October 28th, 2010 by DrRob in Better Health Network, Opinion, True Stories
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Her eyes were bloodshot. She responded to my casual greeting of “How are you?” with a sigh. “How am I? I’m alive, I can tell you that much for sure.” She went on to describe a situation with her adult son who’s in a bad marriage and has struggled with addiction. She sighed again: “I feel weak. I don’t know if I can deal with this one. I’ve had so many hard things in my life already. When will it stop?”
“Many hard things” — yes, I agree with that assessment. She’s been my patient for more than a decade, and I’ve had a front row seat to her life. Her husband died a few years ago (while in his 40′s) of a longstanding chronic disease. Her daughter also has this disease, and has been slowly declining over time. I’ve watched her bear that burden, and have actually shared some in that load, being the doctor for the whole family.
I’ve also taken care of her parents, who had their own psychological problems. They were difficult patients for me to manage, and they had died long enough ago that I had forgotten that difficult chapter of her life. I’ve helped her with her emotional struggle from all of this. It was hard, but she hung on as best as she could. I know. I was there when it was happening.
To me, this is the biggest benefit of primary care. Yes, it’s nice to have a doctor who knows what’s going on with all of your other doctors. It’s good to have a doctor you are comfortable talking with about anything. It’s good to have someone without a financial stake in doing surgery, performing procedures, or ordering tests. But the unique benefit a long-term relationship with a primary care physician (PCP) is the amazing big picture view they have. Read more »
*This blog post was originally published at Musings of a Distractible Mind*
October 23rd, 2010 by DrRob in Better Health Network, Health Policy, Opinion
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Joe Boyd hated the Yankees. “Those damn Yankees. Why can’t we beat ‘em?” Then he got the opportunity to save his beloved Washington Senators by making a deal with the devil — giving up his soul in exchange for being transformed into “Shoeless Joe” to propel his team to win the World Series.
Interesting. I think a lot of doctors are making their deal with the devil. They are looking for a small gain in comparison to a long-term of misery. True — Joe Boyd made out in the end, but that will only happen if someone from Hollywood writes our script.
Here’s the problem: At the core of our problems with healthcare is the total lack of cohesive communication. Doctors have no idea what other doctors have done with a patient. Tests get ordered, medications get changed, procedures, hospitalizations, even surgeries are done without communication to other doctors who would benefit from this information. Read more »
*This blog post was originally published at Musings of a Distractible Mind*
October 18th, 2010 by DrRob in Better Health Network, Health Policy, Opinion
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Gosh, a whole lot of huffing over a little word! “Customer.” Okay, now grab a paper bag and breathe slowly and steadily into it. I know it’s hard to hear that word. I am sorry to have caused such trouble.
Some folks misunderstood my last post, thinking that I thought patients should only be considered customers, or that they should be referred to as customers. I never said that, nor did I imply it. I simply said that patients are customers. They are. Medical care is not free, and it is being paid for by the patient (directly or indirectly). Medicine is a business that has been so mismanaged that we are now in a crisis over its financial side. The trouble is the cost of care. Cost implies money is used, and trading money for services or goods is what business is about.
We’ve been spending our dollars on healthcare like a person irresponsibly running up a credit card bill they can’t pay back. The pain doesn’t happen now, it happens down the road when the collectors knock. We can’t order whatever tests we want or prescribe gazillion dollar drugs without remembering somebody will have to pay the bill. Ignoring the business of medicine has gotten us into deep doo-doo. Read more »
*This blog post was originally published at Musings of a Distractible Mind*
October 12th, 2010 by DrRob in Better Health Network, Opinion, Uncategorized
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What is a patient? What do they do? What’s their role in the doctor’s office? Are they chassis on a conveyor belt? Are they puzzles for doctors to solve? Are they diseases? Are they demographics? Are they a repository for applied science?
Or are they consumers? Are they paying customers? Are they the ones in charge? Are they employing physicians for their own needs?
It depends. It depends on the situation. It depends on perspective.
Some physicians are very offended when the “consumer” and “customer” labels are applied to patients. They see this as the industrialization of healthcare. We are no longer professionals, we are made into “providers” — sort of smart vending-machine made out of flesh.
Patients, on the other hand, get offended when doctors forget who pays the bill. They see the exam room as a right, not a privilege. They think they should be the most important person in the exam room, being treated with respect rather than having to bow at the altar of doctor knowledge.
Who’s right? It depends. Read more »
*This blog post was originally published at Musings of a Distractible Mind*
October 3rd, 2010 by DrRob in Better Health Network, Health Policy, Opinion
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“It will never happen.”
“They know better than to do it.”
“They realize the disaster it would be if they let it pass.”
That’s what I hear. I hear that the upcoming SGR adjustment, the one that will cut Medicare reimbursement by 23 percent, won’t go through.
In case you missed it, the SGR is a formula coming from the Balanced Budget Act of 1997 that does automatic cuts to Medicare reimbursement. This year we witnessed a legislative game of chicken in congress, with both sides agreeing that it was a bad idea to screw physicians in a time that they are trying to fix healthcare. Read more »
*This blog post was originally published at Musings of a Distractible Mind*
