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Monday Jan 28, 2019

Our Health Care System Is Sick

My friend's husband, who I'll call Joe, went to the hospital recently. It didn't go well. His story, in fact, provides a great example of how our nation's health care system is failing patients.

[red emergency sign and arrow]

Joe did not have a family physician, so his wife took him to a local urgent care. His symptoms included facial droop and slurred speech, so the urgent care physician sent them to an emergency room by ambulance.

After an emergency room evaluation, Joe was sent for a CT scan (which was negative). Symptoms of a stroke persisted, so he was admitted to the hospital.

Yet another physician saw Joe the next day. His symptoms had improved some, but there was still facial droop, slurred speech and he was unstable on his feet. The hospitalist ordered a neuro consult, but there was no neurologist in the hospital.

A neurologist arrived in the afternoon -- 24 hours after Joe's ordeal began -- and requested more tests. After an MRI and MRA (and another 24 hours) there was still no diagnosis. The hospitalists said Joe could be discharged and follow up with outpatient physical therapy, occupational therapy and speech therapy.

How did we get here? More importantly, how do we fix it?

If this patient had a family physician who had been providing him with regular health care, it is possible -- perhaps likely -- that he would have been treated in a more efficient, less costly manner. A physician who knew this patient would have been able to avoid the urgent care visit entirely and instead have him admitted to the hospital. A family physician who was familiar with Joe's ongoing health could have personally called a neurologist and possibly gotten him therapies that could have minimized the damage from his cerebrovascular accident. Seeing the familiar face of a trusted FP would have added a sense of security to Joe's experience and continuity to his treatment.

Instead, we have a disjointed, siloed, fragmented system that chops a patient into individual parts and maximizes profit.

Part of the problem is that patients often use urgent care centers for issues family physicians are trained to treat in our clinics.

Why do they do it? Usually it's because they can't get in to see us. When you call your own physician's office, does an actual person answer the phone? When I call, the first thing I hear is, "If this is a medical emergency, hang up and dial 911." Many patients will go to an urgent care center at their local big box store or pharmacy because they can get in and out quickly.

Calling 911 in Joe's case would have been a better idea than what transpired. Instead, he not only will get a bill from urgent care, but he will have one from the ER, the hospital lab and the radiologist just to cover the first few hours of the event. Then comes the admit team, the hospitalists, the specialty consult, assorted therapists, and the list goes on.

This is not an argument about what we would have done "in my day." No. Treatment has improved, but the patient experience has not.

An evolving stroke patient will see multiple people they do not know, asking questions they may not be able to answer. To the hospitalists, Joe was unfamiliar -- one of the 20 or 30 patients they see in a day. Where did the ownership of the patient go? Where did the care of the patient go?

Family physicians have the advantage of getting to know our patients. We know the medications they take. We work with them to control their blood pressure, cholesterol, diabetes, thyroid conditions and more to help them live longer, productive lives.

Do our patients have strokes? Of course, and when it does happen, the family physician is there to help in the treatment and recovery.

Family medicine is the answer to the wasteful system that is draining resources from our nation's other needs. If the medical industry continues to find ways of making money by separating the bits and pieces of health care, we as a nation will find the economy imploding under mounting debt and crushing medical bills.

Family medicine can fix this, but we cannot give in to the pressures of falling in line with health care as it is today. We must continue to stand up for our patients and continuity of care.

We must inform state and national politicians that their constituents are our patients, and their constituents need and deserve a better health care system.

I have said in the past that our country has a great "sick care" system but not a great health care system. Stories like Joe's make me wonder about the quality of our sick care, too.

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

Posted at 09:48AM Jan 28, 2019 by Leonard Reeves, M.D.

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