The best and worse of medicine

One follow up to the last couple of posts with some observations of how medicine in this country is truly great, but at the same time hopelessly awful.

First, the good, and there is a lot of it – mainly the people involved.

Just about everyone who I came in contact with at the hospital was amazing, from the folks who did my intake to the dining services worker who went out of her way to get me some lunch when they brought me into the cardiac observation unit after meals had been served. And of course the doctors and nurses (especially the nurses) involved in treating me. A heartfelt thanks to you all for you kindness, patience and professionalism you showed.

The other thing that amazed me was the efficiency of the processes and technology in place, especially when dealing with a suspected cardiac event. Literally within seconds of walking in the door and saying the words “chest pain, ” they had me in the back and were starting an EKG. Within an two hours they had completed a chest x-ray and I had been seen by and evaluated a physician and moved from the ER into the specialized cardiac unit. Despite some issues with the CT scanner, within 24 hours I had a CT scan of my heat completed, and the results were sent off and analyzed by specialists and available to the doctor within another two hours. Had there been any blockages discovered, I would have had a stent inserted from a vein in my leg through the artery and up into my heart, and, had I been so inclined, I could have watched the entire process on a monitor, and then sent on my way home the very same day. This is all just pretty amazing when you think about it.

Now though, for the bad, and these two things explain a lot of what is wrong with medical are in this country today I think.

During the two hours or so that I was in the ER itself, a handful of other patients were brought in, including optimistic coughing man (see his story here). One thing I noticed was that very few of these people were there for actual emergencies. Most were there for routine medical issues, and when the doctor asked them who their regular physician was (one thing about the ER, there’s little conversational privacy there – those sheets sure ain’t sound proof) the reply was almost always “I don’t have one.” I don’t want to jump to conclusions, but I suspect the reason that is so is because they do not have insurance, so the ER becomes their doctor of last resort, and the cost goes somewhere (you can guess where – next time you grumble about “socialized medicine” and having to pay for other people’s care, guess what, you already are, just in a massively inefficient way).

I don’t know what the best solution to this problem is, but why we ever decided to link health insurance to employment is beyond me. It’s a completely illogical and massively inefficient mechanism for delivering preventive care.

The second problem I noticed came about when it was time for me to go. The doctor came by to talk about what they had found and to give me a list of prescriptions, and then a nurse practitioner and then another nurse came by to talk about all of the possible side effects of these medicines. Included in my large packet was some information about diet, but the doctor mentioned that only in passing. And no where was there any talk or information on dealing with stress, or the negative effects of sleep deprivation, even though I had specifically brought those things up repeatedly – everything was focused on the pharmaceuticals.

Doesn’t it seem insane and wholly inefficient to focus exclusively on treating symptoms instead of addressing underlying causes, especially when those treatments would result in hundreds of dollars a month in expenditures on medicine when a simple “less bacon, more shakin'” would likely produce better results? I am thankful that both my physician and my cardiologist agree with me on that. Both suggested implementing the kind of lifestyle changes that would hopefully address the underlying causes of what was making me sick, versus just prescribing medicine to achieve a particular blood work number. I suppose that has a lot to do with the nature of ER practice vs. longer term care, but to reflexively prescribe multiple medications to someone, which you assume they will be on for the rest of their lives, based on one observation and basically ignoring the possibility of treating or eliminating the underlying causes of the symptoms just baffles me.

I suspect I know the cause of both of these problems, and the biggest reason why neither will be fixed (insurance companies make way too much money off the status quo). Quite honestly I don’t think there IS a way to fix a system we have in place, it takes the inequalities of a purely market based health care system and combines them with the inefficiencies of a controlled model and then dumps a lot of the burden for administering them onto employers.

Am I way off base on this? What encounters have you had with the health care system have you had, good or bad?

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Posted on September 5, 2013, in Tao of JLo and tagged , , . Bookmark the permalink. 5 Comments.

  1. “I don’t know what the best solution to this problem is, but why we ever decided to link health insurance to employment is beyond me. It’s a completely illogical and massively inefficient mechanism for delivering preventive care.”
    Excellent point, Jimmy.

    My brother is an ER nurse. He finds it incredibly frustrating to have to tend to minor, non-emergency ailments. He is well aware that the pitiful state of health insurance in this country has resulted in an inefficient usage of ERs as primary care facilities.

  2. Wage restrictions during World War II led to employers offering subsidized health benefits to attract workers. And, as we all know, once you give Americans something at a discount, raising the price or ending said discount is nearly impossible without an uprising.

    It’s refreshing to hear the perspective from someone who isn’t connected to the health care industry and their observations on strengths and weaknesses.

  3. Interesting topic. Don’t disagree with the frustrations, but may add some perspective to the discussion (and no, I don’t have all the answers):

    * Concerning the people using an ER as their primary “go to”, I don’t believe, is all an insurance issue. I think people have simply been trained to do this over time. However, there are plenty of walk-in clinics (doc in a box) that are probably more readily available than going to an ER. At the same time, if someone really wanted to, the could have a PCP without insurance. Doctors do take cash, sometimes at a discount. As a matter of fact, many physicians are transitioning their practices to a cash model.

    * Insurance is not tied to employment. If an employer offers it, then great. That’s why it’s referred to as a “benefit”. Otherwise, it is just like anything else. You (not you, the general population) can go online (ehealthinsurance.com) and shop for the best plans, rates, and features in your area and buy it. Or they can contact a health agent in their area. Same price whether it’s bought online or through an agent. That’s what many people do. If it’s expensive, chose a higher deductible plan and add a critical illness and accident rider. If there are pre-X conditions, there are already State/Federal programs in place from which to purchase coverage with no qualifying.

    * In terms of prescriptions and the default answer for pharm solutions, I think you answered your own question. The ER Doc, in my opinion, is simply treating the ailment right in front of him/her. This is not an endorsement to stay on the meds forever. That is the discussion you have with a PCP at follow up. The sad truth is that more people probably ask more questions when buying a car than when they go in for a check up. For all of their faults, I can blame an insurance company for a patient that does not seek to help themselves. “Hey doc, I really don’t want to take XYZ forever. What do I need to do to get off of this?” At some point, the individual needs to take some proactive responsibility for their own health. A simple dialog with their PCP can go a long way in doing this.

    * Prevention…at least in the medicare market (more specifically med advantage plans), the doctors are being compensated on the preventative side. Their measurements are set up so that the doctors are making a certain % less than they used to make. The way to earn this back is to ensure that their patients are doing their annual screenings, physicals, and other “preventative” steps. This has not made it’s way to the “under 65” market, at least in terms of compensation yet.

    * Insurance…Again, not defending the companies as I have had MANY run-ins with them myself. However, they do operate on huge numbers, but slim margins. A risk based business model cannot make too many mistakes. One of the first shoe to drop after the AHA was passed was that most if not all companies stopped selling “children only” policies, given the guaranteed issue clause. It would be like asking your P&C agent to buy car insurance while the car is in a ditch. It can’t work. An no, I’m not heartless. Just taking the emotion out of a business model. Again, there are already Pre-X plans that can be purchased on a state / federal level. Beginning next year, they can’t deny anyone, not just children. This is one of the reasons you see many of the larger carriers pulling out of certain state exchanges. They know that they cannot sustain a risk model while at the same time, relying on the Gov’t to make the subsidized payments for everyone on the role.

    Obviously, the HC system needs revamping. I’m just hoping that the benefits of the recent changes outweigh the “unintended consequences” that are staring to arise. Good discussion topic. Thanks for sharing the experience.

  4. Thanks for the perspective guys. It’s good to get a look behind the veil sometimes. I should say that virtually all of my experiences with health insurance have been positive ones, though I know several who have their issues. When I say insurance is “tied” to employment, I simply mean that it’s how the vast majority of people get it. My biggest issue is why we depend so much on insurance for preventive care at all? I buy car insurance for a catastrophic accident, but I don’t buy it for oil changes and everyday maintenance (and yes I know they try to sell those things now.)

  5. Great question about the “preventative care”…My take is this: With auto insurance, you are covered for accidents. The P&C company has no vested interest if you neglect oil changes, transmission fluid, etc. They aren’t on the hook if you blow your own engine up. On the flip side, a health company has a serious interest in the preventative arena. They would rather help cover annual physicals and screenings for a few hundred bucks a year and possibly avoid the $250,000 claim on open heart surgery or a lifelong treatment of another, possibly preventable, illness. Especially now that they will be forced to accept anyone with a pre-X starting next year. Keep in mind, the new AHA stressed the preventative side by forcing major medical plans to pay for 100% of the annual preventative physicals, etc. Prior to that, a physical and corresponding tests were still subject to copays, etc. just like any other Dr visit. Now the insurance companies are required to pick up 100% preventative costs while preparing to approve all pre-X. The AHA is betting on (with the insurance co’s money) that over the long haul, we will become healthier. Otherwise the “utilization review / management” scrutiny will become more harsh down the road. No, I’m not a “death panel-er”, but UR/M is a very real practice where certain medical procedures are reviewed for claim / treatment purposes. This is more prevalent in the world of medicare, especially with Med Advantage (part C) plans. Thanks for the discussion. A lot of these issues will become more defined over the next few months, for sure.

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