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Archive for April, 2012

Time to Put a Stop to Drive-by-Doctoring

As many of my readers know, I speak at meetings and conferences fairly frequently, and most often to groups of patients and caregivers. The focus of the talks I give is usually on a patient empowerment topic – ranging from how to communicate with your doctor, to how to stay safe in the hospital, to a dozen other topics….

Every time I speak to groups of patients, I ask the question, “Have any of you ever felt rushed during a doctor appointment?”

The overwhelming majority raise their hands, and nod, and often turn to the person sitting next to them, poised to share their latest horror story about being rushed, which is often the case after they’ve waited in the waiting room for way too long.  A double whammy.

Frustrating. Maddening. Unfair.  And now, statistically accurate, including its negative effect on both our health and our wallets.

Newsweek Magazine published an article this week called The Doctor Will See You – If You’re Quick.  Written by Shannon Brownlee (author of Overtreated), it quantifies the problem of, what I call, “drive by doctoring” – the concept that we barely see the doctor walk IN the exam room door, before the doctor has retreated back out that door, asking the empty hallway (because he’s no longer engaged with the patient at all), “Do you have any more questions?”

The point to the article (which is excellent – you really should take the time to read it in its entirety), is that over the past few decades, the trusting relationship that used to exist between patients and their doctors has eroded to almost non-existent, and has resulted in bigger problems for both parties.  And both parties are suffering.  Patients don’t like it, and their doctors don’t like it either.

Or (another one of my sayings) – American healthcare is not about health or care. It’s about sickness and money – using sickness to make money.

Here are some of the points that support that:

  • The ideal patient panel (number of patients) for primary care doctors should be fewer than 1,800 patients in order to provide the kind of care patients need.  Today, the average number of patients per PCP is 2,300. And for “Medicaid Mills”, the panel is more like 3,000.
  • To speed things along, doctors interrupt their patients an average of 23 seconds into the answer to the question, “Why are you here today?”
  • One study showed that the average amount of time spent providing “critical information” to patients is 1.3 minutes (yes – that’s MINUTES.)  Your quality or quantity of life only deserves 1.3 minutes?

To those of us who understand this madness, and attempt to be smart patients, there is nothing new here. But the information is beneficial to us for a few reasons:

First – because our world is being driven more and more by data, and not simply our observations and stories. With the quantification of these kinds of problems, the powers-that-be will have to look at solutions, because no nation can afford sicker and poorer people.

Second – because this kind of information is a good reminder to us all that it’s us SMART, EMPOWERED PATIENTS who will manage to get the best of a system that has the capability to be great, but is growing worse every day.

We can’t help those who won’t help themselves… but we can be the ones who will STOP this erosion, and help ourselves.

•  Helping ourselves will mean we find the right doctors - the ones who WILL communicate with us. (A reminder that no doctor is average – they are either better than, or worse than, whatever average is. As empowered patients, we search out the “better than”.)

•  Helping ourselves means we place ourselves squarely in the middle of our own medical decision-making - we don’t default to letting someone else make them for us.

•  Helping ourselves means we find information to support our decisions, making sure it’s credible and reliable.

•  Helping ourselves may mean that we try to manage our relationships with our doctors on our own, or it may mean we ask someone else to help us.

•  Helping ourselves will mean understanding the roll the pursuit of profit takes on our health – we will understand the concept of Follow the Money and why that makes us poorer and sicker.

It took decades for the healthcare system to devolve to what it is today (just in time for us baby boomers to utilize it in huge numbers with, in too many cases, horrible outcomes.) It will take decades more to fix it.

Most of us don’t have decades to wait – and for that reason alone, we must engage in our own care.  We can’t afford, for our health OR our wallets, to let drive-by-doctoring take its toll on us or our loved ones.

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True Confessions – My Take on Health Care Reform

Last week we watched (or more likely heard summaries during newscasts of) the Supreme Court’s (SCOTUS Supreme Court of the United States) hearings on American healthcare reform (AKA The ACA, Affordable Care Act.)  For those of us engaged in health-related issues every day, it was fascinating to watch the transition, and the voices of pundits, from “they will” or “they won’t” or whatever that day’s interpretation was.

Watching this culmination of many years of reform efforts has been fascinating to me. And in the midst of it, I realized that many of my regular readers have probably made assumptions about my take on healthcare reform that may not be true.  So yes, today it is time for some true confessions.

First Confession:  I am a registered Republican and, for many aspects of politics, (economy, defense) a conservative. I am, after all, a small business owner. It would seem, then, that I would be against reform of the system.  However…

As someone who has been personally buffeted by the system, during a time when I was insured (meaning responsible), the conversation held special interest to me.  Because, despite the fact that I was insured, and even though my diagnosis was wrong, I still lost my life savings (all except my house and my retirement).   So as you might imagine, beginning when the 2008 presidential elections began to play out in the media, I was immersed in the questions and arguments about healthcare reform. It was highly personal.

As a result of my conservative business nature, combined with my in-the-trenches understanding of how the healthcare system works in the United States, I was truly conflicted!

In those days, I did a lot of speaking on the subject of healthcare reform.  I believe so many invitations came along because I established a reputation of being able to see and argue all sides of the argument.  Perhaps because I was so conflicted, I could switch sides at the drop of a hat, and plays devil’s advocate no matter what the argument.  I would challenge my audiences to see if they could determine whether I supported reform or not – and rarely could they tell.

Second Confession:  Even though I could intellectually understand and argue why big business “had to do what it had to do,” I never could reconcile in my heart that the current non-reformed system is geared to only the “haves.”  The current system is very much about making sure the have-nots (or choose-nots) cannot access care except through emergency rooms, or by going bankrupt. Period. It’s very elitist – all about controlling those who can’t afford care and making sure they get sicker and die, while reserving decent care for those who can afford it.  And THAT is not me.

And that is not me MORE than the capitalist conservative IS me. And so yes, despite the fact that the ACA is highly flawed, and despite the fact that it requires many changes to make it work well, and fairly, I believe that we must start somewhere and so, yes, I am in favor of the ACA and hope it remains the law of the land.

Fast forward to today – two years post passage of the ACA, and a week past Supreme Court arguments, and…

Third Confession: I am less conflicted than I was then.  Why?  Because in these five years after the arguments have begun, I have seen Americans pay attention to aspects of healthcare they have never paid attention to before. Even if I still heartily disagree with those who are against reform, I know that they are seeing the fruits of what has taken place so far.  Maybe they had pre-existing conditions and, for the first time, have been able to find insurance again. Maybe they have a 23-year-old college graduate who still can’t find a job, but could stay on their family health insurance policy. Maybe they are seniors who have found the donut hole shrinking.  Whatever the reason, at least we as American citizens are engaging in the decision-making process – even if some are on opposite sides from my own thinking.

Fourth Confession:  I am totally confused (and hope someone can enlighten me) on why on earth conservatives want to shoot down the individual mandate.  Their arguments against it just don’t make sense!  Republican conservatives are all about personal responsibility, and so many of the arguments against reform have been aimed at problems that have occurred before now because people don’t take responsibility for making sure they have health coverage.  The individual mandate is what makes “lazy” people (the ones who are working six jobs, none of which offer health coverage), and “poor” people (the ones who have been laid off because of Wall Street greed), and young people (the ones who are bulletproof and won’t ever get sick, so would rather buy stuff than invest in health coverage) get coverage.  The individual mandate is what prevents those who run up their costs beyond what can ever be repaid (today) not have to file bankruptcy because – well – they had coverage. The individual mandate is what controls costs for the rest of us who HAVE been responsible.  So – WTH?  I just don’t get that.

And finally, my

Fifth Confession:  (I have confided THIS confession only to my closest friends before today.) Personally, and in a selfish way, it doesn’t matter to me what the Supreme Court decides.  Because no matter what the Supreme Court decides, I and my loved ones, will be just fine. Whatever their decision – it’s job security for me.

The Supreme Court’s decision won’t affect my ability to be insured because my husband is retired from the military, so we have decent coverage for our lifetimes. Our children are all well-employed in jobs that won’t go away, so they are in good shape, too.

No matter what SCOTUS decides, Americans will continue having trouble getting what they need.  I predict that if the ACA is blessed by SCOTUS, then there will be more confusion in the short term, but less confusion in the long term.  And if they strike it down?  Well then, my fortunes will multiply because my career is all focused on either helping individuals get what they need from the system, or helping them find a health advocate to guide them.

Which, of course, goes back to my original statement…. that is…. I’m a business owner and a Republican.  I’ll just continue to grow my business.  And that creates one heckuva circular argument – don’t you think?

So there you go – my five confessions about healthcare reform.  They say confession is good for the soul.  While I’m not sure this has done much for my soul (because it certainly doesn’t resolve any of my personal conflict!), I do hope it has given you some food for thought.

…MORE…

•  Where Does Rationing Fit Into Healthcare Reform?

•  What Is Socialized Medicine?

•  What is Universal Healthcare?

•  Where Does Rationing Fit Into Healthcare Reform?

•  Follow the Money: How Money Affects American Healthcare

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Want more Patient Empowerment?
Find hundreds of articles at:

Every Patient’s Advocate

About.com Patient Empowerment

and sign up for my 2x per month newsletter
full of Patient Empowerment Tips.