Successful Health Care Should be a Straight Road

photo by Carol Duff

Health Editor’s Note:  There are so many unknowns when you get sick. You may not understand what your body is trying to tell you, you feel lousy, you feel just plain awful and discouraged that you do not know what is going on. Your cells and body systems are not optimal. You need help because you want to feel like you again. You need someone who can figure out this mystery and help you to fix it.  You depend upon your health care provider to find the causes, answers, cures, and come up with a game plan for what is ailing you.

It would be very helpful if all disease processes responded as an algorithm and each would play out in the same way each and every time. This is clearly not the case because we are individuals with different environments, genetics, abilities, thoughts, emotions, etc.

I think the best way to be a partner in your health care is to know as much as you possibly can about any test, procedure, medication, treatment, health care plan, or anything that is being used to diagnose and treat you. The medical world needs to pare down the path it has to take to reach medical decisions.  We, as potential patients, cannot change the way the health care system needs to alter itself in order to be far more functional. What we can do is to look out for any family member or friend who needs medical attention.  Go to appointments with them.  Formulate and write down questions for the appointment. Take a list of your current medications, note if these medications helping you, if they are making you feel worse, list any herbs, vitamins, and supplements you are taking.  Some herbs have the same effects as medications.  You may be getting an overdose or the herbs and medications may be acting against each other.

Then take the time to make notes during your appointment or ask for print outs of any instructions you have been given.  It is often hard to absorb everything in a situation when you may feel uncomfortable, ill, confused, or are hearing new words that you do not understand the meaning of.  Always ask for a clear explanation of any terms/words that are being used, and of course make sure you understand plans that are being formulated to diagnose and treat you…..Carol

Healthcare Has Too Many Moving Parts

We need to figure out ways to reduce them by Fred N. Pelzman, MD.

So many moving parts.

Just last week, a patient I’ve cared for for over 20 years came to see me, and she was despondent over a number of issues.

First and foremost was that her partner of over 60 years has had progressive dementia, and finally things got so bad that he had to be transferred to long-term care facility, no longer safely able to be cared for at home despite all the resources that have been marshalled around them.

But she told me during her office visit that she was on her way there that morning to take him home.

Over the past few weeks, she’d noticed a rapid physical decline in this man who before this placement had been fit as a fiddle except for his fading cognitive capacity. Bedsores, urinary tract infections, falls, an aspiration pneumonia, and finally — the last straw in her eyes — hands and feet so swollen she couldn’t get the wedding ring off his finger.

But even worse than all of this was how she was treated when she complained, or asked to speak to someone, or reached out for help. “That’s not my job, but I’ll pass this on to the nurse/doctor/supervisor.” How can we claim to have a functioning healthcare system when we can’t even take care of those who come to us seeking care and relief from suffering?

So many moving parts.

On that same day I saw another patient, an elderly gentleman who was there for follow-up of his multiple medical conditions, all of which seemed quite well managed.

He relayed a recent frustrating experience in which he had to see a new eye doctor because the ophthalmologist who had been caring for his eyes for several decades had passed away. He had told the new doctor of some worsening vision, and they told him he had dry macular degeneration and a minor cataract, and that he just needed new glasses.

He was given his prescription, which he took to a nearby optician, but when he finally received the glasses several weeks later they made things worse, not better. It took several visits back to the eye doctor before they finally realized that they had fitted his eyeglasses frame with his wife’s prescription, not his.

So many moving parts.

Once a week in our practice, we have a dedicated bit of time set aside where the supervising attendings get to meet one-on-one with the interns and residents who are doing their ambulatory rotations. It’s their time to go over issues related to patient care as well as administrative issues, to fill out some paperwork, and to get a little teaching in, get a little learning in.

Our senior residents do an outstanding job of helping the new interns along, teaching them the ropes, helping them navigate the harrowing electronic medical record, learning how to get things done.

As we talked about the obstacles that one of the interns was facing trying to get a patient the care they needed, I was struck by how much more needed to be done to get stuff done — exponentially more, I think — than when we had to do this so many years ago.

When did we allow a system to be created that made an intern who is trying to learn how to take care of people — how to address their needs and health concerns, how to manage their acute and chronic health problems and soothe their pain — become about so many forms they need to fill out, so many boxes they need to click, so many arcane ways of doing things that are really just barriers to learning and caring?

This poor intern was trying to follow up on a patient she had never met, someone seen a few weeks ago by a different resident, with a new complaint of crescendo angina and recurrent syncope, for which a diagnostic evaluation had been initiated.

Suddenly this intern was being told to figure out how to get an echocardiogram scheduled, how to find this patient a cardiologist who took her insurance, how to get a stress test authorized by her insurance company, and how to get prescription medicines authorized by an insurance company that has no idea what it’s like to take care of human beings.

Working together, our whole team moved these different parts forward, delegating tasks and trying to make sure that each person practiced up to their license as much as humanly possible, in our current resource-strapped healthcare environment.

Remembering that getting the patient the care they need is our ultimate goal, everyone pitched in and we were eventually able to get everything set up, authorized, approved.

But it shouldn’t have to be this hard. Doctors should get to doctor. Nurses should get to nurse. Interventionalists should get to intervene. Community health workers should get to work in the community.

And all of the rest of the stuff that gets in the way of the patient being in the center of all our care needs to be moved aside.

To truly fix our healthcare system, we need to get rid of all of this, to relieve those trying to help and make a difference of the burdens of what’s leading to provider burnout, to patient frustration, and to systems that are destined to fail.

Unless we fix things, then patients admitted to long-term care facilities that are unable to provide the care they promise will never thrive and continue to live with the dignity they deserve.

And patients will get the wrong prescriptions and be told to live with blurry vision.

And interns will find the life of a primary care physician one that just doesn’t seem that palatable, a career path they might not ever choose.

Too many moving parts.


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  1. Precisely. “…forgotten why they were there in the first place….”

    I had a cerebral angiogram as a prelude to skull base surgery. The whole sickening experience took forty minutes, and cost $40,000. That was in 2010. Imagine what that would cost now.

    Thank you Carol.

  2. Khalid, We have actually had the same thing happen in England and in Germany the cost was a fraction of what it would have been in the U.S. A nurse used to be able to go to a supply closet on a hospital floor and take out anything needed for say a dressing change. No tallying supplies, no individual cost to the patient. Same for over the counter meds such as ASA, MOM, etc. No calling down to the pharmacy and waiting for them to send up the medication needed. No additional charge to the patient. It used to be that one hospital in a region would have a CAT scan machine and all patients in need of a scan would come to that one hospital. Now hospitals compete by getting as many of these diagnostic or therapeutic machines as possible. Who pays for these…the patients of course. Insurance companies, deciding what they will or will not cover has done nothing to help keep costs down. Hospitals have become big business and are all about profits and have forgotten why they were there in the first place….Shame on them! Carol

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