“Have a seat, the doctor will be with you in two hours.” Blogfinger.net photo. February, 2017. By Paul Goldfinger ©
By Paul Goldfinger, MD, FACC. 2017
In many ways, our healthcare system is better than ever, and that is largely due to advances in medicine on the part of physicians partnering with new amazing technologies. More cancer victims are surviving and for longer times —–some are being cured while others are being stabilized. HIV and some cancers have become chronic diseases. and our hospitals produce miracles on a daily basis.
There is no question that the ACA (Affordable Care Act) has resulted in many benefits including as we have been reporting, the greater availability of treatment for addicts and guaranteed insurance coverage despite pre-existing illnesses. There also is the option to keep grown children, up to age 26, on a family’s plan.
The American healthcare system, workers and facilities, often produces remarkably high quality care.
However, despite certain advantages, the ACA is flawed in a variety of ways, including rising costs and inconsistent quality and will likely be replaced or changed in the future.
One important element in the equation is that more people than ever before have obtained health insurance, bolstered by government subsidies. Supposedly the number is 20 million more who have insurance thanks to the ACA. Medicaid has also been expanded across the country, but these rising numbers stress a system which already is over-burdened and short-staffed, and this effect will diminish quality unless the issues are addressed.
The marketplace for insurance availability is too narrow and needs to be widened to bring down runaway costs and increase consumer choices. One factor that increases cost is that the ACA requires too many mandatory clinical elements (one-size-fits-all), many of which are not necessary in certain instances. That is why young people, who tend to be healthy, often avoid obtaining coverage.
People should be able to design a plan that suits their needs. And they should be able to band together to shop for group prices across state lines. One idea is to “de-link” insurance coverage from employer mandates. This will create more options for consumers.
From a physician’s point of view, the arm twisting created by the ACA makes life more difficult for doctors and secondarily for their patients. On Blogfinger we have been especially interested in the quality of the doctor-patient relationship.
Here, for example, is a quote from Medscape Cardiology:
“During the office day, physicians spent 27.0% of their total time on direct clinical face time with patients and 49.2% of their time on EHR (electronic health records) and desk work. While in the examination room with patients, physicians spent 52.9% of the time on direct clinical face time and 37.0% on EHR and desk work.
“The 21 physicians who completed after-hours diaries reported 1 to 2 hours of after-hours work each night, devoted mostly to EHR tasks.
“Two hours of documentation at the office for every hour of face-to-face patient time, plus the additional couple hours at night, are ample fuel to add to the burnout fire which increasingly consumes our profession.”
The huge numbers of additional patients with insurance are causing excessive pressure on physicians who lately often pedal too fast and delegate too much.
Currently, on a day to day basis, patients often run into sour notes. For example a person with a problem might have to wait months to see a specialist or have a particular surgery. If they feel ill, physicians may refuse to see them due to crowded schedules, and patients are then sent to emergency rooms and urgent care businesses when such an ordeal could be avoided.
Many doctors have become employees, and managers with no medical training sometimes get in the way of the traditional doctor-patient relationships.
Physician offices are potential trouble spots where carelessness and poor communication may cause quality of care to diminish. Who is monitoring care in physician offices run as businesses? It is often difficult to get a doctor on the phone because their offices have purposely erected barriers to that happening.
Poorly trained desk jockeys answer the phone and stumble as they try to deal with medical issues. This is practicing medicine without a license. This places the patient at risk of serious mistakes.
True medical personnel such as nurses should be manning points of triage for patients. In my cardiology group, only CCU trained nurses spoke to patients who called with medical concerns, and if a decision is to be made they would discuss it with us on the spot. And if necessary we would say to the patient, “Can you come now?” We even made house calls on occasion.
During my time, doctors almost never discussed prevention.
My partners knew little about prevention, and I didn’t have time to discuss nutrition and other related topics, so Eileen and I wrote our book. “Prevention Does Work” to fill in those empty spaces for patients. When I lectured to lay audiences I would begin asking ; “How many of you ever heard your doctor say these words: “prevention ” and/or “nutrition.” Few hands would be raised.
Evidently the new style of corporate healthcare management is placing too much emphasis on efficiency and cost cutting, and quality medical care doesn’t always lend itself to such an approach.
As our government tries to sort out the wheat from the chaff, let’s hope that they keep the patient at the top of the priority list and the doctors in charge of medical care.
2017 Bogfinger.net. Ocean Grove, NJ.
HAYLEY WESTENRA from Celtic Treasures
