Why Prevent Doctors and Nurses from Teaching and Nourishing?

Some basic questions need to be asked and answered by those in charge of the designs. Words have histories that can help us see just how much change has occurred - from the earliest origins of the words "doctor" and "nurse" until today.

One of the most important questions is...

Why have health care designs taken doctors and nurses out of their original designs?

The Word "Doctor" from the British Medical Journal 2011

The origin of the word 'doctor' is to teach. One of the main roles of a medical doctor is to teach the patient about their health and illness. Doctors are effective teachers given sufficient time. Patients and family members are the main agents of positive changes in health at a population level. http://www.bmj.com/rapid-response/2011/11/01/origin-word-doctor-teach

It's all there. Sufficient support and the need to impact patients and families that are the main agents of positive change.

Unfortunately doctors have moved (and have been moved) "beyond teaching" to areas that have minimal overall health impact. Even worse, the high cost of health care defeats efforts at the person, family, and community level. The high cost of defense and health care are what defeat our nation in its most important outcomes.

When I hear someone talk about leaving doctors to do the more exclusive care needs, it is clear that those words are spoken by those that have a very different understanding regarding the primary functions of physicians, nurses, and health care.

Doctors were not alone in this change. From the 1980s to the present, the Era of Cost Cutting has dominated health care design. The designers of health care essentially have shaped the workforce and the consequences by payment designs.  Payment too little in areas such as primary care, mental health, and basic services has clearly compromised
  • time with patients, 
  • teaching, and 
  • support of team members to teach and interact with the community
Designers out of touch with the primary functions of workforce have not helped, and doctors have not stopped them.

Nurses have some defense as they have less time at the help designing health policy, but they have also been forced away from their priority areas.

The Word "Nurse" from Nurse Manifest in 2012

The first instance in English of nurse occurred in the early thirteenth century as the Anglo-Norman nurice, derived from the fifth-century post-Classical Latin nutrice, a wet-nurse (hired to provide an infant with breast milk when the infant’s mother would not or could not do so), although by the time it entered the Middle English lexicon, it had already absorbed the figurative sense of any female caretaker of children (Oxford English Dictionary 2010). Etymologically it is related to our modern word nourish, to feed.
Already by the late fourteenth century nurse had also taken on the figurative sense of any thing or any place that nurtures or fosters a quality or condition, and by the early fifteenth century, any person who takes care of, looks after, educates or advises someone. https://nursemanifest.com/2012/04/24/some-history-on-the-origin-of-the-word-nurse/

As has been previously discussed, the Diagnosis Related Group Prospective Payment change was a dagger pointed not only at nurses, but at their primary teaching, caring, and nourishing roles. Too few nurses and patients discharged too soon has left little opportunity for teaching or learning. Not surprising has been the higher level of readmissions and other adverse events far too frequent via health care payment design.

The designers either intentionally figure out how to micromanage and marginalize, or they focus elsewhere and covertly accomplish the same compromise.

Compromises of Teaching and Learning

Of course our designs hardly give teachers time to teach so perhaps the real problem is about our nation and its approaches to teaching and learning. This impacts children from the earliest ages leaving most behind. Earliest impacts also damage the exclusive in areas that they least understand - and impact our nation in designs for health, education, economics, and politics.

The real crisis in education is an Open Letter from a Teacher to the incoming Secretary of Education. This gives just a glimpse with regard to measurement, test focus, and other impediments in teaching and learning by design.

The Lessons of Exclusive Origins, Exclusive Designers, and Exclusive Designs

Today in Upshot in the New York Times the level of eliteness in the elite colleges was illustrated in graphics. The graphics reveal that the top 1% supplies more students than the bottom 60%.

Most of the time, this is used to illustrate lack of diversity. But few seem to see the most major problem - the lack of awareness. Those born, raised, educated, and trained exclusively have very little chance to understand the real world or most people quite different from them.

Two movies come to mind. In Overboard, Goldie Hawn was given the chance to understand what it was like in poor working class situations after a life of luxury. From her personal servant played by Roddy McDowell - "But you madam, have had the... rare privilege of escaping your bonds for just a spell. ... How you choose to use that information is entirely up to you."

In Father Goose, Cary Grant's character was a history teacher that gave up on the exclusive children that failed to learn from history and were repeating the same mistakes - as seen in World War II. 

Cary Grant dropped out into the South Pacific to major in scrounging and alcohol. He has been forced to become a coast watcher to identify Japanese plane and ship movements. Leslie Caron plays a school mistress in charge of children. They have been stuck on an island together and she has been bitten by a snake – or rather a stick that looked like a snake. They both think that she is dying and they are being totally transparent, with the help of the alcohol used to kill her pain. She is referred to as Goody Two Shoes and Cary Grant is the Filthy Beast.

Goody Two Shoes/LC - What was she like

Filthy Beast/CG - She who

LC - The lady that drove you to … drink

CG - That was no lady

LC - That was your wife – (cackles)

CG - No, No, There was no wife

LC - From what are you running away from, hmm?

CG - Oh I’m not running away

LC - There must have been some…some…

CG - There was, it was a necktie.

LC - A what?

CG - A necktie. I was late for class one morning. I forgot my tie and they wouldn’t let me in.

LC - How long ago was that?

CG - About eight years ago (1933)

LC - Weren’t you a little old to be going to school?

CG - Oh, I wasn’t going (looks around to see if the children are listening)

Ahem… I was teaching. I was a professor of history. (shrinks down)

LC - And what about the necktie.

CG - This is no time to talk about me.

LC - Why not?

CG - (Sighs) Why not?- Well, see, I thought they would be more interested in what was inside of a man’s head than what was around his neck. Then, I noticed that they all wore ties. They all looked alike. They all behaved alike. They all talked alike. They were all going the same way, no matter which way they said they were going. So what was the use of teaching them history, or anything? They weren’t learning by it. They were still creating the same world (or old) problems. So I packed, got on a boat, and got away from them.

Now Look what they got me doing

LC - (Giggles uncontrollably) You - a schoolteacher.

(Sits up, gasps) Oh dear (she collapses and seems dead, he pulls up cover over her head, takes a belt)

Watch Father Goose from 1964 for the revival, marriage, and escape. This movie took the Oscar for Best Screenplay and those winning credited Cary Grant for winning a number of Oscars - for everyone else.

Recent actors deserve some credit for indicating that movies are just movies, but there are lessons to be learned from history.

We can also learn from the roles that they have played. I have been thinking about Robin Williams much lately and the roles in Good Will Hunting, Awakenings, Good Morning Vietnam, and others. In Dead Poets he was teaching the students to explore and reflect and consider. Those most exclusive appear to need different awareness and understanding. 

We need to get away from creating the same world problems and learn from our mistakes. The quality gurus understood the need for the outside perspective. Since this perspective involves well over half of the nation's population, leaders in health, education, economics, and politics better learn to listen.

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