The Worrying Future of Our Health Care, Part 2 of 3

How can we improve the direction of our health care system? By understanding the strengths and weaknesses of the system and filling in the blanks to support our own needs.

The idea of “need” is a key factor of health care. Our current system is organized into “steps of need”. Your insurance coverage, your frequency of visits, your symptoms and even who you are able to see are evaluated through yet another computerized system of algorithms that will then determine your level of need which corresponds to a pre-determined path of appointments, tests and treatments. This is why some visits you see a nurse, while others may be a physician’s assistant or even a lab tech. The physician is reserved for specific types of appointments and as someone who oversees all the patient cases (as though he is provided time to do this).

In Part 1, I made it clear that continuing on the path of treating our health care as a business model will never provide the kind of individual and effective patient care that we would like to have. We do not visit our physician’s office to be analyzed by an algorithm. We are expecting to be treated personally and with compassion. We expect to be understood and for our feelings about our symptoms to be taken into account. But this is not a “need” that is recognized in our current system.

How are physicians supposed to reconcile these two opposing expectations? They are encouraged to determine a diagnosis and write a prescription or provide a referral in a matter of minutes. Many physician’s visits only serve to determine what tests need to be done or what prescription should be tried. There is no time for you to express your concern that many of your relatives seem to develop diabetes or for you to tell him how you are not sleeping. You don’t want to admit that you are up to 6 cups of coffee every day just to function at work.

Studies have proven that when a patient sits down with their doctor, they may be nervous or worried because of their symptoms. They need to first develop trust with their doctor and have enough time to be comfortable so they can divulge all their symptoms and their concerns. It is a proven fact that patients do not provide the symptom that is most worrying initially. It is generally the third or fourth thing that will be mentioned. This means that given the restricted time allotments for appointments a patient may never actually get to the actual reason they came in or give the doctor key information that would point towards a diagnosis. How often would additional testing be unnecessary if there had just been enough time for the doctor to hear ALL the symptoms? How do we fit in enough time for trust and sharing at the same time as the physician needs the time to evaluate us and provide a diagnosis?

It also used to be that you could choose your physician which made trust attainable, but more and more we are simply being forced into a relationship with a physician without any choice because there are so few that will accept new patients. Insurance companies consider any physician adequate for any patient, regardless of proximity to the patient, chronic challenges the patient may have or even something as simple as preferring a female doctor (there are certainly enough women from conservative religious traditions that cannot have a male physician). These are intangibles that are important to the patient but unimportant to the insurance company.

Much of this automation of health care reflects the changes that have taken place with our hospitals. Today more than half of American hospitals are owned by huge national chains. Many hospitals are also moving towards specialization along with the establishment of “health partners” which include physicians agreeing to be affiliated with only one hospital. At the same time physicians are encouraging patients that are actively ill to go directly to an Emergency Room or Urgent Care instead of seeing their own physician. This means that you are seeing your physician less often than was the case years ago. This also means that you are receiving acute care for stabilization (which is the purpose of ERs and Urgent Care), not management of chronic illness or support for wellness. You will be told to follow up with your physician, but many people are simply sent on to a specialist or choose not to return at all.

What this means for us is that health care has become an impersonal assembly line system devoid of personalized care and attention. Our physicians are being forced to treat all patients according to algorithms and systems, while having many of their decisions reviewed and many of their requests denied, often by administrators who are not even medically trained. Patients tell me all the time that their physician never talks about diet, exercise, their stress or their daily routine but that’s because it’s not an essential part of the diagnostic algorithm being used in conventional health care.

One of the most worrying aspects of these changes is the lack of communication between all the facets of our health care. It used to be that we would have only a couple of physicians ... our primary care and perhaps one additional specialist occasionally. But now the systems are set up in such a way that once you see a specialist, you are often expected to continue as a regular patient of that specialist in addition to your regular primary care. Most people now have an ophthalmologist, a cardiologist, an endocrinologist, a gynecologist, a mental health therapist and sometimes even a more specialized physician such as the macular degeneration specialist. Many elderly patients I have are exhausted from just managing their appointments because what used to be one to four visits a year has now turned into one to four visits every month with numerous calls to the pharmacy or their insurance company. With everyone being required to now have a stable of physicians and multiple visits each year, it’s no wonder that specialist’s offices have wait times that are hours. One patient I have told me it took four months for her to receive a diagnosis because of the long wait times for testing, appointments with specialists and then returning to her primary care for a treatment plan.

How do these systems benefit us as patients? They don’t. They are not intended to benefit us, they are intended to create a streamlined, efficient, cost-saving method for providing the minimum benefit for your “level of need”. And how much of our health care is about wellness and prevention? The only aspect of prevention is more testing and the most offered for wellness is a small discount on your gym membership. Even Medicaire’s Advantage program which sends a medical person to your home annually is more interested in an assessment of risk than of helping you with ideas for wellness.

One example of the failure of these systems was well documented at a local large hospital. I was told by multiple medical people working there that when their new patient management system was installed, there were so many failures that prevented communication between departments that many patients would not receive essential medication, the ER would run out of essential supplies and it would be impossible to even know how many beds were unoccupied. The truth is that the long waits in our huge hospital waiting rooms are often due to testing scheduling being overwhelmed. Patients in the ER have to wait because a doctor is dependent on the test results, so until those results are forthcoming, the patient waits ... often in a corridor, often in pain, often worried and scared. How is this treating patients with the best care?

If you watch any of the old medical shows you will remember some things that are non-existent today. Release forms were just a short page. Doctors were respected and encouraged to think on their feet and truly ask lots of questions of their patients, whereas now they have a set form in front of them that they are required to use when questioning a patient as though they can’t provide a thorough evaluation without being reminded. A diagnosis was something that a doctor was not reluctant to provide, whereas now with liability concerns and restrictions, a doctor waits for test confirmation or a specialist opinion before committing to a diagnosis.

Let me give you an example of how the corporate system in health care affects women’s health. Physicians rarely now do a breast examination, instead relying on your self-exam habits and recommended mammogram testing. If you are a woman with dense breast tissue or with breast implants, you will be more prone to breast pain or tenderness from lymph congestion or calcifications. But with the explosion in breast cancer cases, women are naturally nervous and so you may want to see your physician. Your physician is required to have you get a mammogram even though numerous studies have shown that mammograms are only 48% effective in detecting tumors in women with fibrotic breasts, while an MRI has been proven to detect even small lesions in these cases and also correctly diagnosed 93% of breast tumors. But even with this evidence insurance companies and “the standard of care” still require a mammogram before allowing an MRI and often won’t even provide an MRI until after a biopsy even though the MRI might show that a biopsy isn’t even necessary.

Breast biopsies are now becoming a standard method of “testing” and many more women are being escorted to a biopsy as a matter of course. But did you know that frequently a titanium clip will be inserted permanently into the breast tissue during the biopsy as a marker of the biopsy location? I’ve had numerous patients come in with breast pain that turned out to be related to a biopsy clip and the women didn’t even know they had a clip because no one told them. It was simply a standard consent on the form they signed. With the clip implant, some women will run an increased risk of infection or may even experience inflammation that actually can move the clip to other areas of the breast tissue (which defeats the whole point of the clip acting as a signpost).

We have created a world in which profit is the most important determining factor but do we really want this to be the case for our next illness? Cost efficiency needs to be set aside in favor of providing ways for physicians and health care workers to treat patients individually and with the best care possible. This is not going to change unless we start to change it. We need a health care system that is driven by human compassion, prompt access to care and transparent information, not the bottom line.

Read Part 3 of "The Worrying Future of Our Health Care: The Solution" in the August Wisdom Webzine! Karen Clickner, ND is the owner of Conscious Body Natural Medicine, Inc., in Westborough, MA. For more information visit www.consciousbodynatmed.com