Health Care’s Broke: We Are All Connected
(No, I’m not going to get all Kumbaya on you.) Listen:
We’re all in this thing together, whatever it is. That “limited resources” bit you remember from Econ 101? It applies to health care, too.
Look, the lesser argument has been made many times over, by the likes of Paul Farmer and other radicals who have fought battles in Infectious Disease: that if we don’t control infections in one population, they spread to other populations and make us all sicker. That if we don’t treat multi-drug resistant TB in Haiti, Peru, or the prisons of Russia, then we Americans will be fighting the MDR-TB here at home. (Similarly in the infectious disease world is the fact that vaccine “herd immunity” is becoming less useful, as our international lifestyles put us into contact with people who were born outside the US and never got measles vaccines, for example, and may be contagious.)
But the greater argument for our interconnectedness is this: that by allowing whole swarms of people (often but not always the un- or under-insured) to go without necessary chronic care and necessary follow-up, they eventually become sicker and more complex. And this, my friends, creates problems for all of us. Because sicker and more complex patients require more doctors and more time and more hospitalizations. And more hospitalizations that take more time, because sicker and more complex patients have more things that will go wrong with them.
How does this get back to you, oh-self-concerned one? Because when there’s more sick patients, there’s less time for you, when you’re sick. Some say that patients will get worse care and will be seen slower in the Emergency Department. While this may be true to some extent, triage — the sickest people to the front of the line — often takes care of much of this. But because there’s simple more people (quantity, not necessarily quality), your mom with the broken hip is seen slower, and fewer minutes are spent on her since there’s more patients total. It’s no wonder hospitals are stuffed to capacity.
So take a system with sick people, discourage them from seeking primary care by:
- having them pay for primary care when they themselves often don’t see any benefit from it and
- discourage doctors from going into primary care by making it a nightmare of:
- paperwork
- referrals
- tons of complex, sick patients to be seen in 15 minutes and
- little pay compared to other doctors
And you’ve got what we have today: any number of people who are sick, complex, and take up tons of time, energy and resources. And no matter how you spin it, it ends up creating worse care for us all.
We as doctors tell our patients to do certain things to stay healthy — and often pay more money to buy these pills – when often patients don’t see one lick of good from our recommendations. All they see is a lower blood pressure number, and money out of their pockets for expensive pills. (That is, until they stop taking their pills, or have a really bad consequence of their disease, then they see it.) Throw in any number of health care and physician scandals in the past decade, and it’s no wonder they’re skeptical.
In order for us to receive better care and to fight the constant ambulance diversions and hospital overflows, we’ve got to ensure that people take care of themselves. And that starts by removing the barriers to self-care.
I am amused at some of the blame-the-poor rationales for our messed up health care system. So very often the system itself is its own worst enemy.
I remember when I was a kid in the 80′s, standard policy for my family’s HMO was no appointments within two weeks of calling. Needed something sooner? Go to the emergency room.
Until she retired, I “saw” the same doctor for almost 15 years. Each and every visit there was surprise that her handwriting was on my chart because she didn’t have a clue who I was.
I haven’t been to a doctor in 4 years. Despite paying big bucks for catastrophe insurance (which may or may not turn out to be any good in the event of such catastrophe), I don’t expect to be seeing a doctor anywhere but in the emergency room.
My fix for the whole system? Instead of government-financed hospitals and insurance, the cheapest fix would be to subsidize the cost of a medical education. I believe in the free market: more doctors would increase competition and thus efficiency of care.
It would also make general practice medicine feasible, when it’s not currently because of staggering student loans. When a GP charges $300 for a 10 minute visit? That is nuts. I expect to pay $1800 *per hour* to a brain surgeon. I simply refuse to pay that in order to have my blood pressure and weight marked on a chart once a year.
I think this is what they used to call “enlightened self-interest.” It seems to have gone out of fashion (as a phrase, generally; and as a concept, in the US). Reviving it might do us some good.
Graham, you discuss self care without definitions or examples. As a physician-to-be, I understand what self care means but the average reader only latches on to the tone of the discussion.
I understand that this is a blog, and a broadcast of opinions, but the tone lately have been somewhat directed at physicians in fixing all the problems of health care.
Furthermore, while the series of important topics have been interesting, I feel an increasing degree of negativity in your blogs. Negativity breeds more negativity. I know the system is hampered by several problems, but no health care system is perfect. I am just afraid Nurse K’s predictions will hold true and I hate to see you in a few years as a frustrated resident.
U have an influential blog here, and I’d hate to see it being misinterpreted as a fodder for patients to mistrust the system (yes, some already do but that is natural) and jeopardize their health care.
Dear Anonymous: I am very sad about your decision and apologize that previous experiences have driven you to this conclusion. A handful of primary care programs already provide subsidies for medical education but that is not the only thing that will revive primary care.
There is more to annual GP visit than blood pressure measurements and weight marking. I’d encourage you to continue to pursue preventive care by at least visiting your primary physician (family practice, internal medicine MD/DO, and now ER to an extent) at least once a year. Prevention is always better than cure. U are correct, medical care is expensive…but catching a diagnosis and preventing complications is a priceless thing that you and your family (and physician) will appreciate.
@Worried: I think I was mostly writing to try to convince people who believe everything is just about individual responsibility that if we don’t include everyone in the system, it hurts THEM too. I don’t think I’m being negative at all, unless you mean that I’m documenting a number of things I’m concerned about but trying to suggest ways to fix. The tone is definitely that physicians have a responsibility to play a part in fixing health care. We are at the helm of the ship!