Health care reform – Should we start with the doctors?

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.

When was the last time a doctor actually listened to you?
When was the last time a doctor actually listened to you?

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

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11 thoughts on “Health care reform – Should we start with the doctors?

  1. My doctor is pretty good about listening, which is why he is so popular.  You also have to be prepared to see him hours after your scheduled appointment.  But when you see him, he gives you his attention.  He also calls after hours to answer phone calls and I can hear his wife in the background helping him to look things up – seems like they do care.  But the man probably has very little free time.
     
    I did have a problem there recently but it was not with him but someone else there.  The “listen” thing should extend to all health care professionals because it will help the doc do his job better.
     
    I had been doing raw food (nuts, seeds, fruits, veggies, sea veggies) and I lost a bunch of weight but then seemed to stop.  I asked him if it was because of the diabetes – other docs had told me that diabetes makes it really hard to lose weight.  He asked what I was eating for protein and fat  and I said nuts, seeds, and avocados.  He said he would ask his dietician or diabetes educator if that was good for protein/fat.
     
    So I was checking out, in the middle of a crowded waiting room, and she comes out.  She looks me up and down and says, “When I have a skinny diabetic, I tell them to eat nuts, seeds, and avocados.”  Then she stopped and kept looking me up and down.  Silence.
     
    So I said, “Ummmm, so I don’t eat those….”
     
    “BINGO!” She said and turned around and walked out.
     
    So I cut those things out, still eating the other stuff.  Up until that point, I had been doing great on the diet.  No cravings, loved the food.  Felt good.  When I cut those things out and therefore was only eating veggies, a little fruit, and some seaweed – cravings and starvation feelings came on bad, and I went off the diet.  I started to eat “regular” food again and now trying to climb back on the raw food wagon.
     
    If she asked me more questions…and LISTENED – maybe she could have given me better advice.  Maybe.  That’s another thing.  If you are trying to treat yourself in an alternative way, you get discouraged because they don’t have time to accommodate that and aren’t really interested in listening to that at all.
     
    So in my opinion, more than just the doc needs to listen.  Often you go through the hoops before you see the doc and it’s just routine, mindless, disconnected stuff that should be more conscious.
     
    There should be regular reviews of medical files.  Maybe this might cause a light to go on in cases that have been unsolved – like your son’s.  Plus it would alert the team if anyone needs to be checked on.
     
    About your son’s issues – maybe you should extend your search to fitness professionals, forums, communities, etc.  You might find others with similar issues and find out how they handled it.  I looked around the net and saw some people referencing this problem in relation to high aerobic activity.  Not reliable opinions, mind you, but at least another path to take.
     
     

    1. Bjay, If I would’ve been with you when that lady talked to you that way, I would’ve let her have it! I have no tolerance for rude and outright mean people.

       By the way, I think you look beautiful!

  2. Oh, Google “ear pain running,” “earache running” or “heachaches running.”  At least he’ll know he’s not alone.  Maybe if he can get some sort of network going, they can all share info and hopefully come up with an answer.
     

  3. The “payment game” is exactly right!  Sadly, doctors must play the game to survive and some play it more for their own benefit than others.  When a doc orders tests and sends you to a place they own a part of they are obligated by law to inform you of that relationship.  I go where I know I will receive high-quality testing from properly trained and currently certified professionals working with up-to-date equipment because my concern is my health and getting correct results; this may or may not be the same facility the doctor refers me to. 

    Another problem is the insurance companies whose labyrinths of rules, contracts, payment scales, etc are designed to make money rather than pay docs and other professionals fairly for the training they have and the work they do.  Greed in the malpractice and legal venues also adds to the cost, confusion and burden. 

    Good luck to your son!

  4. Speaking of health care, there’s this terrific half-day workshop I recommend everyone attend. It’s called “Surviving Healthcare Hell” and they give good information to help empower patients with the knowledge to get the treatment they deserve. It’s a conference for people who don’t want to get burned by the health care system or their health care experiences. Plus, they will give you a rundown of the new federal healthcare proposals and what it means for you.
    If you’re in the Phoenix area, check it out. http://phoenix.bizjournals.com/phoenix/stories/2009/08/10/daily12.html

  5. I am lucky…I get to go to the VA…where the care is really, really good.Of course, some of the guys (lots) look like they drink too much, do too many drugs and eat way too much…they tend to complain that the VA doesn’t do much for them….But hey….just wanted to say the VA is great….really, really good health care…..but they want me to be pro-active….they are always giving me lists of things to do for my own good.Yay VA !

  6. “some of the guys (lots) look like they drink too much, do too many drugs and eat way too much…they tend to complain that the VA doesn’t do much for them”

    the problem with full blown public health care.

    however, to our vets ……… the world.

  7. i manage my own health care. i do not have to get approval to see who i want. i would never have such coverage.

  8. I get my health care at the VA, they, and my Doctor, David McKenzie, are the ‘gold standard” in my book. If all the world could avail themselves of the diligent care that the Tucson VA provides, there would be no partisan debate.

  9. I have had good doctors who listened in the past, but they were all associated with HMO type organizations or charity clinics where they were not under the pressure of a private practice.
    At the moment I have no medical insurance and thus, not doctor.
    Our problem began with the AMA in the 50s and 60s opposing any kind of healthcare reform in order to guarantee an exorbitant income for MDs (and purposely rationing the number of MDs that could graduate from US medical schools).
    Now even the AMA is realizing they were greedy and foolish, but the resulting rise of the insurance industry (talk about greedy) has become the obstacle to decent healthcare for all.
     

  10. P.S. – I don’t see how recommending Whole Foods is a good way to support healthcare reform.

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