Is It Possible to Reform Health Care?

Sometimes a topic is just so big that I find myself gathering data until the pile is enormous but unable to write about it until a specific incident triggers an outpouring of all the information I’ve stored! Healthcare is a good example of this. Since I’m right in the middle of the maelstrom of controversy, I find myself almost overwhelmed by it all. Not that incidents don’t occur almost daily that should act as triggers. But where do I begin?

There are patients who’ve never seen their actual M.D.’s, or only seen them for a total of 15 minutes over the course of a year. Multitudes of people are multiple medications, with no idea of which is for what symptoms or of the side-effects or drug interactions. There are patients who need to change life-style or unhealthy habits who can’t get a 30-minute consultation with their primary care physician. Well, the M.D. just doesn’t have time! He or she has to see too many patients just to pay his administrative costs, which have risen over 25 % in recent years.

I didn’t even mention paying off school loans for the arduous process of becoming an M.D., or of rising malpractice fees. I’m sympathetic to the realities of practice. As a psychologist, my own time spent on paperwork and non-patient time has risen to the point where I have to pay someone else to fill out forms, code procedures, follow up on billings and payments, etc. etc. etc. No wonder there’s a shortage of family physicians in the U.S.

And if you have Medicare or MediCal or worse yet, no insurance, it’s often difficult to even find a doctor who will accept you as a client. A government survey done in 2007, quoted by the AARP, states that the more than 1.3 million people on Medicare have difficulty finding a doctor. And since seeing a specialist often requires the referral of a primary care physician, you’re out of luck even if you have a clear idea of what you problem is.

With economic conditions getting worse, and people losing their coverage or cutting back, the situation is just getting worse. I found this out after my serious auto accident in 2004, as described in my recent book Surviving Human Venom. Even recommended treatments can be delayed or not covered, and the insurance company can cut those treatments off or raise your premiums beyond your ability to pay for reasons that often make no sense to the poor patient. I’ve seen Workers Comp patients have treatment delayed for years, while their condition worsened, because the insurance company argued with the need.

And despite the high cost of medical care, assuming you can afford appropriate treatment on a timely basis, the U.S still has much lower positive outcomes than many other developed countries. We’ve got over 46 million Americans without health insurance, and we spend over $8000 per year per capita on all Americans, but we have lower life expectancies, a higher rate of preventable deaths, and higher child mortality rates than many Western countries.

I haven’t even mentioned quality of life issues yet! Billions are spent on advertising to convince us that some magic pill will solve all our problems. But chronic conditions and chronic pain persist, and the suffering from depression and anxiety continue to escalate. To really put patients first, psychologists and other behavioral specialists should be part of every treatment team. But more often they’re relegated to the last resort of a frustrated and busy physician, who dooms you to failure by saying, “It’s all in your head! Go see a shrink!” That hardly sets up a positive expectation of success.

I hate to keep harping on personal responsibility. But it always gets back to that, doesn’t it? LBJ brought up the idea of healthcare “regionalism,” where every doctor, clinic, and hospital was affiliated with a regional medical educational center. But instead of thinking “teamwork and collaboration,” when the idea is brought up, most doctors think “oversight and supervision” and panic. Is this just ego?

Many doctors are afraid of any program that is designed to reward efficient, high-quality services because they are afraid they don’t want measures of provider effectiveness applied to them. Insecurity and a sheer meanness of spirit make them resist being accountable for the quality of their care. Integrated care approaches help cut costs while improving services, but that would mean sharing the “golden halo” with other specialists on the team. The most difficult patients often require the most care, but even they have an improved prognosis when evidence-based treatment models and a multi-person team that includes mental health professionals, nutritionists, and other specialists are used to really treat all aspects of the patient.

Putting the patient first should be the first characteristic of healing. And if that means evaluating what you’re doing, consulting with colleagues, working with emotions and thoughts and other intangibles, then so be it! Taking better care of all patients, not just the wealthy ones, should be the goal of any reform plan. Not just splinting the bone or bandaging the wound, but actually educating, reassuring, and motivating the patient, something you can’t do in a 10-15 minutes office visit!

The major psychological organizations are busy coming up with ways to integrate psychologists into interdisciplinary teams, to ensure quality in mental health practice, and to encourage support, consultation, and collaboration among providers. Let’s see that extended to all areas of medical care.

Since I’m more familiar with sub-acute and skilled nursing homes, I’ll put my thoughts into an article or two that should help both professionals and lay persons understand how these ideas of teamwork can be put into effect. Look for them next week or so, because I’ll try to explain all the parts of being human that need care if we’re actually going to heal anybody!.

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