empty bench syndrome

Tuesday, December 7, 2010

One of things that watching football every weekend teaches us is that players are expendable. While there is always a substitute on the bench, they might not possess the quality and skill of the starter. Still, the injury of one player affords opportunity to another and the game goes on. We expect the same continuity in the rest of our lives. Every day, we expect the newspaper to be delivered, Starbucks to serve coffee and the grocery store to have food on the shelves. There’s always the anonymous somebody to do the work, even if another somebody calls in sick.

Other things we expect include the hospital that is always open, the nurses are at their post and that the doctor is always in. Housekeepers will always be there to wash floors, laundry workers to provide clean sheets, technicians to sterilize equipment and cooks to feed the ill. People who work in health care also have that service ethic and routinely come to work when ill and that may be a problem. There is a heightened sense of personal responsibility and self sacrifice that is instilled in the people who care for those who cannot care for themselves. In large institutions, calling in sick may be a reasonable option, but what happens when there is nobody to call in as a replacement.

There is a cost for people staying home when they are ill but there is also a cost when people come to work when they are sick. Replacing an absent worker is expensive, requiring cross training, overtime payments and perhaps hiring extra workers just in case. The cost of an ill worker may be more than just decreased productivity. In the health care setting, an ill worker may spread infection throughout a nursing home or hospital. Patients who have decreased immunity because of age or underlying disease are at most risk to suffer, but healthy coworkers can become sick when exposed.

Infection control specialists recommend that health care workers stay home if they have a fever, cough or have vomiting and diarrhea. Even with the best personal hygiene and hand washing, infection can spread dramatically when caring for the ill and infirm. But theory comes up against the real world when a doctor or nurse becomes ill in a small town or rural setting. There are many places in the United States where only one health care provider exists. It may be a physician, physician assistant or nurse practitioner who is trusted with looking after the patients residing in a hospital and nursing home. There are patients with appointments in the office and house calls to make. The family doctor exists in rural America and there may be no backup to come in as a substitute.

Those same shortages exist in more urban settings as well, where some physician specialists are in short supply. Not every city has a back up neurosurgeon, anesthesiologist or obstetrician. When they become ill or need unplanned time away, patients may find themselves stranded. Emergencies may require significant travel time and distance to get care.

The debate about the cost of health care continues to rage. There is some pressure to increase that cost by providing health access to more of the population and to expand the capabilities of the health care system to provide for the future needs of an aging population. Looking at rural America may provide some direction about how we are going to provide medical care. All the programs and position papers in the world will not look after patients if there isn’t a person available to provide that care. Yet, studies show that making more doctors does not necessarily fix the short supply of care providers in underserved areas.

In sports, some injuries allow an understudy to shine. Wally Pipp begat Lou Genhrig and Don Majkowski begat Brett Favre. But when the doctor, nurse, technician or janitor gets sick, does the local health care system grind to a halt? Who do you calls into the game when the bench is empty?

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