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?