As I write this article, I anticipate the rollout of our new book entitled Unbalanced—The Evolving Medical Care Crisis (authored by me, Spence Taylor M.D., and Jerry Youkey M.D.) later this fall. The book examines what we believe is a crisis in medical care, where patient well-being – defined as the positive experience felt by patients when the shared goals of a doctor and patient are achieved during and after care – is no longer the priority.
Unfortunately, in our current situation, the patient’s experience is often not positive. In fact, we have characterized the experience as the “ABCs of the Medical Care Crisis.”
Let's take a deeper dive.
The “ABCs” are symptoms that we found to be quite common in our research.
It begins with “A – Availability Challenges.”
This curious feature does not refer to poor access to care. It refers to unavailability to existing care. In other words, we are not talking about South Carolina’s I-95 Corridor where there are no hospitals, very few doctors and countless uninsured patients. There we have an “access to healthcare” problem. Here, “A – Availability Challenges” is talking about South Carolina’s larger metro areas with ample doctors, multiple hospitals and insured patients who cannot gain entry into the medical care environment.
Certainly, the challenges along the I-95 Corridor are real and disturbing. But the challenges of availability may be even more confounding. Examples include a patient sent to a dermatologist for a suspicious mole whose first available appointment is in eight months (let’s hope the mole is not malignant melanoma!) or the woman whose annual mammogram was scheduled (first available) for six months, which begs the question: does this mammogram count for this year, next year or both years? If we struggle with available in places where we have ample doctors and mammogram machines, what hope is there for places such as the I-95 Corridor?
“B – Burnout of both doctors and patients” refers to the degree of clinical burnout for doctors -- as high as 65% in some specialties like ER Medicine.
Burnout is associated with a lost sense of purpose. More and more doctors have assumed the role of “employee” in a profession in which they used to own. Is there any question that doctors feel less inspired? As the productivity of doctors slips, so does medical care and patient well-being. How can we restore the sense of purpose doctors once proudly exhibited?
"C – Corporatization” refers to placing the well-being of medicine’s components ahead of the patient’s well-being.
It’s this mystery that patients face when employed doctors insist that they must have their tests done a facility owned by their employer -- a facility with a six month wait for a mammogram -- when the test can be done elsewhere in a week. Or more commonly, when patients discover that the X-ray at the hospital (the only place that the doctor wants you to go for the test) costs four times more than the free-standing radiology center down the street. Why is that? Welcome to provider-based vs. freestanding billing -- a topic for another day. In these examples, who is the beneficiary? The patient or the corporate care system? I think the answer is obvious.
I remember as a child when a neighbor received a telegram delivered by Western Union telling her that her son was ‘Killed in Action’ in Vietnam. I remember the sadness and outrage. Why couldn’t the Army send someone in person—someone instead of a machine generated message—to deliver such bad news? The complaints were fierce. And the complaints were heard. Some days later an Army General drove down from Washington, D.C. to apologize.
Did that make it better?
In our research, we discovered (with little effort or solicitation) three incidences this year where patients received the diagnosis of cancer (one terminal) all by text message (generated by the electronic medical record) through their phone!
Like the Gold Star family of my childhood, this is an example of “D
— Depersonalization,” where patients connect with the medical care environment through an inhumane machine.
I have been told this is an unfair criticism. It is unlawful to withhold patient information. We must send all pathology reports directly to patients. Really? When did we abdicate common sense and our duties as doctors -- duties such as delivering bad patient news -- to non-clinicians like lawmakers?
“E – Exploiting non-clinicians,” by telling those with no professional training to perform clinical duties.
Recently I encountered an overworked hospital administrator who had spent the day cancelling and rescheduling the list of the next day’s elective surgeries because of staffing issues in the operating room. They did so by calling the patients directly. When I asked them how they knew in which order to reschedule each operation -- most urgent to least urgent --she looked puzzled. Apparently, she was canceling and rescheduling operations without any input from the clinical team. This is exploitation. This is also dangerous.
And finally, there is “F – Failed Communication.”
Medical care is faltering because we fail to appropriately resource communication in our service profession. Communication is an add-on something we do after the fact; after we have cared for the patient. It rarely is the sole responsibility of someone on the care team. More on this in weeks to come.
Do these symptoms sound familiar? They must. We have a documented patient satisfaction rate of only 27% in the latest Harris Poll.
The poll seems to tell the obvious. We indeed have a medical care crisis where patient well-being is no longer the priority.