10 Questions: Elizabeth Madigan, PhD, RN
by MedPage Today Staff July 8, 2017
Elizabeth Madigan, PhD, RN, is the CEO Designate at the Honor Society of Nursing, Sigma Theta Tau International (STTI). She was previously Independence Foundation Professor in Nursing Education at the Frances Payne Bolton School of Nursing at Case Western Reserve University in Cleveland, Ohio. Madigan was director of the school's Pan American Health Organization/World Health Organization (PAHO/WHO) Collaborating Center for Research and Clinical Training in Home Care Nursing.
1. What's the biggest barrier to practicing medicine today?
In the U.S., we still have a system that makes care coordination difficult. Almost everyone has a story about an older friend or relative who sees multiple providers, but, for example, there is no communication between that patient's cardiologist and rheumatologist. The electronic health record has helped [when] the providers are in the same healthcare system. Across healthcare systems, we are not there yet.
I come from the home healthcare world. In that setting, we routinely may be unable to access electronic healthcare information for all the systems through which a patient receives care. As a result, home healthcare nurses cannot easily and seamlessly share their observations with other providers. We're making progress on this front, and I am optimistic that this barrier will be greatly reduced in the next five years.
2. What's the most important healthcare issue that nobody is talking about?
The aging of the healthcare provider workforce. Throughout the nursing community, we are well aware of the growing nursing shortage. For nurses, but also physicians, physical therapists, and other disciplines, the retirement projections are scary. With the aging of the American population and the growth in chronic non-communicable diseases, we will need more providers than we have now. There are not enough younger people entering these professions to replace the retiring members. This is not just an American issue; many other countries have the same concerns, Japan being one of them.
3. What changes, if any, will the Trump administration impose on healthcare practice?
I will tread lightly here because STTI is an apolitical organization. There are many payment experiments going on in the Medicare program called alternative payment models (APMs), and they are being evaluated as we speak. The one I watch most closely is the APM for joint replacement. Medicare payments follow the patient from pre-operative through post-operative care (90 days after surgery) and the hospital healthcare providers, surgeons, and post-acute care providers (like home healthcare agencies) work together to achieve the best outcomes. If these APMs work as anticipated, patient outcomes will be positive with less money spent. I anticipate that the Trump administration will allow these to continue.
4. What country do you think has a better healthcare system than the United States?
There is no perfect healthcare system; there are advantages and disadvantages to the different models used around the world. We are blessed in the U.S. to have so many providers, facilities, and interventions available to us. At the same time, we have challenges about making sure healthcare is affordable and available to all of us.
Global discrepancies between healthcare systems and access to care, as well as the need to engage the voice and vision of nurses in this dialogue, spurred STTI to convene the Global Advisory Panel on the Future of Nursing & Midwifery (GAPFON). I look forward to the release of the final GAPFON report this month.
5. How often do new students ask you about some medical finding they heard discussed by a celebrity doctor?
Our undergraduate students are media-savvy for the most part and can distinguish a reliable source from an unreliable source. From time to time, they ask about these things. I worry more about the general public who are not healthcare providers and have trouble making a distinction about reliability. It is a thorny problem -- we want everyone to be informed but there is so much information with so much variation in quality and accuracy!
6. Have you ever been afraid of a patient? (If so, can you briefly describe the situation?)
As a home healthcare nurse, I have been in settings where there were safety hazards like mean dogs, shotguns behind doors or under mattresses, or unsafe conditions such as porches about to collapse. I never had a patient I was frightened of, though. And I could always figure out how to deal with the safety hazards. For example, I carried dog treats in a Ziploc bag in my nurse's bag, or I'd ask the patient to put the firearm away until I was done with my visit.
7. Do you discuss drug costs with patients?
When I practiced as a home healthcare nurse, I did discuss drug costs. Drug costs forced some patients to choose between taking the prescribed drug and buying food. I was lucky enough to practice in systems where there were resources for patients who could not afford their prescribed drugs.
8. What do you consider the best advice you could offer patients (medical or otherwise)?
Talk with your primary provider about what you want for your health. It is in everyone's best interest to share your preferences. Almost all providers are willing to have those kinds of discussions, as it improves their ability to care for you. I am still surprised by the number of people who tell me things like: "I don't want to take a statin." But they haven't told their provider that -- they just don't fill the prescription.
9. If you weren't a nurse, what do you think you would be doing today?
When I was young I wanted to be a marine biologist and study sea mammals like orcas. But I think nursing is a wonderful profession, and I have had a great career. Nurses have the opportunities to support their patients as they experience life's greatest highs and lows. What an honor to be able to accompany people on this journey. Many nurses I have met from around the world share this view. How privileged we are to do this work.
10. What is the biggest difference between your expectations of nursing practice when you graduated from nursing school and the reality?
I knew that nurses could work in all kinds of settings, but until I had those opportunities, I did not appreciate that very well! Many people still have the misunderstanding that most nursing is in the acute care setting. Nurses are actually everywhere -- in homes, in workplaces, in clinics of all kinds, doing global health work, in government settings. We really do have so many choices!