Thursday, January 31, 2008

No Waiting Necessary

I just got back from my annual check-up with my cardiologist--for those of you who like this blog, my heart is doing great, for those who don't like it--tough, I'm going to live to antagonize you another day! I always drag a book or other reading material with me to occupy my time in case there is a wait. Since we're heading into tax time, I took It's Never Too Late to Get Rich: The Nine Secrets to Building a Nest Egg at Any Age thinking I could read about municipal bonds or how to save on taxes but I never got a chance to pull the book out. Instead, I was whisked from the waiting room into the examining room within a few minutes and given an EKG, had my blood pressure taken, my heart listened to and an exam in a timely and efficient manner.

Since I didn't have any big complaints, I shot the breeze with the doctor for a bit and told him how nice it was to be seen so quickly and the conversation turned to socialized medicine. He expressed concern that heart patients, especially those who needed to be seen quickly for emergencies would not be seen in the timely manner they are seen now should universal care come to pass. "I was recently at a medical convention of cardiologists," he stated, "and ran into a cardiologist from England. He said that the waiting list over there was for a period of months for those with heart problems and even those with emergencies such as heart by-pass were not being seen quickly. Somehow, those with the most moolah were ending up getting treatment, while everyone else waited."

Many people who clamour for universal healthcare have never been sick or involved in the healthcare system--right now, care is generally available for various illnesses, not 100% of the time, but a good portion of the time. The current system may not be perfect by any means but those who have emergencies at least have the emergency room, lower fee clinics and other means of getting care--sometimes for free from doctors who volunteer their time. Imagine being on a waiting list for heart bypass or another emergency for months or having others with more cash or connections go in front of you. A universal system seems ripe for corruption. It sounds more fair, but often, like so many other government-run organizations, those with the most clout rise to the top and the rest of us sit and wait....


Blogger SayUncle said...

glad to hear your doing great!


3:08 PM, January 31, 2008  
Blogger Helen said...



3:26 PM, January 31, 2008  
Blogger Trudy W Schuett said...

I am glad you are well. The world is a much better place with you in it!

You've given me so much encouragement over time I can hardly tell you. I'm pretty sure God wants you here on earth to keep doing what you do for a long time to come!

5:54 PM, January 31, 2008  
Blogger Webutante said...

It's wonderful that you're doing so well, Helen. Know that's got to be so, er, heartening to you.

I agree about the level of care here today. Not perfect, but certainly better than the majority of all other systems in the world.

Last week flying back from Scotland to Newark, a man next to me said his wife sold medical software that helped the system manage the very long wait times for surgery. The object of the software being to prevent wait times of greater than 2-3 months. Can you imagine having to go through that if you had a desperate heart condition or an aggressive cancer?

8:42 PM, January 31, 2008  
Blogger Ralph L said...

I endured socialized (Navy) medicine in the 70's, very lean years for the military. If we get government-rationed healthcare, I'm moving to, wait a minute.

11:55 PM, January 31, 2008  
Blogger TMink said...

Agreed Ralph. I did a psychological residency that brought me into contact with two VA hospitals.

I met some nice people there, the folks who worked with patients were really professional and good hearted, all you could ask.

But the political administrators were hacks! They had no background in healthcare and must have been somebody's cousin because they were better suited to be used car salesmen.

I remember sitting through one meeting where a politically appointed administrator talked for 20 minutes. I was asked by my supervisor what he had said and I replied "Not a damn thing." He smiled a sad little smile and said "You will go far kid."

Government run health care? No thanks, I have seen it in action.


9:44 AM, February 01, 2008  
Blogger Sid said...

Universal healthcare will havea n unintended consequence on the population that will only cause more medical expense.

Our citizens will not have the immediate feedback necessary to make wiser, healthier decisions. We are already seeing a coming crisis with obesity. Imagine if the notion that "government will pay to have what is wrong with you fixed" get into the minds of the needy.

2:31 PM, February 01, 2008  
Blogger jay c said...

Government ruins everything, which is why it has historically been so good at war. It is telling that recent administrations haven't even been able to do that well.

4:09 PM, February 01, 2008  
Blogger The North Coast said...

Many people who clamor for universal health care are individuals who have been turned down for expensive, and necessary, treatments by their insurance companies.

One man of my acquaintance, a wealthy business owner, was denied payment on a $20,000 treatment for his heart condition by his health care provider. His premiums exceed $1,000 a month. The treatment was necessary to save his life, and he dug into his pocket for it, saying "it's a good thing I'm rich. What if I wasn't? WE NEED SOCIALIZED MEDICINE!!!" This is an older, plain-speaking man who doesn't bother with euphemisms like "single-payor system"- he uses the S word in public.

I'm not sure that our government can put a decent, efficient system in place, but I'm sure the system we have now is broken badly. Many individuals are simply not getting the care they need. Many people are just letting themselves die.

One solution is to regulate the insurance companies, while permitting people to buy their medications wherever they find them. I believe our current system would improve a lot if we only subjected it to the rules of free enterprise, which means that they can charge what they want but we are free to seek our medication and treatment wherever we can obtain it, which at this time,we aren't exactly.

At this time,our system merely functions as a conduit by which our money is siphoned off to HMOs and insurance companies.

4:04 PM, February 02, 2008  
Blogger Doreen Orion said...

As a psychiatrist, the socialized medicine thing particularly scares me. There is such a shortage of psychiatrists already. New patients routinely wait months to see a shrink in many areas of the country. Primary care docs are thus having to fill the gaps and particularly with more complicated diagnoses, just aren't cutting it. (This is not to rag on PC docs. I would certainly never presume to know how to treat someone's blood pressure and I'm sure they would rather not treat Bipolar Disorder for the same reason.)

As for managed care... I also do insurance review work, so maybe I have a different take. While I would certainly agree that our current system is not perfect, and that a lot about managed care needs to change, I find that the vast majority of the denials I do are because of quality of care concerns, ie the care the patient receives is so bad (the MD/hospital's fault), that his or her stay is needlessly prolonged. One example from just yesterday: A patient has been in a psychiatric hospital for nearly 2 weeks. He had been suicidal on admission. He is no longer suicidal, but still has some obsessional thinking about his wife. I asked the attending if the wife was supportive, or if there was any basis for the patient's thoughts. The attending was stumped. So, being the keen observer of human behavior that I am, I asked if the wife had been in for a family session? No. (It's not that she's busy - she hadn't been asked.) Has anyone in the facility (including the attending MD) even spoken to the wife? No. As egregious as this is, it is all too common. The day before, I did a case where the sole reason given for continued stay was to have a family session with the mother (the adolescent girl had expressed suicidal thoughts after a fight with her mother). Again, during the entire stay thus far (9 days), the MD had not even bothered to call the mother ("our social worker does that") let alone have her come in for a family session. Why? "We don't have enough social workers." Obviously, there should have been several family therapy sessions since admission, to help the mother and daughter work out their issues prior to discharge. Out of curiosity (and, I admit, trying to scare him into giving better care) I asked, "Even if you don't think it's important to talk to an adolescent's family, if God forbid, she was discharged and killed herself, how is this defensible medical-legally?" His answer stunned me into silence (not easy to do - ask my husband): "If that did happen, the expert witness would have to testify on the standard of care in our city and the standard of care here is that the attendings don't talk to the families."

I feel I do my job ethically and when a patient needs treatment, he or she gets treatment. But, all too often, that treatment is clearly substandard. Why should the insurance company pay because the care is so crappy it prolongs the stay? And no, the patients shouldn't have to pay for crappy care, either. (In my opinion, in those instances, the facility and the attending should have to eat the cost themselves.) Obviously, the facility doesn't give the insurance a discount on the days they don't have enough staff to do the job they're supposed to be doing. (Let's not even get into that the MD should be talking to the family him/herself. And God forbid the patient stays over the weekend, when they see the doctor who is "just covering" and therefore doesn't want to change any medications, no matter how much the patient needs it.)

Then, there are what I call the roach motels. You know, the drug and alcohol rehab facilities that have patients fly across the country for treatment. (I always ask how they got to the airport and these places claim never to know. One of these days, one of their patients will have a DUI on the way where someone gets killed and I believe will share liability because they told a patient they diagnosed as an active substance abuser to go to the airport - in many cases even paying for the one-way flight.) I call these facilities roach motels, because once you get in, you never get out. Why treat someone far away from their home area, making family therapy difficult, and follow up less likely, as the patient can't hook up with 12 step meetings - a home group and sponsor - prior to discharge? I did another case yesterday where one of these places wanted 30 days of rehab for a woman who takes 3 xanax a week. That's it. (The rest of her history didn't warrent the treatment, either.) I guess all I'm saying is that managed care is not always the villain. There is a lot more in our system that needs to change.

I sincerely hope that the vast majority of care is stellar and because it is, I never hear about it. My job is just very frustrating, much of the time.

I'm venting. I needed that. Thanks.

5:07 PM, February 02, 2008  
Blogger Helen said...

Doreen Orion,

Thanks for the work you do, I know it's hard, I've been there and don't understand how so many people can do their jobs so poorly in mental health. I doubt the government will make it better, I can only see it get worse.

6:24 AM, February 03, 2008  
Blogger Doreen Orion said...

Thanks, Helen.
I really did need that.
(Feel free to bill me for the session.)

4:09 PM, February 03, 2008  
Blogger Bob's Blog said...

This post certainly caught my attention, having just been wisked off to the hospital with a 99% clogged artery. The local ambulance took me to the hospital that was twenty minutes further away, but was the one that has a cardiology team performing angioplasties all day long. The hospital closest to my house only has cardiac doctors and staff on call. Guess where I would probably would have been taken if we had universal health care?

7:31 PM, February 03, 2008  
Blogger Helen said...


So glad you are okay--what a scare.

10:44 AM, February 04, 2008  
Blogger Serket said...

You have a good doctor, Helen, it is nice that he is not pushing for socialism.

2:47 PM, February 04, 2008  

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