Understanding Health Care Reform

As for the current health care law, I’m not sure what to think of it.  I’ve tried to read a little bit about it, but there is so much more to it than I know.  My social work fiance is pretty excited about it.  It means that a lot of her clients will now be able to get healthcare.

Making it more affordable to get to the doctor would allow more preventative medicine which might prevent long hospital stays.  However, they need to be able to see the doctor for that to work and I don’t think there is anything in the bill to make it easier for patients to see doctors.  More patients and the same amount of doctors with the same amount of paperwork.

That is why I’m hoping for various reasons that PCP legislature gets passed to make it easier on those country docs.  Less paper work and more money.

As it stands, docs still have to report to insurance companies and beg for reimbursement for services rendered.  It is also hard for me to see how this is going to reduce health care costs and lower prices on insurance (unless preventative medicine is able to keep costs low).

I don’t really know enough to have a good opinion on this current health care reform, I do feel however that we as a society benefit as a whole from having a healthier population.  I do feel that we should constantly work towards a healthier population.  I think this is what reform is trying to do and I applaud that.  I also think this is just the first step.

I think the first step is making it easier for patients to see doctors.  I think the next step is making it easier for doctors to practice medicine on their patients.

What are your opinions on the current attempt on health care reform?

let the vaccine wars begin!

Ok, so the vaccine wars have been going on for a couple of years with some parents of autistic children blaming the preservatives in vaccines for their children’s difficulties and the CDC stating that there was no link. Now the CDC is scolding residents of the state of Georgia for not being vaccinated against pig flu in this article from ABC news http://abcnews.go.com/Health/SwineFluNews/georgia-h1n1-cases-spike-low-vaccination-rates-blamed/story?id=10238235.

I wonder if we’ll see a lot more stories like this citing lack of vaccinations as the cause of various outbreaks… I guess we probably will even if the CDC isn’t fighting back with the media.

If you happen to be reading this I’d like to hear your thoughts on vaccines and if you have any first hand stories on how you feel vaccines have affected your life.

Following the Trends of Primary Care Private Practice

What does it tell you when people are abandoning what you are trying to achieve? Do you re-adjust your goals or do you ignore trends and follow the path you feel is best.

My current goal is to become a country doctor. I’d like to run or at least be a part of a small private practice in a small community. It is hard for me at this point to articulate what draws me to that goal. It just feels like the right thing for me to do.

This article from the NYT would like me to take pause and reflect on the advantages and disadvantages of private practice and face some of the realities forced on primary care physicians these days.

Apparently more young doctors are joining hospitals rather than venturing forth in the private practice.  This is even leading to many private practices to being sold to larger entities because existing practices are having a hard time attracting physicians.

This retreat from long hours and Medicaid reimbursement paper cuts into the hospital citadel of stable pay is potentially creating a further rift between the face of medicine (the doctors) and their patients.  Does this make a difference though?  Medical care will still be provided to patients at all hours, but perhaps at the cost of a longer drive?  The patient won’t know the face that the will see that day necessarily, but is that a bad thing?  Perhaps.  Trust is extremely important and often people don’t fully trust that a large entity has their best interest in mind.  That goes both ways, though.  You can trust that more doctors in a community, more minds are better than one.  A hospital will have members of different specialties available.

For right now, a private practice is still what appeals to me.  I’m enticed by the intimacy with the people in the area and the status that comes with caring for a community.  Is it easier as a private practitioner or in a hospital setting to drive community health projects?  It depends I guess.

Another point is that doctors in a hospital can worry less about paper work and paying the bills and managing employees and can put a greater focus in to medicine and the people they are treating.

Perhaps that is a fair trade-off?

Perhaps this trend will allow me to better fit in the niche that I’ve envisioned for myself?

The War Front Between Eastern and Western Medicine is at the Individual

I know nearly nothing about Eastern Medicine or Western Medicine, but I have heard a few comments that reflect a difference exists.  Is Eastern healing more of an art?  Is Western Healing more of a science?  Is Eastern Healing more causal and exact and is Western Healing just a series guesses?  I think that these are interesting questions to explore, as is the question is Eastern Medicine and Western Medicine basically the same.  Are they simply expressions of compassion?

A few weeks ago, I had a discussion with a patient, lets call her Hae.  She was on my list to schedule a routine follow-up appointment in the Specialty Clinic.  I called through a Korean interpreter and greeted the patient.  She sounded glad to talk to someone.  As anyone who works in health care or any social service can tell you:  an illness manifests itself in different ways and you can hear it.  An illness can make a person rude and impatient.  In speaking with them you hear pain sharpening their words.   An illness can make a person feel a sense of entitlement.  You can hear them relentlessly try to take back what pain has taken from them.  Some patients just sound confused.

When Hae spoke she sounded hopeless.  I offered her an appointment and she balked at the timing.  She said that she already had an appointment with another doctor (her primary care doctor)  and she did not wish to return to our clinic.  I thanked her for her time and was about to hang up when she said, “But I don’t like this doctor.  He never does anything for me.”

“OK,” I said.  ” Would you like to come in here for an appointment?”

“Yes, but when was at your hospital last time you didn’t do anything for me.  You only talked.”

This is a common complaint in the Specialty Clinic, especially as people travel from across the state.  They say, “I’m not going to drive 200 miles and pay $150 in gas and another $100 for a hotel and another $10 for parking at your clinic for your doctors to just talk to me.”  The criticism is valid, in my opinion.  A lot of what the physicians do in the Specialty Clinic is simply “eyeball” patient or see how healthy they look and make some basic recommendations.  This is not trivial, however.  A patient can live with a chronic illness for a long time and feel perfectly healthy, then for seemingly no reason at all they fall out of their shell and get really sick really fast.  It is important to see them often to catch them before they shatter.

Hae continued, “If I make an appointment in your clinic will you do something to treat me?”

I stammered something non-committal  like, “The doctors will do what they can…”

“But, I need treatment.  No one helps me.  I go my doctor and he sends me to your clinic.  I go to your clinic and they say that nothing is wrong and send me to my doctor and now you are asking me to come to your clinic again, but you are not offering to help me.  I am in so much pain all the time.  I need treatment.”

I had access to Mae’s medical record and I began reading it so I could understand what the hospital’s interpretation of her problems were.  Mae went on to tell me about her symptoms and her pain.  Her medical records said that she had no diagnosis.  This is very uncommon for me to see.  Usually, by the time we see a patient they have already been diagnosed.  Mae simply had pain.  She had been sent to us because she had an MRI that showed tiny indeterminate nodules that likely had nothing to do with her pain.

I told her, “I can’t promise that the doctors here will be able to offer you treatment.”  I was getting into tricky territory because I’m not medically trained and I cannot get into any thing specific.

She started to sob, “Do you mean there is no cure for me?”

I worried that we were having trouble with the language barrier.  I tried to choose my words carefully and while I trusted the competence of the interpreter thoroughly I had no idea what was actually said to her.

“No, I am not saying that there is no cure for you.  If the doctors see you and believe that there is a treatment that would be good for you they will recommend it.”

She replied, “I don’t understand why doctors here can’t do anything.”

“Well, the doctors can’t treat you until they know what the exact problem is.”

She stated her symptoms again.

“But the doctors don’t know what is causing your pain.  They have to know what is causing your pain before they can treat you.

She started to get angry.  “I don’t understand why doctors here in the U.S. cannot do anything.  In Korea I would have seen someone and they would have treated me right away.  Why can’t they do that here?”

“Because in order to treat you the doctors here have to know what your diagnosis, what the cause of your problems are.  Unfortunately, we just have to wait a while and do another MRI.”

She began to break down again.  “I feel like nobody cares about me.  I feel like nobody cares about my pain.  I feel like nobody cares if I live or die.”

I tried to assure her that I was speaking to her and that I cared about her.  I went on to say, “the doctors cannot give you a treatment until they know what your diagnosis is.  Sometimes in Western Medicine if the doctors don’t know what to do they have to wait a little while and do another test and then maybe they will have enough information to make a diagnosis.  Then once they have a diagnosis they will recommend a treatment for you… if there is one available.”  I was kicking myself for being so honest and transparent, but I couldn’t lie to her just so she would see us.

We went back and forth like that for over 50 minutes with the interpreter caught in between.  Many times Hae would decline the appointment and as I thanked her for her time she would get worked up again stating that she wanted to be seen, but she wanted to also be treated.   I would tell her that we would be happy to see her, but I couldn’t guarantee anything other than talk.   Our conversation was like the Cyclic Universe theory where the big bang is repeated  for all of eternity.

I made one last push, pacing up and down the staff only hallway, “I am very sorry that you are in pain and that it seems like no one is helping you.  I understand that Western Medicine does have flaws, but I assure you that the doctors here do care if you live or die and I do care if you live or die.  If you choose to be seen here  I assure you that the doctors will do everything in their power to help you.  However, they might not have a treatment for you.”

At that point she said that she understood and that she appreciated the information.  She said that she did not wish to be seen in our clinic.  I asked her to please follow-up with her primary care doctor and I thanked her for her time.  She agreed and said goodbye.

Was it a wasted hour of my time and my employer’s pay?  Was it a waste of Hae’s time?  Did I upset her or calm her?  Did she follow-up with her pcp and is there any treatment that will help her?

I hope her body can heal her.  I hope that I helped shrink the rift between her and her primary care doctors and western doctors in general.  I hope that she gave me a greater insight to one of the many barriers in the doctor patient relationship… Or in this case, the patient-scheduler relationship.