Present Healthcare Reform Legislation is before Congress in a form that no one understands, especially those who will be providing it. One thing healthcare providers know is that more bureaucracy will not solve the issue.
Almost everyone, in Congress and in "real" America, agree that something has to be done about access, cost and quality of healthcare. Perhaps a look at where we came from will be of some help.
In 1992, when I was three years out of a Family Practice Residency, an elderly gentleman in his 90's was brought in to see me for an acute respiratory infection on a Saturday morning. His daughter explained to me that he was a retired physician and was only visiting for a few days.
Fascinated by this man, this historian of the noble art of medicine, I pondered the fact that he had gone to medical school shortly after WW-I. He had served over-seas during WW-II, and had re-entered the world of "everyday" Family Practice in the late 1940's.
Temporarily forgetting his illness, I blurted-out, "What is the biggest NEGATIVE change you have seen in medicine since you went to medical school?" Without hesitation, he pointed to the waiting room: "There, in the lobby. We would NEVER have let a person as sick as I am sit among other patients, either well or sick, in a common room."
When asked to explain, he replied that mornings were generally devoted to house-calls, and afternoons were used for the "non-infectious" cases, fractures, lacerations, obstetrics, surgical evaluations and dermatologic cases.
I have often thought about his remark, and glanced into a waiting room where five or six doctors had as many as fifty patients waiting, most coughing or febrile. We tried to schedule well-visits and routine follow-ups in the first slots of the morning and after lunch, but inevitably, the contagious would show up and ask to be seen.
We should gather two things from this: first, prevention of illness is key to containing the cost of medical care, and opening access to doctors available; second, patients must be better educated, or develop better understanding of what is urgent and not push in to see a doctor, for what even twenty years ago would have been recognized as a "common cold" and no medical treatment generally necessary. There is a split responsibility here.
I have previously written on "The Dangerous Co-Pay" and how it led to over-spending and over-utilization of resources. Doctors and hospitals have been blamed for much of the cost of healthcare, but in my experience, at least 1/3 of the tests ordered and as much as 1/2 of the money spent on office visits is unnecessary. Any new plan for healthcare reform must address this patient-driven model of care. Perhaps it is time that we quit letting "sick" people into the office and return to home visits.
Let us do some thinking about ways in which knowingly sick people subject dozens of other people to illness, usually needlessly. This will account for much of the over-utilization at the primary care level.
Just Thinking, The Sand Hill Philosopher
