What happens when you place an entire nation’s health care in the hands of an overly-controlling, ineffective government bureaucracy and huge corporations whose mission it is to squeeze as much money from the system, no matter the cost, including people's lives? You get the carnage that is the American health care system.
You get my week as a family doctor in the worst health care system in the world.
This week a diabetic patient who stopped taking insulin because of the extreme cost came in with a terrible foot infection.
This week a patient died in a hospital that has no physicians regularly seeing its patients.
This week my own elderly father was in the hospital, and then a nursing home, and we were so concerned about the potential for mistakes, based on past experiences, that we had private nurses at his bedside around-the-clock.
This week I saw a patient with abdominal pain, and there were so many insurance barriers to getting him evaluated as an outpatient that we gave up and sent him to the ER instead.
On a daily basis I read about the opioid crisis in part caused by doctors overprescribing dangerous narcotic pain medications. But this week I was called by a hospital risk management nurse who was demanding that I write a prescription for Dilaudid (a very powerful narcotic) for a patient I barely knew. I was threatened with legal action when I refused.
And every day my staff and I struggled to find ways (and the extra time it requires) to get patients basic medications and testing despite an expanding system of insurance company prior authorization processes that makes it harder and harder to do almost anything. A patient with asthma came in because her Asmanex (a commonly used inhaled steroid) was no longer covered. The patient was sent a list of other inhalers that were covered, but when we submitted a prescription for one of the listed medications, we were still required to go through a lengthy prior authorization process before it was approved. Another patient was having trouble getting the weight loss medication, Contrave. The first month, the medication had been covered, but when he tried to get a refill the second month, the pharmacy said it had been rejected because prior authorization was needed. My staff filled out the prior authorization questionnaire, and submitted it, only to find out that the medication was not covered. It was a complete waste of time.
And this week, as always, I checked the extra boxes in my EMR and supplied the extra codes so that the government could get the data it demands so that it can judge the "value" of my care. And, as always, I did everything I could to provide "value," prescribing all the medications necessary to lower blood pressures and glucose levels, immunizing every patient, and ordering tests for cancer screenings, all in the hopes that my quality metrics would be up to government standards, qualifying my practice for "value-based" incentive payments. But conversely, I also worried that all of the care my patients required to satisfy these "value" metrics would be costly, and my practice would be penalized for having high cost-of-care metrics. I'm damned if I do, damned if I don't.
That was my week in American health care 2018, where the system tries to make as much money as possible off of every patient, spending as little as possible on patient care, forcing us to use unusable computer systems to generate metrics that are impossible to attain.
And if anything goes wrong, it's my fault, and I get sued.
It should be no surprise that heading up the list of "Top 2018 Challenges" in the December 2017 issue of Medical Economics is "Avoiding burnout/remaining dedicated to medicine." We are in an abusive relationship that we can't get out of.
But we soldier on, because we care deeply about our patients, and we still love taking care of them despite it all. I marvel every day at my staff's ability to work miracles, despite the incredible barriers and distractions, and to keep smiling while they do it.
And we soldier on because there is still so much good going on—and because this week one of our patients brought us a huge crockpot with French onion soup, with cheese to sprinkle on top, and delicious bread to dip in the broth. And we keep going because this week an elderly patient's wife called us one afternoon to thank us for the great care we had given her husband the day before.
But it is not a situation that is tolerable, nor that we should tolerate. Every physician must become a loud advocate and warrior for change. Patients need high quality, affordable health care. Doctors need a system that helps them, rather than hinders them, from delivering that care.