The Patient Experience

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From A Medical Practitioner’s Perspective

by James Auberle, M.D.

There has been a shift in healthcare in the short space of the last approximately 20-25 years.  Health care was previously centered around you, the patient, with his / her healthcare needs that were individualized to testing towards a possible diagnosis and ultimately to find a treatment.  There was also this silly idea that good insurance would take care of the needs of that average individual.

However, in a very subtle and disturbing way healthcare has changed.  It has changed slowly and probably deliberately so that your average Howard was not able to notice the differences.  It has become decentralized from the individual and been made to service the insurance companies rather than the individual patient.  Insurance companies talk about how many “insured lives” that they have.  But you as an individual, are no longer Bob, Ted, Jane or Alice but a number and one of the “insured lives”.  Subsequently, you become a number.  Even the disease that you suffer becomes a number.  This is evident by the recent change from ICD-9 classification of diseases to the new more comprehensive ICD-10 categories of diseases.  ICD-10 has more than 50,000 new diagnoses added to the few thousand in ICD-9.  So even your disease has now become a number.  Heaven help the poor soul whose insurance company does not like your diseases number.

Many of you may have read the book, “Moneyball” by Michael Lewis or perhaps seen the movie with Brad Pitt.  The idea for the story is that a person could use statistical numbers to help calculate the best hitters / players in baseball which could vary month to month or which players need more rest as the season wears on.  Armed with these statistics, they could potentially give themselves an edge in various activities such as playing baseball.  Baseball has always lent itself to a lot of statistics.  Just look at any box scores in a paper or to ask some kid who has memorized the statistics on the back of baseball cards.  (They haven’t gotten rid of those yet, have they?)

This particular idea of observational statistics and logistics has been passed on to the medical field.  For example, I recently ordered an MRI on a patient due to their symptoms.  Their insurance company sent not one but two rejection letters.  Each of these was approximately 12 pages long stating the insurance company feels that the study should be denied.  However, the letter was based on a statistical process without even reviewing the patient’s history or the results of that examination.  They were stating that they would not pay for the study at all under any circumstances.  It did not meet their particular statistical criteria.  I was perturbed that several good sheets of paper were used to say so little.  Therefore, we got them on the phone.  When asked what they were using as scientific criteria to make this statistical answer; where it was published, they declined, saying that was proprietary information.  They did not care about the patient in terms of their examination, their symptoms or the differential diagnosis that could indicate some severe damage.  They simply declined this study.  Not even backing up their claim with some scientific data, they just said “no”.  And the ultimate insult is you can’t fight them because you, as the physican caring for the patient, are not allowed to see the data on how they made their “brilliant” decision!!!

As a physician, I got into medicine to take care of my patients especially when their health is not going well.   I try very hard to be very good towards my patients.  The patient’s rely on that relationship.  Insurance companies make some bad decisions.  On several occasions, I have to inform insurance companies that I can no longer see my patients because it becomes an ethical problem.   I cannot agree to treat a patient without some basic knowledge that the insurance company is holding back.  Sometimes they will back down but many times they won’t.

In other respects, I believe patients have lost a great deal of confidence in healthcare.  They are no longer seeing the same physician time after time after time.  Many times a physician is hired to do a clinic here and a clinic there and there is no basis or established relationship between the physician and the patient.  I think that this erodes the confidence the patient has in the doctor-patient relationship.  I think it erodes the confidence that the patient has in their respective insurance company.  I think this erodes the confidence in the entire health care system.  I think it erodes the confidence that we have in the officials that gave us this messed up healthcare system in the first place that doesn’t seem to work.

Unfortunately, the average physician is now obligated to spend huge amounts of time doing computer work.  We are not even certain that anyone actually looks at all this data being collected.  It is now a healthcare requirement to do a great deal of extra work that does not directly benefit the patient.  Time studies have demonstrated that if a physican were to do all the individual computer related clicks and buttons and websites that he / she should, that would require only 26 hours per day.  That would mean no sleep and not even having seen a single patient during the course of that day.  (Note: Howard, most days only have 24 hours.)  This means that many physicians spend their time with a computer in the room with the patient trying to improve the efficiency of a very bad system and many times do not even know what their patients even look like.

These days a physician ends up doing more triage than actual patient care.  There is a rush to get the patient into a hospital and there is a rush to get the patient out of the hospital.  However, no one cares what happens in the hospital, but what happens there may end up having a huge impact on the particular patient.  They often wait too long so when they do arrive in the hospital they are sicker than if they had just gone when some of the symptoms had just started.  Patients are scared of going into the hospital.  They are afraid of huge bills that they have no way of paying.  For example, beware the “observational status”.  Sometimes patients will go into a hospital and think that they are admitted to the hospital.  However, if one is in observation, then technically they are not admitted to the hospital and the tests ordered, the physicians seen may not be paid for by your insurance company.  So first of all you are sick.  You go to the hospital.  Some careless clerical person puts your hospital stay as observational.  Your insurance says that they will pay nothing for your care because you were not sick enough.  And perhaps as you are finally starting to feel better (let’s hope).  The hospital sends you a huge bill stating that you owe more than your house because a clerk who only gets minimum wage could not take the time, effort and trouble to perform their job appropriately.

This is just one of many types of hospital problems and errors that are now very commonplace in healthcare.  Because of these vast computer systems, there are now so many problems in hospitals in terms of medication errors that most hospitals have given up on any corrective process.  For that reason, we recommend a family member watch everything including medications, checking against your home medication list or printout for dosages and amounts and frequencies that the meds are given.  There are just simply too many errors in the meds.

We have forgotten that we are supposed to be taking care of people.  The people we care for have feelings, hopes, desires and dreams.  The new healthcare has big computer systems and statistics in a game of “Moneyball”.  So if it feels like you have become the little ball in a game of Pong being smacked between paddles by the hospitals and various insurance companies you are probably correct.  No one cares or can measure or take into account the intangibles of the doctor-patient relationship.  Therefore, in the big scope of healthcare if they cannot find a way to count it, then it doesn’t count at all.

We have barely touched on some of the atrocities of healthcare.  There is a great deal of discussion on the topic from our politicians but all the talking in the world will not fix the trust that has been broken between a doctor and his / her patient.

My mom and I wanted to thank you for hosting such a great symposium this year. This was our third year and we are looking forward to next years. E. Mathews