Tuesday, October 6, 2009

Why does the doctor always make me wait before my appointments?

1. Because he/she can – Seriously, think back to the last time you waited at the office. Did you cause a stir? Did you complain? And I mean complain to the doctor, not the poor receptionist so frazzled she can’t even remember her own name. Did you say anything? Now, think, if the cable guy was that far outside the “window” – would you have called the cable company in a huff? I bet you would have.

Doctors keep us waiting because we let them. We don’t make “timeliness” a condition of our devotion. In fact, many of us don’t have any conditions for which doctor we see other than 1. Does he/she take my insurance? and sometimes 2. Do I “like” him/her? We don’t take advantage of online tools that compare doctors of hospitals based on performance or numbers of procedures. We go to people our insurance covers and we “like”. We are more picky about choosing a car than a doctor. Yet, we complain when doctors don’t meet our expectations. Before choosing your last doctor, did you ask how often do you run on schedule? How do you communicate with the patients? E-mails? Phones? Do you call with test results even if there is nothing wrong? What are the chances I can get a same-day appointment if I am really sick? Well, if you didn’t ask, you may think twice about complaining about your doctor running two hours late after you waited 3 weeks for the appointment just to find out your test results.

But it’s not all the doctor’s fault. There is a systemic problem to blame as well:

2. Because she/he has to – The cost of a medical education in this country is insane. Yes, clinically insane. In order to clear themselves out of debt, doctors have to see patients. Reimbursement rates are by patient, not per hour, so the incentive is for doctors to see as many patients as they can in the shortest amount of time that they can. That standard has moved from 2 patients/ hour to 4 patients/ hour to one doctor that I had to break up with that scheduled people every 10 minutes. Now, it’s no wonder they are always running late. Imagine what happens if a patient has an actual condition that requires explanations of treatments and side effects and a weighing of options. Now, the doctor has spent 2 time slots on one patient and pushed off the whole day. Some doctors manage this better than others. They work with their staff and rely on their nurses for the bulk of the exam so the 15 minutes with the doctor are efficiently used.

Here’s a good example: A few months ago, I went to the doctor with several issues I wanted to discuss. None of them were serious, but I still had some concerns and questions. The doctor informed me that we could only discuss one or two issues and that I would have to schedule another appointment to go over the rest – in one to two issue increments. So it would take me at least 3 appointments over probably 5-6 weeks to figure out if the 5 issues were related. In the meantime, I would have started treatment on each issue as if it was an isolated problem. This does not make sense. I quickly switched to the University Faculty Group of the local Medical School where the Medical Student was more than happy to hear all my issues and try to piece them all together and present a diagnosis to the doctor. Then the doctor was more than happy to explain why the Med Student was not quite right and come up with a plan that addressed all the 5 issues. Time with Medical Student: 45 minutes. Time with the physician: 12 minutes. Time in the Waiting Room: Zero. Now we are talking! This was partially possible because the physician’s salary was supplemented by being part of the faculty and she had access to medical students.

In my opinion, solutions to the doctor waiting problem go from:
Schedule the first appointment of the morning and bring a list of issues you want to discuss TO
Nationalize physician education so that doctors don’t leave school with so much debt and reform the reimbursement system to value diagnosis/treatment/outcome over volume.

Just depends how much effort you want to put in.

Sunday, October 4, 2009

What should be done with health care reform? Does there need to be a public option?

Yes, there needs to be a national health plan that every man, woman, and child can receive, regardless of previous condition, that pays for 100% of their care as long as the care complies with best industry practice. Now, put turn down the Glenn Beck show and hear me out people. Our country is suffering because we do not have an adequate health care system. I took developing country economics in grad school. The experts agreed that in order to have a productive society, the workforce must be healthy and educated and there must be an infrastructure to support the means of production and export. THAT IS FOR DEVELOPING COUNTRIES! We are going backward.

You know that massive credit crisis we face? Could that at all be related to the fact that 41% of Americans under the age of 65 have medical debt? Imagine if that all just went away. Imagine if small businesses could retain employees. Imagine if people didn’t have to stay at jobs they hated because their kid has diabetes. Imagine if people could get adequate preventative care and therefore eliminate costly medical interventions down the road and be healthy. I don’t want to imagine that. I want to live it. I want to have a backup plan. A place where I can go – no matter what – and get health care and not have to mortgaged my house to pay for it.

Let me break down that first sentence so people know exactly what I am talking about:
There needs to be:

A national health plan – Note I said health plan – not government administered hospitals and clinics. My Congressman can’t figure out that cutting Veterans’ benefits and voting for the war are contradictory. We can’t leave it up to him. We need a smart person that knows something about medicine, and people and curing people with medicine and running hospitals and clinics and nursing homes. That’s what we need.

that every man, woman, and child can receive, regardless of previous condition – Now I am talking crazy. I can just hear your thoughts now: “We should give health care to people who we know are sick. WHAT???? That’s insane. We could actually make them better, then there would be more people in line at the Wal-mart. That would be bad. Patients with previous conditions should be forced to move to Montana and die alone.” However, I like people with previous conditions and I think they need medicine and I hate Wal-mart so the line can be filled with people with previous conditions 24/7.

that pays for 100% of their care as long as the care complies with best practice –What the heck does best practice have to do with this? Well, there are people out there – bad people. They like to give patients, especially elderly patients, lots and lots of tests and procedures they really don’t need because it makes more money for them. They appear to all live in Florida – South Florida to be exact. Using best practice will be a good check on the medical delivery system that ensures patients are getting what is best for them while the taxpayers are getting a good value on their tax dollars.

Aren’t I concerned about “government” making health care decisions for me? Well, they kinda already do. What Medicare decides to reimburse and not reimburse basically sets what the care plan is going to be for a particular disease or treatment – even for private insurers. And this is because we have a health care system where doctors and other health care professionals have to adapt their care plan to what will be covered – not what is best for the patient.

Am I concerned about socialism? Not really. A public option can be funded through tax money and still be run by the private sector. I would prefer it be run as a non-profit because I don’t think health care is the place to be skimming profits. Plus I kinda like some aspects of socialism like roads, the post office, public education, parks, sewers, police, fire protection, and all those other pesky things that taxes pay for that EVERYONE gets to access.

What I am concerned about is that this generation will likely have a worse future than their parents. What I am concerned about is that our 2004 infant mortality rate places us 29th in the world. There are 28 other countries where babies have a better chance to live. What I am concerned about is that we pay more money for health care than any other country and still 41% carry medical debt. What I am concerned about is the conversations I have with nurses and doctors about the state of our country’s hospitals.

We need health care reform and we need it now. I am disappointed and disgusted by the cowardice of the Democrats in the House and Senate and White House that refuse to step up and use the Super Majority to save this country. I am disheartened by the Medicare beneficiaries that are out raising their voices against “government health care” – even though their very lives depend on it - because talk show host told them to yell louder. I ache for the small business owners who every day have to close the doors on their dreams because they just can’t afford not to have health insurance anymore. What will it take to get what we need?

I’d love to hear your thoughts on what we need to do to fix this health care crisis.

Friday, October 2, 2009

What do you think of the flu vaccine?

This is actually the question I posed to two of my dearest friends the other night over dinner. After all the hype over the swine flu and the vaccine development in China, I wanted to get others’ opinions. My overall reaction to the flu vaccine has always been the opinion that it is a scam by the pharmaceutical industry to make more money off of people’s fears. Viruses mutate a lot. The idea that a vaccine can be developed and ready by October and have the right strain to fight off a virus that will hit its peak in February befuddles me. I just don’t see how it is possible. Plus we can’t trust China to make safe children’s toys, but now they are the leading experts on vaccines? I find that interesting.

The question of vaccines has become very controversial in recent years. To me, the question boils down to personal risk versus social responsibility. Yes, we each take a personal risk every time we get vaccinated. That risk is somewhat ameliorated by the personal benefit of protection from that disease, but all vaccines have side effects. I can’t imagine living in a country where the mumps, small pox, and polio still ravaged cities and villages so I am more than willing to roll up my sleeve and take the shot. I think vaccinations should be required for attendance in public schools. I think that is a good use of government regulation for overall public health.

But the flu just doesn’t seem that serious to me. I have a healthy immune system, good insurance and sick time at work. I can afford to be sick and allow my own immune system fight off the invaders. I understand others don’t. Plus, we won’t wipe out the flu if everyone gets vaccinated. The virus will still be around. However, if I interacted every day with people with depressed immune systems due age or disease, I would likely get the flu vaccine to protect them. What is a little sniffle to me is likely catastrophic for them. Did you get the flu vaccine? Why or Why not?