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Friday May 24, 2013

We All Play a Role in Mending Our Broken Health Care System

The role of an AAFP officer can be challenging. We have intense travel schedules; deal with myriad government agencies, health care organizations and committees, along with the accompanying alphabet soup of abbreviations and acronyms to memorize; represent diverse opinions within our own membership; and challenge our elected officials at every level to make changes in our dysfunctional health care system. 

That system is broken, and our country seems unable to move forward in addressing this critical failure despite great need. Whenever I get frustrated, however, I can count on reminders of why family physicians are so important, and how we must strive for success.

One of the many hats of a physician is to be a good neighbor and member of the community. The other day, my wife and I received a call early in the morning from our neighbor. She asked if we could come over and help her husband, who was outside yelling. We immediately went over and found that he had slipped and fallen. He complained of severe pain in his hip, and I was pretty sure it was broken. We moved him into a chair, waited for the emergency medical services (EMS) team and made sure he was on his way to be evaluated. Everything went smoothly, and it seemed the system had been effectively mobilized.

Later that afternoon, I followed up and found out that he had gone to the emergency room (ER), had an X-ray that, supposedly, did not show any fracture and was sent home. Unfortunately, no one made sure that he could actually transfer from the stretcher to a wheelchair and from the wheelchair to a car. They did not check to see whether he could walk.

So, when he finally got home, his wife had to find another neighbor to get him into the kitchen, where he sat for five-and-a-half hours unable to move and in excruciating pain. She finally called EMS again, and he was taken back to the ER, where this time a CT scan was done. 

The CT scan did show a fracture, and the report noted that the original X-ray revealed the fracture as well. He was admitted for surgery. I went by the next afternoon, and he was in a hospital bed after having been in the ER for several hours. At this point, the orthopedist had not yet decided when he might have surgery. He had not received medications and still was in agony. Neither he nor his wife had any idea what the plan was or when a plan might be implemented. His care was complicated by the fact that he and his wife are extremely hard of hearing, and he has early dementia. 

As I was headed out of town -- again on Academy business -- I called his family physician, who is a friend of mine, to make sure he was aware that his patient had been admitted. The physician had not been notified during the ER visit, and he appreciated the opportunity to go and provide continuity of care for this longstanding patient.

Certainly, things happen. Even in the best systems, some things don't go smoothly. However, such problems reinforce the fact that family physicians must be foundational to any health care system we have, and that we must work hard to create this reality. 

We have to be sure that we do thorough histories and physical exams and not just rely on tests. If a test result doesn't support our clinical judgment, then we have to believe the patient and not the test and keep pushing until we get an answer. 

We need to be sure that patients are seen as people and not as test results and assess that they actually can do the basics, such as stand and walk, if we truly are going to provide appropriate care. 

We need to address people's needs, especially acute pain management. 

We need to communicate to ensure that the right people are in the right place at the right time to provide care. We also have to communicate clearly so that our patients know what we are doing and why. 

Finally, we just have to care. I was extremely disappointed in our health care system in this case and felt that at most of these steps, we let this gentleman and his wife down at a critical time of need. Health professionals as a whole must do better.

Your voice is critical to helping us move our system forward. We must ensure the message of family medicine resounds loud and clear with our representatives, our physician colleagues and other members of the health care team, and our patients.

Thanks for all you do for our patients, our communities and our country.

Reid Blackwelder, M.D.is president-elect of the AAFP.

Posted at 03:45PM May 24, 2013 by Reid Blackwelder, M.D.

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