A Diseased System

Think about your last doctor’s appointment. Why were you there? How was your wait time? What about the office staff? Friendly? Abrupt? Neutral? Do you remember the amount of face-to-face time with your provider? Did the visit end on a good note? Did you leave feeling comfortable with the outcome? Or, scratching your head with confusion? Final question: If a loved one asked you to summarize your visit, could you do it confidently?

The questions are a backdrop to my proposition that the healthcare delivery system in the United States is badly damaged. And as a result, the most essential components of this system (patients and providers) are suffering.

The practice of medicine is becoming less of an art and more of a business. As medical technology advanced and pharmaceutical companies produced more sophisticated drugs, medicine became more expensive to practice. Somebody has to pay for it. So corporations with deeper pockets than doctors and hospitals swooped in to bankroll the rising cost of health care. “What’s the problem with that?”, you ask. Well… that’s where the problem begins.

Problem 1: The goal of the corporation is to make money. Big surprise, right? That goal, in and of itself, is not the problem. The issue at hand is that the “powers that be” in the corporation (usually not medically trained individuals) have worked their way into the doctor-patient relationship. The most basic and common example is a company has purchased a doctor’s office. The company’s accountant looks at the doctor’s books and gives the numbers to the company’s CEO, CFO, COO, etc. They meet and decide how to increase the doctor’s (read their own) bottom line. They make a few good suggestions and a few not-so-good suggestions, like having the doctor see more patients. Again, on the surface, not a problem… initially.

What happens eventually is that the doctor is getting doubly and triply booked and can’t spend enough time with each patient, leaving both the doctor and the patients frustrated.

Problem 2: Now that the corporations have been successful in helping the doctor to thrive financially, other folks want a piece of the pie too. Let’s see what the pharmaceutical and electronic medical record and laboratory and compliance companies can do to “help” (i.e., take over). The assumed bonus is that the insurance companies help both the doctor and the patient, right? Please don’t misunderstand. Overall, I do value the roles these entities play in “health care” (which I put in quotations because I really think it should be referred to as “sick care” but that’s a topic for later). But the common denominator is MONEY. Everyone wants to make some money out of the essence of medicine: patient care.

My request is simple: I want to have a relationship with my patient. That takes time and familiarity. I don’t want the insurance company, the CEO, the EMR, or anyone telling me how much time I can spend with my patient. The hoop-jumping that is required these days is ridiculous. And patients have no idea what we have to do. They only end up feeling rushed out of the room, and left out. I can only speak for myself when I say that I did not go into medicine for this. Until providers and patients make some noise and claim the care they deserve, I fear that nothing will change.

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