Treatment is not Care

SUZANNE GORDON

September 12, 1993|By SUZANNE GORDON

Infecting our national health care reform debate like an uncontrolled virus is a central confusion between the two key components of any real health-care system -- treatment and care. This makes it very difficult for Americans to fashion reform proposals based on the more efficient and less expensive models of health-care programs found in other countries.

Although it may come as a surprise to some so-called health-care experts and political pundits, treatment and care are not identical. The word "treatment" comes to us from the Latin tractare, "to handle," while "care" stems from the Old English caru, akin to Old High German kara, "lament," and Latin garrire, "to chatter."

Treatment includes first the diagnostic examinations and tests that determine what is wrong with cells, limbs or organs and, second, the surgical or chemical interventions designed to cure disease or extend life.

Care comprises not only monitoring treatment but educating patients and their families about therapeutic regimens, teaching xTC them how to cope with discomfort, manage pain and side effects and alter lifestyles as a result of disease or dysfunction. Care requires attention to the patient's social context; it may extend far beyond the beginning and end of medical treatment.

Indeed, in industrialized countries, like ours, where advances in medicine and public health have dramatically lengthened the average life span, long-term care of the chronically ill and elderly may be needed for decades.

Not surprisingly, in our quick-fix society, medical treatment and health care have been totally equated. Our current Orwellian political dialogue in fact uses the term "health care" or medical "care" to describe a system that has become internationally renowned for its ability to promote the very latest in medical treatment while simultaneously denying patients the advances in the care-giving demanded by that treatment.

Consider only a few of the most striking examples of this routine phenomenon. An elderly woman, hands and feet crippled with rheumatoid arthritis and entirely wheelchair-bound, has major surgery to repair two hernias, but is not allowed to spend even a night in the hospital to receive follow-up care and monitoring.

With all due speed, a man with colorectal cancer is given a colostomy, but is then ejected from the hospital while his wound is still draining, and he is unsure how to care for his colostomy bag. A woman in labor is given a Caesarean section but is discharged after only three days. Still in pain, weak and exhausted, she returns to a home where she will have to care for her newborn and three other young children without any family or professional assistance.

Although American critics of other, more socially oriented, less-market-driven systems insist that the latter deprive their citizens of "appropriate medical care," health-care systems such those in Western Europe and Canada may provide far more medical "care" than we do and often equal levels of treatment.

For example, a woman in Britain would indeed be far less likely to get a C-section than one in America. But when necessary, she'll get the operation plus a longer stay in the hospital -- and home health assistance after discharge.

A terminal lung cancer patient in Canada will definitely not be treated with aggressive chemotherapy until his very last gasp, but he will have access to high-tech pain and symptom control, counseling for himself and his family and other hospice services that are delivered in every major cancer center and teaching hospital for as long as he survives.

Unfortunately, the inability to distinguish between care and treatment lies embedded at the very core of the reform proposal -- managed competition -- that seems to have conquered the imagination of the Washington policy elite.

The central tenet of managed competition is referred to as "managed care." But managed care -- with its radically shortened hospital stays, attempts to blame patients and their families for their need for follow-up care and failure to provide mental health care or chronic care -- simply increases the anonymous bureaucratic micro-management of medical treatment while reducing or sometimes eliminating care.

Returning to the origins of these two words -- treatment and care -- is an instructive exercise. Diseases may need handling, but the human beings who have them, and their attendant sorrows and anxieties, need care.

And a health-care reform proposal that cannot even conceptualize the latter is guaranteed to fail.

Suzanne Gordon, the author of "Prisoners of Men's Dreams," is working on a book about the role of nurses in the American health-care system. She wrote this commentary for Newsday.

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