Friday, October 27, 2006

A broken system

I've spent a fair amount of time over the last few years attending various medical society meetings. We talk about lots of things, but the overarching them usually seems to be "how to fix our broken health care system". There are many reasons the system is broken, but usually the discussion has to do with reimbursement and how there just plain is no way the current rate of growing expenses can be sustained in our society. Too many uninsured, too many frivolous lawsuits, too many primary care providers fleeing to higher-paid specialties.

This has never been so strongly impressed on me as during my current rotation. I'm doing general internal medicine (primary care) and the team I work with has traditionally made this one of the easier rotations of the year. Too easy, as it turns out, so the program director completely changed the system earlier this month (right after I started) so that I carry 3 to 4 times as many patients as the interns on the other team. I have so many patients, it turns out, that I don't have time to really spend more than a few minutes with them. I can't get to know them or follow up with them several times a day. I can't really care for them like I should. I spend my day running around frantically trying to get all the busy-work and paperwork out of the way. I dictate, review lab results, and chart my little heart out. I've got 20 years of education to be a specialized secretary, it seems. And the patients suffer.


Tarimisu said...

Your posts about your medical career are always very interesting, and I'm glad you write them. Here I am, a patient, staring into that corrupt medical system, and I am seeing the other side of it through your eyes. But then, before you were a doctor, you too were a patient (and from time to time still are, I imagine!) and you have a wife and a son who are patients. You must have lots more thoughts that you can write. I have to say that I do suffer as a patient under my PCP. So how do we fix the system, Coach? I'll tell you that for our part, there really never does seem to be enough money to pay all the medical bills, and what exactly are we paying for? A minute of the doctor's time? The nurse's? The shot? Things of which we are not even aware? Please fill us in, because it can get tedious for us, when we pay through the nose for insurance, but then have to pay through the nose for what the insurance doesn't cover, and all that after an often unsatisfactory health care experience that leaves us with more questions than answers. Thanks for caring about what your patients aren't getting.

Coach said...

The way I understand it, most of the cost of medicine goes toward administration. That's one strong argument for a national health care system. Medicare administrative expenses are only a fraction of what private payers are.

I don't know a whole lot about it. I just go to AMA meetings and try to learn. But the day to day makes it pretty clear that there's a lot to fix.

Thanks for the comment, Amy. It's fun to know someone reads my boring musings!

Tarimisu said...

They're definitely not boring! They're relevant because I have spent a lot of time in doctor's offices in recent years, either being pregnant or taking the kids for check-ups.

I can see how a national health care system would e good in theory (but so is communism, good in theory), but one argument against it is that the quality of healthcare would deteriorate because doctors wouldn't get paid as well. Do you hear that in the meetings? Being a doctor would turn into a government job. It would also become a less attractive career choice.

Insurance is a big issue, of course. If I ever considered going into politics (which I haven't!), my platform would be insurance. I have a friend who is diabetic and pays outrageously for any kind of coverage. At one point, he went uninsured for awhile because he and his wife just couldn't afford it. My mom was taking an insurance policy that had her paying something like $500 a month with a $10,000 deductible. $10,000!!!! I encouraged her to drop the insurance, which she did, and she's been better off just paying the bills as they come up.

The thing that Scott and I talk about often is that we don't ask to get sick, but it's almost like we cannot afford to get sick. I read an article in the Reader's Digest several months ago with just that title, "I Can't Afford to get Sick!" and the article discussed how most families have stacks of medical bills that they cannot pay (I don't remember the percentage of Americans, but it is astounding). I wonder what will happen in the future as far as medical bills are concerned. I wonder if Americans will say to insurance companies, "Enough is enough," stop taking out insurance policies, and just try to make it on their own. I doubt it, but imagine if every American dropped their insurance.

I like hearing your side of it, Coach, and thanks for sharing it with us.