Doctors in the trenches speak out – Part One

I grow weary of the politics of health care reform. Powerful interest groups buy the politicians. The need to get re-elected takes precedence over the national interest. Paul Krugman writes: “Actually turning this country around is going to take years of siege warfare against deeply entrenched interests, defending a deeply dysfunctional political system.”

My sympathies may lean towards one side of the health care reform argument, but I find it distressing to see good people on both sides insult, demean, and provoke one another. I know it’s a dog-eat-dog world out there, but does it really have to be? When Rodney King said “Can we all just get along?” did that resonate with us and become unforgettable because it was so naïve?

I don’t think so. I believe, deep down, the vast majority of Americans would prefer a kinder, gentler nation. What we have now is a spectacle with high entertainment value.

So here’s something on health care reform that has nothing to do with Democrats, Republicans, liberals, conservatives, or one group arguing with another.

Money-Driven Medicine

Bill Moyers recently showed excerpts from Money-Driven Medicine, the documentary based on Maggie Mahar’s book of the same title. One prominent health care blogger called it this year’s Sicko . Like the Roger Moore film, it’s very thought provoking. Unlike that film, I believe it’s much more objective.

When Mahar, a financial journalist (and former Yale English professor), started her book on health care, she made cold calls to doctors. Five out of six called her back and talked for over 30 minutes. They said, “Please, we want someone to know. Please tell people.” They were passionate about the declining quality of health care in this country, what was happening to their profession, and how little they could do about it.

The film interviewed members of the medical profession. These are not men and women of one political persuasion or another. There are no opinions of health care legislation here. These are professional doctors who want to do their job and who are frustrated and disappointed.

The text — in this and the next two posts — is from a transcript of Bill Moyers Journal. For information of the availability of the complete documentary, visit the film’s website.

If you read just the highlighted portions, that’s enough to get the flavor. This is an important perspective. It’s not about what’s happening in Washington or in town hall meetings. It’s what’s happening in the lives of real patients and the professionals who try to care for them.

The Medical Industrial Complex

Larry Churchill is a bio-ethicist who asks: How can we deliver health care in a profit-driven system.?

Larry Churchill: We’re now treating medicine as if it were an industrial product. Through put. How many units of care can you deliver? The idea that you are going to see a patient on average for between 12 and 15 minutes, no matter what their condition or how many kinds of problems they have or how complicated their diagnoses or how much reassurance they might need is an idea that you can treat medicine like a production line product and you can turn out patients in the same way like we produce widgets. That’s a commercialization and an industrialization of the relationship. So this is a system which is fundamentally broken in terms of the kind of conflicts it raises in the minds of physicians and, also, in the minds of the patients.

Health Care Availability and the Primary Care Physician Shortage

Maggie Mahar: Over the last 12 years the number of people visiting America’s emergency rooms has soared. Yet here’s what’s surprising: The number of low-income people going to ERs has not increased. The increase has come almost entirely among middle-class people and many of them have insurance.

So why do they go to the ER? Why aren’t they seeing their own doctor?

Dr. Nixon: There’re just not enough resources out there for, not only your uninsured patients, but also your insured patients. Insured patients have a problem also because their doctors, when they call their office and say, “I need to see…” … “We can’t see you for three weeks.” “Well, what am I going to do for three weeks?”

Health care costs keep going up, up and up and up. But the access seems to be going down down down down.

Sick Care vs Health Care

Dr. Donald Berwick is a pediatrician who’s disturbed by the waste, inefficiency, self-interest and disrespect for patients that he sees in the health care system. He believes his colleagues are dedicated, caring people, but they’re stuck in a system that amounts to a national tragedy.

Dr. Donald Berwick: It is, I guess, politically correct, widely believed, to say that American health care is the best in the world. It’s not. There’s a much more complicated story there. For some kinds of care my colleague … calls it rescue care. Yes, we’re the best in the world. If you need very complex cardiac surgery or very advanced chemotherapy for your cancer or some audacious intervention with organ transplantation, you’re pretty lucky to be in America.

You’ll get it faster and you’ll probably get it better than in at least most other countries. Rescue care we’re great. But most health care isn’t that. Most health care is getting people with diabetes through their illness over years or controlling the pain of someone with arthritis or just answering a question for someone who is worried or preventing them from getting into trouble in the first place. And on those scores: Chronic disease care, community-based care, primary care, preventive care. No no, we’re nowhere near the best. And it’s reflected in our outcomes.

… We’re not the best health care system in the world in infant mortality rates. We’re like number 23. There is an index that is used in rating health care systems, which is the rate of mortality that could have been prevented by health care. There are at least a dozen countries with lower rates of preventable mortalities than the United States and not one of those countries spends 60 percent of what we do on health care.

Related posts:
Doctors in the trenches speak out – Part two
Doctors in the trenches speak out – Part three
Why are US health care costs so high?
Health care reform: Navigating the maze
Health Culture Daily Dose #6: Health care reform
Health Culture Daily Dose #11: Health care reform
Edward Kennedy: Healthcare is a fundamental right, not a privilege