The New Yorker.

By   Paul Goldfinger, MD, FACC

I am a retired physician who has now experienced healthcare at the receiving end  and I am not happy.  When Obamacare rolled in I wrote editorials on my site--Blogfinger.net,  predicting that quality will be negatively  affected, and my conclusions were  based on the Hippocratic concept of always placing the patient first.

I find that the changes which are rapidly taking hold in healthcare  may result in declining aspects of  quality.  I don’t want to be unfair, but often when  I interact with the healthcare system I look around and find issues to complain about.

It’s usually not a problem of technology or facilities—that has been remarkable, but it has more to do with basics that are the same now as 50 years ago when I started working as a doctor and it is  now often about new management methods  provided by corporate healthcare giants.  I read of one company in the midwest which owned 100 hospitals.

These companies want to change everything. Sometimes the changes are innovative, but often they are about maximizing profit, leaving patients wondering “why?”

Four  of my favorite Monmouth County doctors have left practice early.  At a national level, doctors are leaving medicine in droves, many suffering burnout, and most practicing doctors would not pursue medical careers again according to one survey.

Protect yourself by questioning and doubting what you are experiencing regarding your diagnoses, treatment, and doctor-patient relationships.

When in doubt, get a second opinion.*

Here is an incomplete  list of some of my concerns. Consider this a warning flare bursting in the sky.

a. Doctors often no longer own their practices, so they are now employees who must take orders, such as my pulmonologist who was ordered to spend only 10 minutes with each office patient. That is ridiculous. Physician  flexibility and control  are being compromised.

The management of medical  practices is often via efficiency experts whose main priority is to maximize reimbursements for their corporate employers.

b. You can call a medical  office and ask to receive a call-back from your doctor, but you often receive resistance, no response, or else a nurse calls back and her priority is to come between you and the doctor.   It is unusual for the doctor to call you back.

Speaking to the patient on the phone is discouraged because it doesn’t pay.  Sometimes an office  may make you wait 2-3 days before returning a call. And this may occur when the situation warrants an immediate call back.

If you call an office you may be greeted by a computerized triage system where someone with no medical training is empowered to make  decisions about your care such as when you might be safely seen by the doctor.

Front desk phone answerers may, without any medical credentials, ask you questions such as, “Where is your pain and what does it feel like.?”   Sometimes you are given an appointment which may be scheduled for one or two months away.  (“We have an opening.”)   Who is making that triage decision?   To me this is practicing medicine without a license.

c.  If you seek a physician’s care you may be offered a nurse or a PA as if they are just as skilled as a doctor. That is a lie, and the AMA agrees with me.

d.   Some doctors belong to medical groups which have affiliated with a large  corporation, such as the Robert Wood Johnson Barnabas Health.   This company, based in New Brunswick,  has been striving to access patients from Monmouth County and they have their eyes on our area including Ocean Grove and Fort Monmouth.

What you are seeing  is corporate takeover of healthcare in communities,

So some  physicians who have  contractural affiliations, such as with RWJBarnabas Health,  may have a conflict of interest by insisting that the patient go, for example, to Monmouth Hospital instead of Jersey Shore or by referring patients for specialized attention to their referral centers out of this community.  For example, RWJ provides some specialized services in New Brunswick. You could be sent to such a place when there are such providers nearer your home.

e.  And who is providing your care at Jersey Shore University hospital?   I have been to the Jersey Shore ER  recently  where highly qualified attending physicians/specialists were not visible  despite the hospital’s list of consultants.

In the past, if you  were a  patient in an ER  or medical surgical hospital  unit, you could expect your doctor and/or consulted specialists to manage your care in person.

One urology group in Ocean has affiliated with RWJBarnabus Health. As a result, they do not go to Jersey Shore even if you are brought there as an emergency.  And if you live in Ocean Grove and need surgery you will be sent to Monmouth Hospital by that group.  Taking such decisions out of the patient’s  hands is not in the patient’s best interest.

And if you are an inpatient, find out who is your attending physician named on your chart and see if he/she comes to see you or if your care is by unknown  unmarked  residents or medical assistants. And such practitioners are of uncertain competence, and you often are not informed as to who is who.

See if board certified specialized care is provided when appropriate and then try and demand such attention. You may be crudely disappointed as I was recently.

Not knowing who is in charge of your case is scary.

And take a look at who is billing your insurance company for your care.  Look at our EOB’s (explanation of benefits.)

f . Record keeping has become onerous for  doctors in the office typing on a keyboard while trying to take a complete history, perform a physical exam, analyze your case, and give you advice. There is never enough time.    The doc is expected to create a competent and complete chart note before you leave.

Some practices use scribes to take care of the chart work freeing up the doctor.  But are scribe notes trustworthy?

Communication of this sort may not come with comprehensible discussions and explanations by your doctor.

The doctor  may order a blood or imaging test, and you may be unable to read the report, and the doctor may not call with an explanation.

If there is a consultant involved, request a copy of the report.

The use of “My Chart” apps has advantages, but they will text or email you repeatedly and pressure you to keep responding in the face of lab reports, chart notes, ratings, appointments, reminders, instructions, billing, etc, and I find that badgering to be oppressive. And it often leaves it up to you to review reports when you may find that to be difficult.

g.     Watch for manipulative marketing such as the billboard in Red Bank which says that Monmouth Hospital is one of America’s best. Or the cynical use of the term “university hospital.”  Be aware that the best interests of patients may not be the top priority by your providers who may become more “mad men” than physicians.

h.   Watch your billing.  The hospitals are now beginning to bill you or alert you  on line for services you haven’t yet received. Make sure that they have all your insurance documentation.  For example if you have Medicare, make sure that they know your secondary coverage.

Some billing offices fail to bill your secondary insurance. Then you will be balance billed and you don’t want to deal with billers who are out to collect and make you crazy.

Here is a link to a Blogfinger post about second opinions:*

Second opinions BF article.  *

And there is much more.  Watch for more posts as I make discoveries in the swamp known as American healthcare.

Make sure that you choose wisely for those who would watch over the health of you and yours.

Phillip Smith is a world famous trumpet musician, formerly with the NY Philharmonic Orchestra who spends his summers in the Grove, and here he is with Joseph Turrin on piano:   Gershwin’s “Someone to Watch Over Me.”

Phillip Smith of Ocean Grove and the NY Philharmonic Orchestra.