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Tuesday, January 28, 2014

The State of Health Care (from this old curmudgeon)

Now that it's January, and most of the country is sitting (shivering) under this polar ice cap, I thought that it was time that I render my own views of the state of the medical world (from the perspective of an old, and increasingly grumpy, old man of medicine).

And to do that, I'd like to harken back to some comments which I made in an earlier post on the condition of our own "health care system." If you are so inclined, you may read my post from June last year to get some idea of my perspectives on the state of our health care conglomerate, and where we (as physicians) sit in the great scheme of things. And perhaps more importantly where we (as society) see the role of physicians in our culture. What has happened to the physician-patient relationship? It seems to me that the once special relationship has ben swept under the wheels of progress in the name of "health care."

Let me assure you, that I know the realities of modern medicine, having lived through the last half of the previous century (and having become a physician for the last quarter of the last century). Besides that, I have what I have come to find out is a unique perspective, in that I am the seventh generation physician in our family, and so I carry with me that legacy, too. Let me say this right out: what has happened to the physician-patient relationship has become a fleeting memory, a mere warm spot in the hearts of those of us old enough to remember. And I fear it has been permanently replaced by something else, which I will later attempt to define.

All this came to a crisis of the mind just yesterday. I had just finished working a week of nights (7PM - 7AM), and was looking forward to two days of recuperation, before starting back to working days (7AM - 7PM) again, when I got an email from my "boss" (why do I get a disturbing image of that pointy-haired person from the Dilbert comic strip?). In that email I was informed that "we" had an agreement with the ER that we (as in the hospitalists) would come down to the ER within twenty minutes, and that we would then render a decision, WITHIN 5 MINUTES, as to whether said patient was to be admitted to an acute-care bed or placed in observation. The justification for all this had to do with the hospital getting more money (and, I think, paying for the billboard on the highway) and the speed of moving patients through the ER. Nowhere in all this was anything said or implied as to the patient's rights, and what was the appropriate thing to do for him or her.

Now, I am a hospitalist (and I understand the needs of office physicians, as I have been one for years), and it seems to me that, because I could concentrate on the sicker, hospitalized patients under my care, that I could offer something to my patients which was special, and perhaps different from, that which my harried colleagues in the office could offer. Well, I'm here to tell you that is wrong! In the collective mind of the hospitals for which we work (not the patients, mind you), we are nothing more than some cogs in the wheels of "health care." I'm sorry to sound so cynical, but this is becoming truer and truer. And the hospitals are just becoming another factor in this conglomerate, who are all fighting other hospitals for their own "market share" in the world of ever-tightening budgets (hence the billboard).

So, then, what has become of the doctor-patient relationship? It would seem to this old codger that it is now permanently gone, to be replaced by the producer-consumer relationship, in which you purchase your own particular "health care," and know that Mount Saint Elsewhere will look after your needs, and the needs of your family, after all, that's what they're in business for. And know that, if you're in a coma, in some ICU, that MSE will have, at its disposal, attorneys who will see to it that they will carry out the judge's order.

So, what is the good news? Well, let me just say that if you can still find some old guy, who might even look like a doctor, out roaming the halls of medicine, and you just happen to be one of those people who, by the powers of chance, just appeared on his list of "patients," that you still stand the chance that he might just sit down with you, examine you, discuss what he makes of your miseries, and see to it that you get the care that you deserve. And fie on those 5 minutes!

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