This is the story of Dr. C, the general practitioner that my family and I would go to see when we were sick. Dr. C’s office was in a small red brick building across town by the railroad tracks. In my mind’s eye, I can still see the framed photo on the wall in the waiting room — a picture of a nurse in white uniform and cap, her index finger poised in front of her pursed lips to remind us to be quiet while we waited. I don’t know how old the magazines in his waiting room were because I never had to wait long enough to find out.
Dr. C’s wife, Eda, a registered nurse, assisted him in the practice. She was the behind-the-scenes woman who, in that generation (and maybe this one too), made it all work – practice, patients, running the household, raising the children. Dr. C and his family lived next door to us and his children were our playmates. We liked playing dress-up games in their basement, and often were entertained when Dr. C would play his accordion.
My parents and us siblings would go to Dr. C’s office for routine check-ups and vaccines. I also remember visits for a variety of childhood problems – mumps, recurring nosebleeds, a sprained elbow, and a strange outbreak of allergic reactions when I was a teenager. This reaction would appear as random swelling of various areas on my body.
One afternoon, I woke up after a nap with my face swollen up and went to find my mom, who was talking on the phone to a friend. When mom caught sight of me, her eyes opened wide, she got off the phone immediately, and together we ran up the hill to Dr. C’s house. After an examination, Dr. C thought it best to admit me to the local hospital for observation, and he came in each of the days I was there to check on me. After my release, he took me through the rounds of allergy shots, trying to uncover the culprit causing the allergic reactions. We never did discover it, however, and the outbreaks disappeared as mysteriously as they appeared.
Now, this series of events would involve at least 3 physicians and their support staff. If one of my children were to have this same mysterious problem, the primary care doctor (or perhaps the physician in the emergency department, if that’s where we went) who ordered my child’s admission to the hospital would likely be required to hand off care to one hospitalist (or more depending on how many shift changes took place), and after release, we would likely be sent to an allergist. All of this activity would require phone calls to several offices and perhaps even clearance through the insurance company – long, drawn-out chains of calls managed by layers of front-office staff, appointments, and most of all, paperwork. Even in a small town, it is no longer possible to just walk up the hill to find the person you need.
If we are to make any progress in truly reforming healthcare, we must understand that this is not how most physicians prefer to work, and not how patients want to be treated. Most doctors still want to be able to spend as much time with a patient as is necessary to solve the patient’s problem. This new scenario is what managed care, driven by business people focused on numbers – whether at an HMO (or its reincarnation, the “medical home”), an insurance company, or the administrative offices of a hospital or government agency — has done to the American healthcare system.
Dr. C presents the image of the personal family doctor that we romanticize, and that we all wish still existed, a physician with whom we can have a direct, unimpeded connection. But this connection has been broken down in the current world of corporate medicine. (Make no mistake, the ACA, a.k.a., “Obamacare” is NOT socialized medicine, but corporatized medicine.) The entities driving this machine, as we can see from the recent cancellation-of-policies debacle, are still the insurance companies, in conjunction with other corporate overlords. In reaction to this interference, some primary care physicians are now setting up “concierge” practices, shifting the model back to the old style of practice in which they make their services available directly to their patients for direct payment. And who can blame them? For it is the primary care physicians who are on the front lines of medicine, the very ones who will experience the greatest impact from the ACA.
Corporate medicine is not the model Dr. C practiced or advocated. He devoted his life to justice in medicine — taking care of each patient, regardless of status, in the way that was of greatest benefit to the patient, not to the business. He was active in promoting the rights of doctors to treat their patients as they believed necessary, but in the few years before his death, Dr. C had to stop listening to reports about the increasing interference of government and corporations in American healthcare; doing so broke his heart. Because so much of the control of medical care has been removed from the doctor’s influence, it is now especially important for us patients to recognize and use the power we have to ensure our own health care. I write this blog to help all of us, patients and care providers, understand the influences at work in the current American healthcare system. The more we patients know, the better we can ensure our own health.
Here are some of the topics that will appear in later postings:
The many influences at work in the American healthcare system: Why healthcare reform isn’t a one-time fix
Who benefits – financially and otherwise — from the ACA
How hospitals ensure their income stream and what this means for patients
Changes in physician training and how these changes have or have not affected your care
The HIPAA law – its original intent, what it’s become, and how it serves and fails patients and practitioners
The billing conundrum: What does medical care really cost you?
The rights (and responsibilities) of patients
The problems with online rating sites for healthcare providers
The ongoing shortage of physicians – will you ever see a doctor?
Does your physician need to be Board Certified?
Medical care in countries with socialized medicine: Is it better, worse, or just different?
A letter from patients to doctors: Going beyond the Hippocratic Oath