This summer, I’ve spent more time than I care to in a doctor’s office trying to support my 23 y/o college student in his search for a cure to his sinus/ear problems. This is an ongoing issue that has found little to no relief and has caused him – a naturally gifted athlete who was once a talented volleyball player, snowboarder, skateboarder, golfer, etc. – to give up anything that pumps blood quickly through his veins because of the pain it causes in his ears and sinuses.
Sitting in the doctor’s office, I’ve thought alot about health care reform and how one of the priorities should be training doctors how to LISTEN to their patients. The ENT we’ve seen charges us $181 (not $180, not $185) per office visit, not counting thousands of dollars for tests that he orders – I’m certain – to only help him validate what he’s already decided b/f actually LISTENING to what is happening to my son.
Or, he could be ordering them, according to someone who used to work in hospitals and has intimate knowledge of the whole payment-insurance-patient system, because that’s the only way he can afford to pay off his medical school loans, keep up his malpractice insurance and cover his office overhead b/c the fee for those (and insurance reimbursement of) will cover what our $181 office visit doesn’t.
Now, if that $181 got us, say 30 solid minutes with the doctor listening to us and then either saying he’s clueless and recommending someone smarter than he is, or coming up with more than one simple diagnosis/cure, I’d have no problem with the charge. But that $181 gets us less than 10 minutes with the actual doctor. He doesn’t have time to listen carefully to the symptoms, ask probing questions, look us in the eye even (!), b/c if he does, he’ won’t see the other patient he’s double-booked into the 10-minute time slot he gave my son.
Of course, we didn’t actually GET 10 minutes of the doctor’s time. No, I timed it, and we got six with him in the room trying to talk to us, which is, as anyone with a brain would tell you, not enough time to figure out five years of problems with a young man’s health. (We got more than that with the tests, but the doctor wasn’t engaged with us, just doing the test and then quickly writing prescriptions. As my son said, “He already had his mind made up before he even heard what was wrong.”)
So, while everyone debates if we should have a public option or not in our health care reform, I think we need to also concern ourselves with the sad fact that even if you do have insurance, it is no guarantee that you will get decent service for the money you fork over at the doctor’s office.
A brave physician has decided to do something about the problem with health care at the root: physician practice. Her model might be something reformers should keep in mind when trying to tweak our horrible system. (And why do I say it is horrible? Check out this Frontline video.) The doctor in question is Pamela L. Wible, in Eugene, Oregon, who in 2005 pioneered a community-designed ideal medical practice. She writes about it in this month’s issue of Spirituality and Health. The actual article isn’t available online yet, but you can buy the magazine at Whole Foods – and you should, especially if you’re a doctor — or if you’re a citizen planning on attending any Town Halls on health care reform. (You do want to be informed before you protest, no?)
One of the most interesting lines of the piece comes from a recollection Wible had of the town hall she held to ask her community what they wanted in a medical clinic. One man said, “Is it possible to find a doctor who’s happy?” That might be the first key to any reform – having doctors who aren’t suicidal (a doctor/day takes his/her own life, according to Wible) and so worried about paying their bills that they can’t LISTEN to your need to be well. Here’s more from the piece:
“… Nobody is ever turned away for lack of money. How is all of this possible? By slashing overhead, I can work less and earn more because my patients and I no longer subsidize fancy buildings with cafeteria-style waiting rooms and huge parking garages halfway across town. With no staff, we don’t have administrators ministering to us or managers managing us. Inexpensive technology streamlines scheduling, billing and record keeping. Veronica, my two-dollar laminated “secretary,” hangs from the door, smiles, and announces, ‘The doctor’s in.’ It’s so simple. For the first time, I can see my patients unimpeded …”
To find out more about Wible’s advocacy for health-care reform, go to idealmedicalpractice.org