Imagine What We Could Accomplish in a Health Care System that Worked
August 28, 2017
The other day, rather than being at the office, I was sitting in the waiting room of our favorite gastroenterologist’s endoscopy suite. I had dutifully accompanied my wife, who was getting her colonoscopy. My cellphone buzzed. It was my nurse calling from the office. I had seen a patient late the previous day who was complaining of right leg pain. I had ordered a D-dimer, hoping the test would be negative, ruling out a blood clot. But the test had been positive. The patient was still experiencing pain, and now wanted further instructions. I asked my nurse to order an ultrasound of the patient’s leg, which she was able to do with a quick phone call. The patient was sent right over for the test. About an hour later my cellphone buzzed again. It was radiology calling to let me know that the patient did indeed have a blood clot. They put the patient on the phone, and I informed them of the diagnosis and asked them to come right back to my office on the way home. I met the patient there and started one of our newer anticoagulants, for which we had samples that came in a handy-dandy one-month starter pack, and sent them home.
This was just a simple case, but I love how easy it can be to get things done when we have smartphones, smart, motivated staff, a simple ordering process, and new treatments like this anticoagulant. Not too long ago, this patient would have had to go to the ER to start IV heparin, and be admitted to the hospital for days until the warfarin (an older anticoagulant) blood level was therapeutic. It’s actually amazing what we can get done today with such relative ease.
It made me think of other times and other ways that newer technologies or treatments enabled me to treat patients in ways that were impossible just a short time ago. A couple of years ago, I was on vacation in the Canadian Rockies, and was browsing Facebook, and caught a post from a patient (who is also a Facebook friend) inquiring if anyone in Facebook land could diagnosis his rash. I messaged him, jokingly admonishing him for turning to social media for such things, but also asking him to send me some better photos of the rash. I immediately received his photos, and was able to diagnose his cellulitis. I called in an antibiotic to a pharmacy back home. I know that I was supposed to be relaxing, but it just tickles me so much that we can do things like that today that I do it almost for the fun of it. And the whole episode took just a few minutes of my time.
Then there was the patient who had come in for dizziness and a slow heartbeat. His EKG looked an awful lot like complete heart block to me (an extremely serious finding), but the automated electronic EKG interpretation disagreed with me. I called a local cardiologist, took a picture of the EKG with my smartphone, texted it to his phone, and in seconds had his interpretation. He agreed that it was heart block.
I really love this next one. A patient of mine was on vacation in Eastern Europe and began experiencing abdominal pain. The patient had a previous history of pancreatitis following a Whipple procedure (a very complicated abdominal surgery) for a suspicious pancreatic cyst. The patient was visiting a national park, where they happened to have a doctor, who evaluated her and treated her pain, all for $50. The next day, a lab tech came to her hotel room, and drew blood. The lab results were available through a portal and were emailed to me. With those results, and in a phone conversation with the patient, we were able to come up with a simple plan of care, and as the pain had abated, keep the patient on their wonderful trip.
Again, these were all relatively simple cases. But what we can accomplish, and how easily we can do it, with newer technologies, like a smartphone, is truly profound. Imagine what we could accomplish if we brought to bear all of our newer technologies and other capabilities, diagnostics, and treatments. We could be working miracles all day long.
I imagine what it might be like.
Instead, we have a health care administrative system that fights us almost every step of the way.
Instead, we are distracted by a day filled with cumbersome and useless tasks made necessary by an out-of-control government bureaucracy and greedy insurance companies: the incredible time and work required just to get paid for basic services; unbelievable documentation requirements and data collection; mandated electronic health records that do not work; time-consuming prior authorizations for even basic testing and treatments; and now new hoops to jump through and websites to visit in order to prescribe pain medications.
Instead of working miracles all day long, as we could, we struggle all day to comply with a health care administrative system gone mad.
If we want better health care in the United States, we must, first and foremost, wipe the slate clean of excessive and unnecessary government and insurance company administrative hassles. We need:
Markedly streamlined payment systems that eliminates most billing and denials altogether.
Usable, affordable (or free) EHRs in the hands of all practicing physicians.
Elimination of barriers to basic care, like prior authorizations for basic treatments and testing.
Administrative simplification for both patients and medical professionals: elimination and/or streamlining of forms, paperwork, duplication, and complexity of every manner.
For our political leaders, licking their wounds after a bruising spring and summer of trying to reform the health care system, and looking for a way forward—this is the path. Until then, I am left to imagine what we could do in a health care system that helped us, worked with us, and fostered better care rather than fought it at every turn.