Last week we discussed 'modern medical organizations and health care and poverty as it relates to long term health care and urgent/emergency care'. Well, I attempted to discuss these topics!
Please understand, I am not making assumptions or believing the hype. I am working on the front lines and have been doing this for five years. I have worked in different parts of the state, in different clinics. This is what I know and what I see every single day.
Are all of my patients taking advantage of the situation? No. Do I like my job? Yes. Are there problems with the system? Yes. How do we change it? I don't know.
Another issue this question didn't ask in a direct way but still factors in, is insurance companies. I do not have an intimate relationship with any company but they are acutely aware of every move I make with my patients. Insurance companies, or health plans for my patients, are the gatekeepers. They decide who you see, when you'll see them, and if you'll see them. Not me. So, call them and get mad at them, not me! You may have heard about the recent scandal at Aetna; a medical director admitted to never looking at patient charts before granting or denying care. If a patient had chronic low back pain, had completed physical therapy without improvement, and had x-rays indicating more severe problems that could be better diagnosed with an MRI or CT scan, this doctor would not even review the chart before approving or denying my request on your behalf for the MRI or CT scan. This is the problem. People who not at all involved with your care making decisions about your health. In a perfect world, you would be able to give me a perfect history of your injury or case, we would complete all the conservative treatment, physical therapy, x-rays, etc., we would make referrals for an MRI and maybe even a neurologist referral. The insurance company would have a reasonable medical professional review your case and approve the imaging and referral. There are many, many stories of doctors arguing with insurance companies because they are denying care to patients. Obviously there is a role for the insurance companies; someone does need to ensure the proper documentation is in order and resource utilization, but it's doctors against doctors; one fighting for you, the other fighting to save money on behalf of the insurance company.
Without getting political, the current system isn't working. I remember being told if I liked my doctor and health plan, I could keep them! This hasn't been the case. I want a hybrid system. I want access to my providers and am willing to pay. I want to help my patients who cannot afford to pay. I don't want my patients to wait 2 years for a colonoscopy. There has to be a better way than what we currently use. It is not fair to keep the poor waiting while the rich get to the front of the line. It's not fair that the poor have no financial investment in the healthcare while relying on the rich to pay for everything. Again, the insurance companies (and pharmaceutical companies (don't get me started there!)) are the ones determining costs. A CT scan should cost as much for the poor as it does for the rich. Should we have a sliding scale fee based on income? I don't know. Should there be a cap on annual income that if you fall below, you get free healthcare? I don't know. Should it take 2 years to get a colonoscopy? No. I fall into the category of a hand up as opposed to a hand out. As you can see, this issue is so much greater than healthcare. Poverty, economics, politics, and immigration all play a substantial role.
I believe my clinic is doing the best we can. We advocate for our patients to receive low-cost medications and free clinic visits; free womens' health and pediatric care. We are responsible for being good stewards of the federal and state money we receive. The patients are responsible for being good patients! For taking care of themselves, for educating themselves, for evolving as medicine evolves, and for being good stewards of the services being offered.
Ultimately, that is what The Total Patient aims to be; a resource and source of empowerment and encouragement for you and your family during these changing times. What can you do for your family? How do you make the most out of your visits? How does the system work? Can we influence change? Absolutely! Share this blog and Facebook page with your friends and family, comment on what you want to learn about, write your political representatives about the changes you need, ask the pharmaceutical rep who makes all the money (just kidding...not really).
No comments:
Post a Comment