From The Trenches

(Healthcare Reform for the Real World)

#2: Access Solutions

This is the second in a series examining 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.

Last time, we visited the Nature of the Problem and showed how the advent of the bureaucracy of modern medicine and defensive medicine were causing an access problem. This time, we’ll take a better look at that problem, and present a few variations on practical solutions. We encourage discussion, and hope you’ll weigh in with your thoughts.

In the case study previously mentioned, the patient had Type 2 Diabetes, had acquired a stomach virus and was unable to keep down the oral medication that treated his condition. While it was a legitimate concern that the patient maintain a level of Metformin to control blood glucose levels, the symptoms were not particularly suggestive of H1N1. Since the patient complained only of the vomiting and nausea and concerns about not being able to take his medication, it’s likely that a conservative approach would have been to prescribe Ondansetron to control the vomiting. Instead, because it was a weekend and the patient had no access to his regular physician, the RN line recommended the E.R. That was defensive medicine. Then the E.R. visit itself, which included a simple test to see if he had a flu virus, basic bloodwork, and an EKG (just in case, the otherwise healthy patient is Diabetic, after all,) and a bag hung to rehydrate. An hour or two in the E.R. on a slow evening, and $2600 later, the patient walks out with a script for Ondansetron and instructions to return if symptoms don’t improve within a couple days.

The generic version of the medication costs $5 per dose. Even if a phone consult fee was charged it would have amounted to a tiny fraction of $2600. If only this were the rare exception… but it’s not. The cost of heath care is regularly inflated, costs increased exponentially, because the patient lacks access to regular health care. Now on to potential solutions:

Potential Solution #1: Make sure that there are doctors on call for all physicians, and see to it that they’re working efficiently and cost-effectively. Obviously, this will require a change in tort laws and physician protections. Medical Justice founder Jeffrey Segal, MD, JD, FACS, proposes that doctors be exempt from suits so long as they follow established, acceptable standard-of-care procedures. How to get the doctors? Simple enough. Rotate weekends. That was standard not long ago, and still is the means of operating in many practices today. Whenever reasonably possible, keep the patients out of the expensive and overly congested emergency rooms.

Potential Solution #2: Hawaii has implemented it already. Provide video-conference consultations with doctors. Again, rotation is one means, or physicians could be hired specifically to man those lines. Voice conferencing may be enough for some circumstances. The Internet is an integral part of today’s technologies. When surgery can be performed from halfway around the world by means of remote controlled robotics, we can certainly attend to many patients swiftly and effectively via communication technologies, if only we’d implement them. Here again, some aspect of Risk Management will be necessary.

But does that require that Congress pass anything? Not necessarily. Medical Justice provides its members with methods that have proven results to deter frivolous lawsuits

When patients are able to get access to their regular health care providers, the exponentially higher costs of ER visits will be eliminated. The cost of heath care can be greatly reduced and the quality of patient care and safety increased as well. This would be a huge step in the right direction.

Strong tort reform is also important. It’s pretty clear, though, that it won’t be coming from Congress. The best thing for both doctors and their patients is to implement the methods provided to Medical Justice Members.

Be sure to be on the lookout the next From The Trenches article. Meanwhile, please weigh in with your thoughts and suggestions!