From The Trenches

(Healthcare Reform for the Real World)

#1: Nature of the Problem

This begins a series of examination of the problems in our health care system from the real world where patients get sick and injured, and doctors and other health care providers work to heal them. In the series, we’ll identify the actual non-political problems, and offer sound, sensible solutions that we can enact ourselves to reduce risk and increase patient safety.

Some 35-40 years ago, people would see a physician PRN — as needed. They’d call up and go in to the doctor’s office, and wait to be seen. If there was an emergency, that person would go ahead of the others, so anyone who had need of urgent care would be tended to. If it was after hours or on the weekend, the answering service would patch you through to your doctor, or the doctor who was “on call,” taking care of his patients while he or she was away or unavailable. You’d explain the symptoms, the doctor would then either say it could wait for an appointment, tell you to go to the pharmacy to pick up the prescription he/she called in, or meet you at the hospital if that was necessary. My family physician didn’t have front OR back office staff. A surgeon and surgical nurse instructor, yet he had no need of staff to take care of his patients. And that was in Chicago, in the 1970’s. It stayed that way until about 20 or so years ago, and the system worked well. Then the trouble started.

Then came “Modern Medicine,” and the age of specialization, HMOs, managed care, and miles of bureaucracy. I was in pre-med for the beginnings of it, about the time the Policies and Procedures list came out, and a $2 an hour clerk started telling doctors how long the patient could stay in the hospital, based on what the insurance company’s list said was the appropriate time for that sort of injury, illness or procedure. When I was home next, I spoke with my family doctor about my concerns. The guy who had stitched up my knee under a local in his office (taking the time to explain what all that colorful stuff in there was as I watched,) told me that he’d seen the writing on the wall, that if he had to do it over again as things were at that time, he wouldn’t have become a doctor at all. Too much red tape, too many forms and hassles — and that was just the beginnings, a fraction of the mess a doctor must deal with today! It’s a wonder anyone signs up for med school at all.

Today? Today you’d better have very good insurance, and be sure to get sick or injured during the week. Even then, you may not be able to get an appointment for weeks, and it depends on your health care group (Group? what ever happened to a doctor?) whether or not they’ll even try to squeeze you in. If not, you’ll be sent to an E.R.

A few weeks ago, a patient ran up a $2600 bill at the E.R. for something that would have cost under $100 at the doctor’s office. Why? He had the poor luck of getting sick on a Saturday. Those who are with a Group that has staff on call over the weekend may not realize it, but a great number of people don’t have that kind of access to health care providers. $2600 to prescribe a $18 medication because the patient had no other access to a physician over the weekend. That’s at LEAST 26 times as expensive as it would have been from Monday through Friday… And they wonder where the fat is at in health care?

This is a problem of access to care. The problem starts with defensive medicine. The doctor might very well have picked up the phone, heard the patient’s complaint, asked relevant questions, and prescribed something to solve the problem. But he can’t do that now. He has to worry that someone will sue him, so he has to examine the patient in person, do every test imaginable, document findings, code it all, so the billing staff can issue a bill. If he doesn’t and the patient sues (with our without valid cause,) he could lose everything. So defensive medicine also affects access.

Check out the next article in the From The Trenches series, and we’ll present the first of several real-world win-win solutions to the health care reform problem. Congress may have taken a year and still not have a solution. We’ll have one for you here, in a matter of weeks! Meanwhile, check out this tip:

One solution to defensive medicine is Medical Justice. Their methods have demonstrated success. Medical Justice Members can worry less and provide their patients with better quality of care. Isn’t that a great place to start?