croup and needed to be treated in the ER. We recently all recovered from a second bout of COVID with our children each running high fevers for five days straight. The nearest pediatric hospital is over 30 minutes away and we live in the rather densely populated area of the north Charlotte metropolitan area. People in the most rural parts of the US might be 2-3 hours from pediatric specialty care and have to rely on emergency room and family practice physicians to care for their children. That’s all well and good for a check-up or a routine illness, but when your child is critically ill, the vast majority of these doctors lack the expertise and experience to manage the airways and circulatory systems of children.
I know better than the average person that the physiology of an infant, toddler, and teenager are all vastly different. I also know that there is a world of difference between an ER physician’s training and a pediatric hospitalist or pediatric intensivist. It’s the same difference that distinguishes my skillset from that of an adult Pulmonologist and adult Intensivist. Children are not just small adults. We know this, and yet we do not currently have a healthcare infrastructure equipped to support the triple onslaught of COVID, Influenza, and Respiratory Syncytial Virus that is presently gripping the nation. Sadly, none of this surprises me.
I have watched the adult medical world teeter dangerously on the brink for more than two years of dealing with COVID. The crisis is now more or less contained but the disastrous downstream effects that it has had on outpatient medicine, ERs, hospitals, and rehabilitation facilities are unprecedented and not going away any time soon. As a result, many physicians, nurses, nurse practitioners, and physician assistants are reducing their hours or leaving clinical medicine altogether. I am counted among those who have reduced their hours of clinical practice for the sake of preserving my mental/physical health and prioritizing my family’s needs.
The healthcare delivery system in this country is in crisis. It’s time for people who are at the front lines of this to start speaking up about why this is occurring and the changes that need to happen in order to turn this situation around. The question is, will the lawmakers and business owners who largely dictate the way medicine is practiced in this country bother to heed our warnings after failing to heed them for over two decades? Sick children don't make most hospital systems rich, so the solution was to close dozens of pediatric units across the country. Now we are paying for it. The health of the children in this country should not be at the mercy of our inglorious politicians and short-sighted yet ridiculously wealthy hospital CEOs. Kingdom-minded healthcare workers...let us be mindful of this situation and open to opportunities to be a blessing to sick children and their families during this dark time.