It isn’t much fun these days to be a physician but it’s even tougher to be a patient. The “shenanigan factor” physicians have to go through to get their patients treated appropriately continues to increase with each passing day. Sadly, truth and integrity in the health care system also seem to diminished with each passing day. In order to provide the accepted diagnosis which will allow treatment, physicians often have to be creative in order to “push the right button” so that a computer somewhere will give approval for the care needed by a patient. As this trend continues the diagnoses continually become more disparate from that of the actual disease entity thus “garbaging” health care data. Being a patient also isn’t easy in a health care system increasingly more interested in denying, rather than providing, health care. Even when care is approved it is not infrequently accompanied by gobblygook such as this example:
Where then is the focus of the system? It appears to be primarily concerned with the benefit of corporate shareholders and corporate officers rather than sick patients. It seems that patients must now take on a task akin to the Greek philosopher Diogenes, who searched the world for an honest man to find a trustworthy physician.
Minnesotans increasingly take less pride in the fact that the concept of Health Maintenance Organizations (HMOs) started in their state. While the highly touted ability of HMOs to improve care and reduce costs has become more frayed each day patients only get to appreciate this when they have a health care problem. HMOs have basically replaced the “Hippocratic” principle of medical practice with that of the “Veterinary” variety.
What is the Veterinary Principle? Well veterinarians are not ultimately responsible to the animal they are ministering to. Their basic loyalty is really to the animal’s owner (who pays the bills). Increasingly. in the United States physicians are becoming part of systems where their primary responsibility is to a health care entity rather than to the patient (do their patients really understand this?). The phenomenon of veterinary care is at its worst when physicians or payers are reimbursed on the basis of what they save (or deny) more than on what they provide to the patient. How many physicians today are actually practicing “Veterinary”, rather than “Hippocratic”, medicine?
We are being told that a health care crisis presently exists in the United States. There is little disagreement regarding this observation but the crises may actually different than most people think. 14.5% of our present Gross National Product is now being spent on health care. This is clearly a great deal of money. But, would this be too much money if the public received appropriate value for the expenditure? It is interesting to note the great cost inequity in spine care where back problems, which represent only about 10% of all the disabled (actually as high as 55% in Sweden) often account for as much as 60% of total health care expenditures (after chemical dependency and psychiatric disorders). Here then is a marvelous opportunity for change! All we have to do is to stop being a “disease” system (where all we do is to wait for disease to strike and then treat it) and become a true health system. It is actually within our power to promote change.
Managed health care has not yet lived up to its advertising and there are politicians clamoring for a federally mandated socialized system as the panacea.
It is appropriate at this time to the status of other socialized systems. If we cast our eyes across the Atlantic we can view the British National Health Service. Is this something worthy of emulation? Waiting has always been the price the English have had to pay for free service. But even in a society used to “queues” (something Americans definitely do not have a stomach for) the emergence of waiting lists to simply get on waiting lists has had a serious demoralizing effect on patients as well as physicians. How can the urgency of a problem be determined when the wait to even see a consultant can be months? Patients waiting for a hip or knee replacement often wait 18 months. Physician frustration with the system results in a less caring attitude toward unhappy patients, resulting in a vicious cycle of more unresponsive and less respectful physician attitudes toward their patients.
If we turn our eyes to our northern neighbors the only good news is that the wait for health services in Canada is sometimes less than in England. “When George Zeliotis of Quebec was told in 1997 that he would have to wait a year for replacement for his painful arthritic hip, he did what every Canadian who’d been put on the waiting list does: He got mad. He got even madder when he learned it was against the law to pay for a replacement privately. But instead of heading south to a hospital in Boston or Cleveland, as many Canadians already do, he teamed up to file a lawsuit with Jacques Chaoulli, a Montreal doctor.” (Unsocialized Medicine, WSL, June 13, 2005).
On June 9, 2005 the Supreme Court of Canada held for Mr. Zeliotis. Their decision struck down a Quebec law banning private medical insurance and said “Access to a waiting list is not access to health care.”