America’s REAL Healthcare Crisis

I had planned on the subject of my next blog being motor vehicle accidents, however; with the recent Supreme Court hearing on The Patient Protection and Affordable Care Act (Also known as Obamacare), I have decided to put that blog on hold and address some relevant national healthcare issues.

The purpose of this blog is not to take a political stance, nor is it to influence opinion on the health care legislation currently under review.  I do have an opinion on the matter, but shall reserve it for the time being.

What I hope to illustrate is what I feel are the real core issues of why Americans spend so much money on health care, and why access to that care is sometimes limited.  These are points that I believe most of my fellow health care providers will endorse, yet they are issues that politicians on both sides of the aisle have neglected to address.  And so, my dear readers, I shall endeavor to shine some light in a dark corner of the medical basement.

Americans like to feel good:

This is the greatest nation on earth.  Our forefathers endured a lot of suffering and hardships to get us where we are today, and for that we should be thankful.  Even the less fortunate among us enjoy a relative level of comfort to be envied by less developed nations.  We are generally well fed, well clothed, have a roof over our head, and go about our lives avoiding discomfort.  When we encounter pain or illness in our lives, whether it is physical or emotional, we want it to stop, and to stop right now!

Advertisements by pharmaceutical companies have only worsened this, as they portray their products as providing instant relief. One minute, the patient is in the throws of unimaginable physical and emotional turmoil, and the next they are smiling and laughing as they ride their unicorn over gumdrop rainbows, all courtesy of (Insert name of pill here).

What has happened is simple, we have become a nation that runs to a healthcare provider and the first sign of discomfort, rather than deal with it on our own or wait to see if it resolves without intervention.

Americans are well informed:

The information age has placed such a wealth of knowledge at our fingertips, via the internet, documentary television, and medical entertainment shows loosely based on fact.  As a result, the average American has a greater BREADTH of knowledge on medical subjects than they did a century ago.  However, the DEPTH of that knowledge has not grown at pace.  When an American has a stomach pain or a rash, they instantly go to the internet to research their malady.  The flood of information that ensues provides a long list of potential illnesses, some of which are quite serious.  The patient then becomes alarmed, and feels they must seek immediate medical care in order to prove or disprove the diagnosis.

Several times a month, I have patient’s tell me that the reason they are seeking care is that they have either read something on the internet, or have a family member with some level of basic medical training, which spurns them to come to the hospital to be “checked out” for a feared condition.  The subsequent costs of these visits, as well as the cost of the tests to prove that the patient’s fears are unfounded, add up to a staggering amount of needless medical expenditures.

Fast food nation:

Aside from the actual fact that fast food and our diet of excess in general has caused a litany of health problems, one should also take note of the fast food MENTALITY, and how it affects our health care.  Unlike decades ago, when Americans today decide they want something, then they want it RIGHT NOW.  In the process of wanting it NOW, we also want it our way, and with as little effort as possible.  Ever notice that there will be 15 cars in the McDonald’s drive-thru but no customers inside?  Americans want to sit in their climate controlled vehicles and listen to music while awaiting their rapidly prepared foods.  This mentality carries over to how Americans view their health care.  We want to feel better NOW, right away, and we want to do so in a manner that we dictate, preferably without leaving the comfort of our vehicle. The bottom line, we want drive through cures.  Just as you can suddenly decide you want fries and a shake, and pull off the highway for both, Americans want the freedom to suddenly decide they want their shoulder pain to stop and want the services at their disposal to have it completed in time to get home to watch Jersey Shore.

This is the real cause of Emergency Room overcrowding.  Several studies have shown that access to care and insurance have little to do with who goes to the ER.  Most non-emergent ER visits are a matter of convenience.  We are the drive thru, and are viewed as being easier and faster, even when our wait time exceeds six hours.  People FEEL like they saved time and effort when they come to the ER, even if their primary doctor could see them in a day or two, with minimal time in the waiting room.

Americans are special:

This factor has a two pronged effect.  On the patient side it is obvious; everyone wants to feel as if THEIR case is unique, and that they deserve a special level of care and attention from their physician.  As a result, most patients feel that, although every other patient should get the alloted twenty minutes of the physician’s time, THEY are special, and deserve more.  Since every patient feels this way, the result is that everyone wants a bigger piece of the pie.

The other side of the coin pertains to my colleagues and I, and how we perceive our role as care providers.

A study conducted in the 1980’s evaluating why Detroit automakers lagged behind their Japanese counterparts in efficiency and production showed that the percentage of American auto workers who were “managers” or “supervisors” greatly exceed those in Japan.  Americans like to have special titles, and to be recognized as subject matter experts.

American doctors want to be experts and sub-specialists.  The prestige, monetary reward, and limits of liability are all heavy factors in this.  A recent study of graduating medical students showed that only half as many new doctors are choosing to enter primary care specialties as a decade ago.  What this means, is that fewer doctors are choosing to be clinicians who patients go to repeatedly for their day-to-day healthcare needs.  Instead, doctors are overwhelmingly choosing the path of the “Expert consultant”.

The percentage of sub-specialists to primary care physicians has a huge impact on access to care.  In Great Britain, where the number of primary care physicians is still high, a patient can consistently rely on being seen within 48 hours of calling to make an appointment, but may wait up to eight months to see an endocrinologist if they are diagnosed with a thyroid problem.  In America, primary care visits are often booked weeks in advance, but a patient can be seen by a sub-specialist within 3 weeks of the referral.

Americans like to be in control:

If you visit a major city anywhere in the world, you will see streets filled with cars loaded to capacity.  In America, everyone rides alone, and the carpool lane is empty even while the expressway is at a standstill.  Americans like to drive themselves, to choose their own radio station, to be in CONTROL.  When it comes to health care, Americans want to choose.  They want to choose their doctor, the tests they receive, and play an active role in their own treatment.

This desire for control is a great thing, it is what makes us leaders of the free world, but it also makes treating us a bit more challenging, and time consuming.

The American Spirit is an amazing and unbridled phenomenon.  We are different from every other nation on Earth.  It is for that reason that we should remember that our health care system is unlike every other.  For a moment, let’s forget about the argument of where America’s health care “Ranks” in the world (FYI, those VERY flawed studies had more to do with patient’s PERCEPTIONS of health care, and less to do with patient’s actual OUTCOMES), and let’s remember all we have done as leaders in healthcare.  From control of infectious diseases such as malaria, to vaccinations, to cancer screening, our system has lead the way, and the world has reaped the benefits.  Do not be too quick to condemn our system based on cost, and consider for a moment the rewards it has returned.

The next time you wonder who is responsible for the state of our current healthcare system, ask yourself if perhaps you may have been one small part of the problem.

(Author’s note:  I did not discuss frivolous lawsuits and tort reform, that would take an entire blog by itself)

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