What the US health care system assumes about you | Mitchell Katz

Translator: Elda Indria Sari Reviewer: Bias Ayu

A few years ago,

Beberapa tahun lalu,

I was taking care of a woman who was a victim of violence.

saya merawat seorang wanita korban kekerasan.

I wanted her to be seen in a clinic that specialized in trauma survivors.

Saya mau dia dirawat di klinik khusus penyintas trauma.

I made the appointment myself because, being the director of the department,

Saya mendaftarkannya sendiri, karena sebagai kepala departemen,

I knew if I did it,

saya tahu jika saya yang melakukannya, dia bisa segera didaftarkan.

she would get an appointment right away.

The clinic was about an hour and a half away from where she lived.

Klinik itu berjarak sekitar satu setengah jam dari tempat tinggalnya.

But she took down the address and agreed to go.

Tapi dia mencatat alamatnya dan setuju untuk pergi.

Unfortunately, she didn't make it to the clinic.

Sayangnya, dia tidak datang ke klinik.

When I spoke to the psychiatrist, he explained to me

Waktu saya bicara dengan psikiater, dia menjelaskan

that trauma survivors are often resistant

penyintas trauma kadang enggan

to dealing with the difficult issues that they face

berurusan dengan masalah pelik yang mereka hadapi

and often miss appointments.

dan sering kali melewatkan janji temu.

For this reason,

Karena alasan ini,

they don't generally allow the doctors to make appointments for the patients.

dokter pada umumnya tidak diiizinkan membuat janji temu untuk pasiennya.

They had made a special exception for me.

Mereka membuat pengecualian untuk saya.

When I spoke to my patient,

Ketika saya bicara dengan pasien saya,

she had a much simpler and less Freudian explanation

alasan kenapa dia tidak datang jauh lebih sederhana:

of why she didn't go to that appointment:

her ride didn't show.

tumpangannya tidak datang.

Now, some of you may be thinking,

Beberapa dari Anda mungkin berpikir,

"Didn't she have some other way of getting to that clinic appointment?"

"Bukankah ada jalan lain untuk datang ke janji temu di klinik?"

Couldn't she have taken an Uber or called another friend?

Dia bisa datang dengan Uber atau minta tolong temannya?

If you're thinking that,

Jika Anda berpikir begitu,

it's probably because you have resources.

mungkin karena Anda punya sumber daya.

But she didn't have enough money for an Uber,

Tapi dia tak punya cukup uang untuk Uber,

and she didn't have another friend to call.

dan dia tak punya teman untuk dihubungi.

But she did have me,

Tapi dia punya saya,

and I was able to get her another appointment,

dan saya bisa mendaftarkannya ke janji temu lainnya,

which she kept without difficulty.

yang bisa dia tepati dengan mudah.

She wasn't resistant,

Dia bukannya tidak mau,

it's just that her ride didn't show.

hanya tumpangannya tidak datang.

I wish I could say that this was an isolated incident,

Saya berharap ini hanya sebuah kejadian tunggal,

but I know from running the safety net systems

tapi saya tahu dari menjalankan jaring pengaman sistem

in San Francisco, Los Angeles, and now New York City,

di San Francisco, Los Angeles dan kini kota New York,

that health care is built on a middle-class model

layanan kesehatan dibuat berdasarkan model kelas menengah

that often doesn't meet the needs of low-income patients.

yang sering kali tidak cocok dengan pasien berpendapatan rendah.

That's one of the reasons why it's been so difficult

Itu salah satu alasan kenapa sangat sulit bagi kami

for us to close the disparity in health care

untuk menutup kesenjangan dalam layanan kesehatan

that exists along economic lines,

pada seluruh tingkatan ekonomi

despite the expansion of health insurance

meski ada perluasan asuransi kesehatan

under the ACA, or Obamacare.

di bawah ACA atau Obamacare.

Health care in the United States

Layanan kesehatan di Amerika berasumsi,

assumes that, besides getting across the large land expanse of Los Angeles,

bahwa selain melintasi dataran Los Angeles yang luas,

it also assumes that you can take off from work

Anda juga bisa meninggalkan pekerjaan

in the middle of the day to get care.

di tengah hari untuk mendapatkan perawatan.

One of the patients who came to my East Los Angeles clinic

Salah satu pasien yang datang ke klinik saya di Los Angeles Timur

on a Thursday afternoon

di suatu siang di hari Kamis

presented with partial blindness in both eyes.

menderita buta sebagian di kedua matanya.

Very concerned, I said to him,

Dengan prihatin, saya berkata kepadanya,

"When did this develop?"

"Sejak kapan jadi begini?"

He said, "Sunday."

"Hari Minggu.", katanya.

I said, "Sunday?

"Hari Minggu?"

Did you think of coming sooner to clinic?"

Kenapa tidak datang lebih cepat ke klinik?"

And he said, "Well, I have to work in order to pay the rent."

Dia menjawab, "Saya harus bekerja supaya bisa membayar sewa."

A second patient to that same clinic,

Pasien kedua datang ke klinik yang sama,

a trucker,

seorang pengemudi truk

drove three days with a raging infection,

yang mengemudi selama tiga hari dengan infeksi parah

only coming to see me after he had delivered his merchandise.

dia baru datang menemui saya setelah mengantarkan kirimannya.

Both patients' care was jeopardized by their delays in seeking care.

Kedua pasien ini terancam karena terlambat mendapat perawatan.

Health care in the United States assumes that you speak English

Layanan kesehatan di Amerika berasumsi Anda bisa berbahasa Inggris

or can bring someone with you who can.

atau membawa seseorang yang bisa berbahasa Inggris.

In San Francisco, I took care of a patient on the inpatient service

Di San Francisco, saya merawat seorang pasien rawat inap

who was from West Africa and spoke a dialect so unusual

dari Afrika Barat yang berbicara dalam dialek yang begitu tak biasa

that we could only find one translator on the telephonic line

hingga kami hanya bisa menemukan satu penerjemah lewat telepon

who could understand him.

yang bisa mengerti dia.

And that translator only worked one afternoon a week.

Penerjemah itu hanya bekerja satu sore per minggu.

Unfortunately, my patient needed translation services every day.

Sayangnya, pasien saya membutuhkan jasa penerjemah tiap hari.

Health care in the United States assumes that you are literate.

Layanan kesehatan di Amerika berasumsi bahwa Anda terpelajar.

I learned that a patient of mine who spoke English without accent

Saya mengetahui salah satu pasien saya yang berbicara bahasa Inggris tanpa aksen

was illiterate,

ternyata tidak terpelajar,

when he asked me to please sign a social security disability form for him

ketika dia meminta saya menandatangani formulir jaminan sosial cacat untuknya

right away.

secepat mungkin.

The form needed to go to the office that same day,

Formulir itu harus diserahkan ke kantor hari itu juga,

and I wasn't in clinic,

dan saya sedang tidak berada di klinik.

so trying to help him out,

Saya coba membantunya,

knowing that he was the sole caretaker of his son,

karena saya tahu dia orang tua tunggal.

I said, "Well, bring the form to my administrative office.

Saya katakan, "Bawa formulirnya ke kantor administrasi saya.

I'll sign it and I'll fax it in for you."

Akan saya tandatangani dan fax untukmu."

He took the two buses to my office,

Dia naik bis dua kali ke kantor saya,

dropped off the form,

menyerahkan formulirnya,

went back home to take care of his son ...

dan kembali ke rumah untuk merawat putranya.

I got to the office, and what did I find next to the big "X" on the form?

Saya sampai di kantor, dan apa yang saya lihat di samping tanda "X" di formulir?

The word "applicant."

Kata "pemohon."

He needed to sign the form.

Dia harus menandatanganinya.

And so now I had to have him take the two buses back to the office

Saya harus minta dia kembali ke kantor naik bis dua kali

and sign the form so that we could then fax it in for him.

dan menandatangani formulirnya supaya bisa kami kirim dengan fax.

It completely changed how I took care of him.

Ini mengubah cara saya merawatnya.

I made sure that I always went over instructions verbally with him.

Saya memastikan untuk selalu memberikan instruksi secara verbal kepadanya.

It also made me think about all of the patients

Hal ini juga membuat saya memikirkan pasien lain

who receive reams and reams of paper

yang menerima berlembar-lembar kertas

spit out by our modern electronic health record systems,

dari sistem rekaman kesehatan elektronik kita yang modern

explaining their diagnoses and their treatments,

yang memaparkan diagnosa dan perawatan mereka

and wondering how many people actually can understand

dan mengira-ngira berapa orang yang sungguh bisa memahami

what's on those pieces of paper.

apa yang tertulis di kertas itu.

Health care in the United States assumes that you have a working telephone

Layanan kesehatan di Amerika berasumsi bahwa Anda punya telepon yang berfungsi

and an accurate address.

dan memiliki yang alamat jelas.

The proliferation of inexpensive cell phones

Pertumbuhan ponsel murah

has actually helped quite a lot.

sebenarnya sudah sangat membantu.

But still, my patients run out of minutes,

Tapi, pasien-pasien saya kehabisan waktu

and their phones get disconnected.

dan telepon mereka pun terputus.

Low-income people often have to move around a lot by necessity.

Mereka yang berpendapatan rendah kerap berpindah tempat karena kebutuhan.

I remember reviewing a chart of a woman with an abnormality on her mammogram.

Saya ingat meneliti grafik seorang wanita dengan kelainan pada mamogramnya.

That chart assiduously documents that three letters were sent to her home,

Grafik itu menunjukkan ada tiga surat yang dikirim ke rumahnya,

asking her to please come in for follow-up.

memintanya datang untuk pemeriksaan lanjutan.

Of course, if the address isn't accurate,

Tentu, jika alamatnya tidak akurat,

it doesn't much matter how many letters you send to that same address.

maka sia-sia saja, tidak peduli berapa banyak surat yang dikirim.

Health care in the United States assumes that you have a steady supply of food.

Layanan kesehatan di Amerika berasumsi, Anda punya persediaan makanan stabil.

This is particularly an issue for diabetics.

Ini masalah khusus bagi penderita diabetes.

We give them medications that lower their blood sugar.

Kami memberi mereka obat yang menurunkan gula darah mereka.

On days when they don't have enough food,

Pada hari di mana mereka tidak punya cukup makanan,

it puts them at risk for a life-threatening side effect

mereka berisiko terkena efek samping yang mengancam nyawa

of hypoglycemia, or low blood sugar.

karena hipoglikemia atau gula darah rendah.

Health care in the United States assumes that you have a home

Layanan kesehatan di Amerika berasumsi Anda punya rumah

with a refrigerator for your insulin,

dengan kulkas untuk insulin Anda,

a bathroom where you can wash up,

kamar mandi tempat Anda mandi,

a bed where you can sleep

ranjang tempat Anda tidur,

without worrying about violence while you're resting.

tanpa harus cemas soal kekerasan ketika Anda beristirahat.

But what if you don't have that?

Tapi bagaimana jika tidak ada?

What if you live on the street,

Bagaimana jika Anda tinggal di jalan,

you live under the freeway,

tinggal di bawah jalan tol,

you live in a congregant shelter,

tinggal di pemukiman padat penduduk,

where every morning you have to leave at 7 or 8am?

di mana tiap pagi Anda harus pergi jam 7 atau 8 pagi?

Where do you store your medicines?

Di mana Anda menyimpan obat-obatan?

Where do you use the bathroom?

Di mana Anda mandi?

How do you put your legs up if you have congestive heart failure?

Bagaimana bisa mengangkat kaki ketika mengalami gagal jantung kongestif?

Is it any wonder that providing people with health insurance who are homeless

Kenapa penyediaan asuransi kesehatan bagi para tunawisma

does not erase the huge disparity

tidak menghapus kesenjangan besar

between the homeless and the housed?

antara tunawisma dan yang tidak?

Health care in the United States assumes that you prioritize your health care.

Layanan kesehatan di Amerika berasumsi Anda mengutamakan layanan kesehatan.

But what about all of you?

Tapi bagaimana dengan Anda semua?

Let me assume for a moment that you're all taking a medication.

Anggap saja Anda semua sedang berada dalam pengobatan.

Maybe it's for high blood pressure.

Mungkin untuk darah tinggi.

Maybe it's for diabetes or depression.

Mungkin diabetes atau depresi.

What if tonight you had a choice:

Bagaimana jika malam ini Anda punya pilihan:

you could have your medication but live on the street,

Anda bisa diberikan obat tapi hidup di jalanan,

or you could be housed in your home but not have your medication.

atau tinggal di rumah tapi tanpa obat?

Which would you choose?

Mana yang Anda pilih?

I know which one I would choose.

Saya tahu mana yang akan saya pilih.

This is just a graphic example of the kinds of choices

Ini hanya contoh grafis dari pilihan-pilihan

that low-income patients have to make every day.

yang harus dibuat para pasien berpenghasilan rendah setiap hari.

So when my doctors shake their heads and say,

Jadi ketika dokter-dokter saya menggeleng-geleng dan berkata,

"I don't know why that patient didn't keep his follow-up appointments,"

"Saya tidak tahu kenapa pasien itu tidak datang ke janji temu,"

"I don't know why she didn't go for that exam that I ordered,"

"Saya tidak tahu kenapa dia tidak datang ke tes yang saya perintahkan,"

I think, well, maybe her ride didn't show,

Saya pikir, mungkin tumpangannya tidak datang,

or maybe he had to work.

atau mungkin dia harus bekerja.

But also, maybe there was something more important that day

Mungkin juga ada sesuatu yang jauh lebih penting hari itu

than their high blood pressure or a screening colonoscopy.

daripada tekanan darah tinggi mereka atau pemeriksaan kolonoskopi.

Maybe that patient was dealing with an abusive spouse

Mungkin pasien itu sedang berhadapan dengan pasangan yang bersikap kasar

or a daughter who is pregnant and drug-addicted

atau anak perempuan mereka yang hamil dan pecandu narkoba

or a son who was kicked out of school.

atau anak laki-laki mereka yang dikeluarkan dari sekolah.

Or even maybe they were riding their bicycle through an intersection

Atau mungkin mereka tengah bersepeda melewati persimpangan

and got hit by a truck,

dan tertabrak truk,

and now they're using a wheelchair and have very limited mobility.

jadi mereka kini memakai kursi roda dan pergerakannya terbatas.

Obviously, these things also happen to middle-class people.

Tentu hal ini juga terjadi pada mereka dari kelas menengah.

But when they do,

Tapi ketika itu terjadi,

we have resources that enable us to deal with these problems.

kami punya sumber daya untuk menghadapi masalah ini.

We also have the belief that we will live out our normal lifespans.

Kami juga percaya bisa hidup melebihi rentang hidup normal.

That's not true for low-income people.

Ini tak berlaku untuk yang berpendapatan rendah.

They've seen their friends and relatives die young

Mereka menyaksikan teman dan keluarga mereka mati muda

of accidents,

karena kecelakaan,

of violence,

kekerasan,

of cancers that should have been diagnosed at an earlier stage.

atau kanker yang seharusnya bisa didiagnosa di tahap awal.

It can lead to a sense of hopelessness,

Ini dapat menimbulkan rasa putus asa,

that it doesn't really matter what you do.

bahwa apa pun yang Anda lakukan sia-sia.

I know I've painted a bleak picture of the care of low-income patients.

Saya tahu saya menggambarkan pasien berpendapatan rendah secara suram.

But I want you to know how rewarding I find it

Tapi saya ingin Anda tahu betapa berharganya

to work in a safety net system,

bekerja di jaring pengaman sistem,

and my deep belief is that we can make the system responsive

saya percaya kami bisa membuat sistem tersebut responsif

to the needs of low-income patients.

pada kebutuhan pasien berpendapatan rendah.

The starting point has to be to meet patients where they are,

Titik awalnya adalah menemui pasien di tempat mereka berada,

provide services without obstacles

menyediakan layanan tanpa halangan

and provide patients what they need --

dan menyediakan apa yang pasien butuhkan,

not what we think they need.

bukan apa yang kami rasa mereka butuhkan.

It's impossible for me to take good care of a patient

Mustahil bagi saya merawat pasien

who is homeless and living on the street.

yang tunawisma dan tinggal di jalan.

The right prescription for a homeless patient is housing.

Resep yang tepat bagi pasien tunawisma adalah merumahkannya.

In Los Angeles,

Di Los Angeles,

we housed 4,700 chronically homeless persons

kami merumahkan 4.700 tunawisma

suffering from medical illness, mental illness, addiction.

yang sedang menderita penyakit medis, mental, dan kecanduan.

When we housed them, we found that overall health care costs,

Setelah merumahkan mereka, kami menemukan bahwa biaya kesehatan mereka,

including the housing,

termasuk perumahan,

decreased.

menurun.

That's because they had many fewer hospital visits,

Ini karena mereka jadi lebih jarang mengunjungi rumah sakit,

both in the emergency room and on the inpatient service.

baik di ruang gawat darurat maupun rawat inap.

And we gave them back their dignity.

Kami mengembalikan martabat mereka.

No extra charge for that.

Tanpa biaya tambahan.

For people who do not have a steady supply of food,

Bagi mereka yang tidak punya persediaan makanan yang stabil,

especially those who are diabetic,

terutama penderita diabetes,

safety net systems are experimenting with a variety of solutions,

sistem jaringan keamanan sedang menguji berbagai solusi,

including food pantries at primary care clinics

termasuk dapur makanan di klinik perawatan primer

and distributing maps of community food banks and soup kitchens.

dan menyebarkan peta komunitas bank makanan dan dapur sup.

And in New York City,

Di kota New York,

we've hired a bunch of enrollers

kami mempekerjakan sejumlah pendaftar

to get our patients into the supplemental nutrition program

untuk memasukkan pasien kami ke program nutrisi tambahan

known as "food stamps" to most people.

yang lebih dikenal dengan "food stamps".

When patients and doctors don't understand each other,

Ketika pasien dan dokter tidak bisa saling memahami,

mistakes will occur.

kesalahan akan timbul.

For non-English-speaking patients,

Bagi pasien yang tak bisa bahasa Inggris,

translation is as important as a prescription pad.

terjemahan sama pentingnya dengan resep.

Perhaps more important.

Bahkan mungkin lebih penting.

And, you know, it doesn't cost anything more

Tahukah Anda, tidak butuh banyak biaya

to put all of the materials at the level of fourth-grade reading,

untuk menyediakan seluruh materi bacaan kelas empat SD

so that everybody can understand what's being said.

supaya semua bisa mengerti apa yang dikatakan.

But more than anything else, I think low-income patients

Namun dibandingkan lainnya, saya rasa pasien berpendapatan rendah

benefit from having a primary care doctor.

diuntungkan dengan adanya dokter layanan primer.

Mind you, I think middle-class people also benefit

Orang-orang dari kelas menengah juga diuntungkan

from having somebody to quarterback their care.

karena ada seseorang yang akan melayani mereka.

But when they don't, they have others who can advocate for them,

Jika tidak, mereka punya orang lain yang bisa menyokong mereka,

who can get them that disability placard

yang bisa mendapatkan plakat cacat untuk mereka

or make sure the disability application is completed.

atau memastikan permohonan kecacatan mereka lengkap.

But low-income people really need a team of people who can help them

Orang-orang berpendapatan rendah butuh sebuah grup yang bisa membantu mereka

to access the medical and non-medical services that they need.

mengakses layanan medis dan nonmedis yang mereka butuhkan.

Also, many low-income people are disenfranchised

Banyak orang berpendapatan rendah yang kehilangan haknya

from other community supports,

dari dukungan komunitas lainnya,

and they really benefit from the care and continuity provided by primary care.

dan mereka sangat diuntungkan dari layanan dan kontinuitas layanan primer.

A primary care doctor I particularly admire

Seorang dokter perawatan primer yang saya kagumi

once told me how she believed that her relationship with a patient

bercerita bahwa dia yakin hubungannya dengan seorang pasien

over a decade

selama lebih dari 10 tahun

was the only healthy relationship that that patient had in her life.

adalah satu-satunya hubungan sehat yang dimiliki sang pasien sepanjang hidupnya.

The good news is, you don't actually have to be a doctor

Berita baiknya, Anda tak perlu jadi seorang dokter

to provide that special sauce of care and continuity.

untuk menyediakan layanan dan kontinuitas itu.

This was really brought home to me when one of my own long-term patients

Ini jadi nyata, ketika salah satu pasien lama saya

died at an outside hospital.

meninggal di rumah sakit lain.

I had to tell the other doctors and nurses in my clinic

Saya harus memberi tahu dokter lain dan suster di klinik saya

that he had passed.

bahwa dia sudah meninggal.

But I didn't know that in another part of our clinic,

Tapi saya tidak tahu di bagian lain dari klinik kami,

on a different floor,

di lantai yang berbeda,

there was a registration clerk

ada pegawai registrasi

who had developed a very special relationship with my patient

yang menjalin hubungan spesial dengan pasien saya itu

every time he came in for an appointment.

tiap kali dia datang berobat.

When she learned three weeks later that he had died,

Ketika dia tahu tentang kematiannya tiga minggu kemudian,

she came and found me in my examining room,

dia datang menemui saya di ruang pemeriksaan,

tears streaming down her cheeks,

air mata mengalir di pipinya,

talking about my patient and the memories that she had of him,

ketika dia berbicara tentang pasien saya dan kenangan bersamanya,

the kinds of discussions that they had had about their lives together.

hal-hal yang mereka bicarakan tentang kehidupan mereka.

My patient had a hard life.

Kehidupan pasien saya sulit.

He was by his own admission a gangbanger.

Dia adalah seorang anggota geng.

He had spent a substantial amount of time in prison.

Dia menghabiskan sebagian besar waktunya di penjara.

He suffered from a very serious illness.

Dia menderita penyakit serius.

He was a drug addict.

Dia seorang pecandu narkoba.

But despite all that, he rarely missed a visit,

Walaupun begitu, dia jarang melewatkan janji temu,

and I like to believe that was because he knew at our clinic that he was loved.

dan saya yakin karena dia tahu dia dicintai di klinik kami.

When our health care systems have the same commitment to low-income patients

Ketika layanan kesehatan kita berkomitmen pada pasien berpendapatan rendah

that that man had to us,

seperti halnya pria itu,

two things will happen.

dua hal akan terjadi.

First, the system will be responsive to the needs of low-income people.

Pertama, sistem akan responsif pada kebutuhan orang berpendapatan rendah.

It will speak their language, it will meet their schedules,

Ia akan berbicara dalam bahasa mereka, ia akan menyesuaikan dengan jadwal mereka,

it will fulfill their needs.

ia akan memenuhi kebutuhan mereka.

Second, we will be providing the kind of care

Kedua, kami akan menyediakan jenis layanan

that we went into this profession to do --

yang diharapkan dari profesi kami --

not just checking the boxes,

tidak hanya mencentang kotak,

but really taking care of those we serve.

tapi juga merawat mereka yang kami layani.

Thank you.

Terima kasih.

(Applause)

(Tepuk tangan)