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Friday Oct 19, 2018

We Shouldn't Have to Struggle to Put Patients First

On a bright, sunny summer day when I was 10 years old, I awoke to a pain in my right lower abdomen. The pain was sharp to dull, coming and going. I remember breaking out in a cold sweat, but after a while it got better. I reassured my mother, but that was not enough to keep her from taking me to the doctor's office.

At Dr. Matheny's office, I was asked a couple of questions (which my mother answered). I remember him pressing on my abdomen and feeling a funny twinge of pain. Later, he took some blood and looked at it under a microscope. He even let me look at the red and purple dots under the glass.

Later that evening, my mother took an unsuspecting future physician to the hospital, where I was told to put on a gown, and a fellow I did not know rolled me down the hall on a gurney.

"You won't even know anything happened," he said.

I did not know what was going to happen. In a big room with a huge light over me, another man I did not know told me to count backward from 100. I refused, but I awoke later with a different pain in my side and a big incision with sutures.

That was my introduction to the health care system. It was simple then. My father worked in a union plant and we had health insurance. No one stopped us at the door to check an insurance card. They just took care of me.

Fifty years on, I sat in an ER with my wife, who would die five days later. After the decision was made to admit her to the hospital, a lady came into the ER with papers in hand, asking me to pay $500 up front. My, how things had changed.

Where is the physician who can diagnose appendicitis from a physical exam and a finger stick? Where is the hospital that takes care of you first and the insurance that covers a significant portion of the cost? What happened to putting the patient first?

I have worked in several practice locations, from small southern Georgia towns to a teaching hospital where I was trained and later became the associate director. I continually hear the phrase "No margin, no mission!" It is sad, but I reply, "No mission, no margin."

Technology has taken us a long way -- a long way away from the patient. Students, residents and physicians all have fallen into the trap of treating test results instead of the patient. Electronic health records separate us from our patients. We spend more time with the computer than we do examining and treating our patients.

No wonder physicians are burned out. We went into medicine to help people. Now we are governed by checkboxes and data we have to report rather than care for the patient before us.

I call it the Modern Health Care Industrial Complex. Hospitals, computers, data centers, lab technology, Big Pharma, durable medical equipment, account managers, insurance companies -- the list goes on and on. Where is the patient in all this?  

Unfortunately, they are the widgets we work on, and there's a set time period to work our magic before we discharge them from the hospital because there is another widget walking in the door behind them.

It is big business. According to NBC News, nonprofit hospitals made $21 billion on investments in 2017.(www.nbcnews.com) That same year, hospital care nationwide was projected to cost more than $1.1 trillion.(www.medpagetoday.com) Small rural hospitals are not doing so well, but larger hospitals in affluent communities continue to thrive.

Hospitals are not the biggest culprit. All parts of the Modern Health Care Industrial Complex add to the cost. Meanwhile, patients are going without medicines they can't afford and delaying care until problems become so big that the damage is already done.

We must get the patient back to the center of the health care system. We must be able to listen to their stories and help them the best we can. The AAFP has adopted policy that "health is a basic human right for every person." Health care should not be only for those who can afford it. Health care should not be an industry. Health care is personal and should not be something held in a computer. We need to put the patient back in the exam room with a physician who can listen, diagnose and help their fellow human.

I keep in my office a framed hospital bill. It was from when I was born. My father made a $50 dollar down payment in 1954 for his expected baby. (They didn't know in those days if a baby would be a boy or a girl -- no ultrasound.) When my mother checked out with her newborn son, there was a $6.55 credit on the bill. Yep, it seems I am worth only $43.45.

Things were simpler then. We can never go back to that simpler time. But what we can go back to is treating patients, putting them first and worrying about the other stuff later.

Leonard Reeves, M.D., is a member of the AAFP Board of Directors.

Posted at 09:56AM Oct 19, 2018 by Leonard Reeves, M.D.

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