AN ESSAY ON HEALTH CARE AND THE MEDICAL SYSTEM
This past year, the University of Texas at Austin initiated the opening of their new Medical School on the main campus in Austin. UT has other medical schools in Texas, but a central medical school on the main campus is a historic first.
In January of this year, Dr. Clay Johnston, the newly appointed Dean of the Medical School, wrote a tongue-in-cheek article on the ‘top ten’ issues he was facing. It was penned as light-hearted humor and insight. But it inspired me to seriously examine the real problems and issues with our healthcare systems as I have experienced them over the years.
I worked for UTMD Anderson Cancer Center as a Director of Support Services from 1999 to 2005. I am a Communications College graduate from UT Austin. So I embraced the opportunity to write on one of my two favorite social topics (education being the other). I personally worked with some of the finest Doctors, Researchers and Administrators in the world.
This past month I traveled to an internationally renowned hospital facility on the opposite end of the globe from Texas. My experiences reinforced my fears about the obvious and dramatic deficiencies in the quality and efficiency of our healthcare operations.
I composed this essay in the hopes we will distance ourselves from the recent misdirected goals of profitability and greed. We should instead strive to achieve the more valuable and compassionate goals of quality personal health care, convenience with minimal disturbance to the quality of life, and providing efficient costs with effective results.
I also sent this essay to Dr. Clay Johnston as a courtesy before I published it. His response was positive and supportive. He also stated he would share it with his colleagues. One more small step forward for all of us.
1) WHY IS A HOSPITAL LIKE A PRISON AND WHY SHOULD IT BE MORE LIKE A 5 STAR HOTEL?
Let’s face facts; most people don’t spend very much time in hospitals anymore unless it is something serious. Most procedures are now done on an outpatient basis. If you do have to be admitted into a hospital, it is a very difficult process. Most physicians will only approve admittance if it is a serious issue. Or if you visit the Emergency room and they realize it is serious enough to admit you. It remains a very, very costly process for the patient.
Once you are admitted, the hospital resembles a prison in many ways. Most of your choices are made for you. The atmosphere and surroundings are generally the stylish ‘sterile institutional depression’ design pattern. You are inserted with an IV tube and a bevy of wires for vital sign monitoring (although I have seen wireless versions lately). All of this makes it difficult to sleep or rest. Which oftentimes is what you need the most. And you may be awakened consistently throughout the night for meds, injections or other tests.
The physicians services are dependent on who might be available based on their current patient load. In other cases, it is based on how long it takes them to get to the hospital. Possibly taking time away from their personal practice. Diagnostic testing is also susceptible to scheduling and staff conflicts. And they are all dependent on the analysis and interpretation from staff and personnel.
Everything has to be meticulously recorded. This also takes time, patience and skill. A patient might spend 10-20% of their time receiving ‘medical services’, and the other 80-90% watching television, reading books, sleeping or staring at the wall (ah, but now we have internet). It is a very inefficient system when you consider the cost of that hospital bed both for the patient and for the facility. Of course, all of these variables also depend on how serious your ailment might be.
Is there a better way? Yes, there is. First, let me qualify. One of the major reasons many organizations do not modify or restructure certain operational procedures, is because they don’t want to lose money. I will clarify. If making a change means they will no longer make money from a specific product or service, even if the final outcome is a cost savings and a benefit for the consumer; they don’t want to lose the budget revenue. It’s as simple as that. Unfortunately, this is aside from the fact that the operational changes may be more effective and efficient. So in reality, effectiveness and efficiency should always be the priority. This was management 101 back in the day. Not so much today.
A very respected physician and department head I worked with many years ago would stress the importance of the three most critical responsibilities of a hospital or healthcare facility; prevention, diagnostics and treatment. Prevention is important before something happens. Treatment is important after something happens. But diagnostics are important all the time. We are failing.
On the subject of diagnostics I shall highlight two specific areas of focus, Star Trek and human biological excretions. We all know what human biological excretions are (blood, saliva, urine, stool, epithelial skin cells, sweat, tears and genital excretions). These are our most important tools for individual diagnostics. Yet, although as easy it is to collect almost all of these, we have no current system in operation to consistently collect and analyze these vitally important warning signals essential to our wellbeing.
Mr. Rodenberry knew what he was doing when he gave Dr. McCoy the ultimate diagnostic and treatment tool, handheld no less. And although we have come quite a long way in the development of modern diagnostic equipment, we are still waiting on the major diagnostic equipment designers and manufacturers to design and release the ultimate diagnostic tool. In the meantime, the old tools make very good sales commissions. Where is the incentive?
We need to break out of the confinement mentality now!
2) WHY DON’T YOU KNOW WHO I AM IF YOU HAVE BEEN ASKING ME THE SAME QUESTIONS ALL MY LIFE?
How many times have you been to a physician’s or dental office and filled out the same information over and over again. Name, address, phone number and medical history. These do change on occasion. Why don’t we have a standard label or form for basic medical record information by now? Always bring your mailing labels for those multiple forms! When you have a stack of forms to fill out, this is a good option. Some facilities are now set up for you to fill out the forms online before your appointment. It is basically the same information and questions you answered when you went to visit that other doctor or practice.
3) WHY DON’T YOU KNOW WHAT I HAVE IF I HAVE BEEN SEEING DOCTORS MY WHOLE LIFE?
We have visited doctors over and over again. Yet each doctor we visit has no clue where we’ve been before. In the old days, your doctor kept your records for life because he or she was your doctor for life. No more. Now you have to take the initiative to ask for a copy of your blood work, or your medical records report from the visit, or the CD/DVD of your X-ray, MRI or CT scan. Doctors and clinics do not volunteer this information to you. The only thing you receive after a visit is a receipt (if you even receive that). Demand you receive a report after each and every visit. You paid for it. You deserve it. And it may make your next visit that much easier and more effective for your physician.
4) WHY DO I VISIT 7 DIFFERENT DOCTOR ‘SPECIALISTS’ TO TELL EACH OF THEM THE VERY SAME THING?
Once again, the same issue as the last one. This major hole in our healthcare system, is not only dangerous, it is deadly. You will visit several ‘specialists’ and none of them talk to each other. The idea is to have a general practitioner to coordinate your health care. But how many of us have a general practitioner anymore? And how informed are they on the procedures or the diagnostics the specialists are performing or considering? How many doctors even take the significant amount of time to review your records? There are exceptions.
There needs to be a physician or medical practitioner whose sole responsibility is to review the procedures and diagnostics the specialists are performing or considering. There needs to be a patient evaluation for advanced conditions. The patient evaluation is a meeting on video chat, if nothing else, where the specialists listen to each other’s evaluations and discuss options with other specialists for the patients. This form of ‘group consultation’ must be implemented to minimize the inefficiency and ineffectiveness of various ‘specialists’ on one patient.
5) WHY CAN’T I SPEND A DAY IN DIAGNOSTICS INSTEAD OF HOURS IN THE WAITING ROOM?
Why do doctors and insurance companies insist on requiring people who have medical issues to spend days going back and forth to diagnostic clinics? Many are elderly and have a difficult time with transportation. Why don’t waiting rooms have equipment for personal blood pressure and heart rate monitoring? Or have equipment in the waiting room for do-it-yourself weight, height, heart rate or body temperature? Efficiency is vital and our health care system is negligent.
6) HOW DO YOU KNOW THE DRUGS YOU ARE GIVING ME ARE NOT GOING TO INTERACT WITH THE DRUGS ANOTHER DOCTOR GAVE ME LAST WEEK?
Few doctors have any idea which medications may interfere with others. Some physicians do have basic information. And others might even attempt to research interactions. But in general, this is another major failure of our healthcare system. Not everyone’s metabolism is the same. In fact, it is the opposite. We are all biologically very different. What may work for one person may not work for another. Dosage for one person may not be the right dosage for another.
The pharmaceutical companies in coordination with the physicians and the insurance companies should be funding major studies and creating information databases to at least provide minimal information to patients and physicians on known or potential drug interactions. It would not just be beneficial; this should be their responsibility as profiteers from the sale of medications and health services.
7) WHY CAN’T YOU TELL ME WHAT YOUR PRODUCTS AND SERVICES WILL COST BEFORE YOU PROVIDE THEM TO ME?
This is a very important intentional failure and should really be our number one priority right now. Have you ever left your car at the mechanic or service shop and just walked away without asking approximately how much it would cost? I know I haven’t. I make it a point to get a written estimate. It may not be the final cost, but the written estimate reminds them to call me if there is something else my vehicle needs that they might find as they start working on it, or that they did not include in the original estimate.
How many times have you gone to the hospital or doctor’s office and found a listing of published cost estimates for procedures? Rarely, if ever. Why not? Simply because health service providers can vary their costs based on whether you have insurance or not. And they can vary the claim information for supplies and services rendered to increase their profits. It’s all about money. Convenience and transparency for the patient does not factor in the equation at all.
This must change immediately. I recently visited a few of the international tourist healthcare destination hospital websites. They do have published approximate costs. At least it gives the patient an estimate on the amount of money their procedures might require.
This negligence in providing health care consumers with approximate costs for any procedure or service, has allowed health care providers in many cases to charge whatever they want. Why shouldn’t they? You have already authorized them to do what they need to do (or what they want to do). So what is to stop them from submitting any cost they deem appropriate to your insurance company for payment? Nothing.
Every service provider should be required to provide you an estimate or range of costs ahead of time. A reasonable and easily understood estimate to review how much you and your insurance company will be required to pay for your visit, service or product. This should be a LAW. Why isn’t it? Most politicians are heavily vested in the health care industries and some of their highest profits are a result of their investments in these industries. So the answer here is money, greed and politicians. They had sufficient opportunities to require these consumer friendly measures in recent healthcare legislations. It didn’t happen.
And I don’t think I need to remind anyone that these inefficiencies between health care providers and insurance companies are what have skyrocketed our healthcare costs in the past few decades.
8) WHY DON’T I GET TO APPROVE AND VERIFY THAT WHAT YOU CHARGE MY INSURANCE COMPANY IS WHAT YOU ARE ACTUALLY PROVIDING ME?
This one simple procedure for checks and balance is the major reason health care costs are exorbitant in the USA and in other countries where there is no patient control on what is charged and what is paid for. Give the patients the responsibility to review and approve the supplies and service costs! This would reduce service providers from turning in costs and charges to insurance companies that they didn’t actually provide or were overinflated.
This is another efficient procedure that would not be difficult to implement and yet would save millions, perhaps billions. Even if a consumer’s review of a bill is not a final authorization on whether the insurance company pays or not, it is still a transparency measure that would be invaluable in the long term to consumers and insurance companies.
9) WHY DO YOU KEEP PRESCRIBING AND GIVING ME MORE AND MORE DRUGS?
I have boxes and boxes of drugs that have been prescribed to me in the past few years. Most of them I may have used maybe once or twice. Many of them I never even used at all. Why? Is it because I don’t like to listen to my doctors? No, it is because they were almost all over-prescribed. The pharmaceutical companies make money from them, the pharmacies that dispensed them made money from disbursing them, the doctors and clinics got freebies or brownie points, and the hospitals made a huge profit bumping up the cost of the drugs for patients in the hospital’s care.
It is better to accurately prescribe a few strategic medications than to prescribe medications as a ‘catch all’ that may in fact do more harm than good. This unfortunately is another failure of our healthcare system. And it is irresponsibility on the part of pharmaceutical companies and those that prescribe them.
10) SHOULDN’T EVERYBODY RECEIVE AN AUTOPSY IF REQUESTED?
This final item is more important than it may at first seem to be. If approved or requested by family members, autopsies would provide families and physicians with more accurate results of why the patient may have died. It is also an excellent source of data for continued research and scientific discovery. Would it provide firepower for some families and attorneys to seek retribution from doctors and facilities? Possibly. But the benefits far outweigh the consequences.
More accurate diagnosis and limitless research material on ailments and diseases is the reward. I do not know of any medical facility that will provide autopsies unless requested by law enforcement or lawyers. Could this be part of an organ and body parts donation program? Possibly. Could interns or medical schools perform these autopsies? Possibly.
Our healthcare system is broken in more ways than one. It is a complete failure in certain areas. Although we have come a long way from the days of Hippocrates, and although there are excellent facilities, physicians, healthcare workers and companies doing excellent work, we can and should do better for all patients and consumers worldwide. There are solutions. Sometimes it means a little less profit, sometimes temporarily, sometimes long term. But if these changes can provide a more efficient health care system, better diagnostics and health care, better research and solutions, and better health for patients, then it is well worth the temporary or long-term reduction of profits.
Profit is considered to be the revenue accounted for after all expenses and reinvestments have been covered. In the healthcare industry, profit should be measured in the quality of health care, the increase in the statistics of healing and the increase in long-term survival rates. In other words, people above profits. Only those involved in the health care system on a daily basis can make this happen. Let us all hope they succeed. Soon.
Fernando J. Llorente
October 1, 2015