Health Care Disarray
A neurologist friend of mine, Kevin, moved to Paris for the year with his wife and three children. They rented an apartment in an unfamiliar neighborhood. A week after their arrival their seven-year-old son began complaining of a severe earache. Kevin (who had not yet begun working in a hospital) had been told of a service (SOS Medecins) that made house calls. He called the designated number and within an hour someone rang his doorbell, diagnosed his son's otitis, prescribed amoxicillin and offered him a ride to an open pharmacy. It was 11PM.
"Zoot alors!" I thought, on hearing the tale, and began to consider the American health care system. Admittedly some large cities have physician groups that offer house calls and most communities have a myriad of doc-in-a- box clinics for drop in medical services. While these create an aura of accessibility, the American health care system still seems difficult to navigate.
After a number conversations with friends and some personal experiences, I have come to the hardly startling conclusion that the American health care system is very screwed up. Aside from the forty million Americans without health insurance who are denied access to health care -- even those who are
covered -- have difficulty getting their due for a variety of disparate reasons.
Many times I have suggested that patients hoping for an appointment with a sub-specialist try to make the appointment themselves. Occasionally they call back the next day asking me to intercede on their behalf. More often than not the medical situation is not urgent from a clinical standpoint but to the parents of a child with intractable abdominal pain, who are at the end of their patience and riddled with anxiety and guilt, the problem is acute. While the medical situation may not necessitate an early appointment, the psychosocial situation may.
Given limited resources and availability, the latter may not seem a legitimate reason to aid in speeding up the medical referral process, but the angst of parents confronted with delay can be intense. Admittedly one of our cultural biases when confronted with a potential crisis is for immediate
satisfaction and information. But listening to parents concerns, I try to talk them through the situation to assess their level of anxiety. Usually I will ask for an immediate reading on x-rays, ultrasounds, CT scans or MRIs so that I can give them the results. Being there for them with some information, regardless of the findings, usually allays their fears..
Symbolically, the discovery of cancer has almost more significance than the actual diagnosis. When people are saddled with the diagnosis of cancer, the natural response is to have it extirpated as rapidly as possible. They do not want to wait for treatment that may not start for weeks due to the
evaluation and staging of the tumor. Explanation of the process to the patient may ally some anxiety, but the psychological need to take a pro-active step remains. Once again the desire to push the medical system faster than it might ordinarily move is in the patient's emotional interest.
The advent of large medical centers and clinics -- with their focus on specialty and subspecialty care -- has been harmful to the patient's best interests. We have bought into their system and envision ourselves as a set on disparate problems held together by our skeleton. A knee problem leads us
to an orthopedist, preferably a knee specialist; similarly a torn rotator cuff leads us to an orthopedist, preferably a shoulder specialist. We compartmentalize ourselves into a disconnected set of medical problems unless there is someone in our lives who can help us think in an integrative
manner about our medical situations.
But who should that person be? Ironically, the most effective person would likely be a physician who has worked in a community long enough to know its medical resources and personnel, and who might even have a personal relationship with a referral source. The medical system is not geared for an ombudsman of this sort. An individual who serves this function does so as an act of concern and kindness. S/he will not be paid for this service. It is a labor of love that evolves out of frustration with a discombobulated and unresponsive health care system. For those of us who do carry out that labor of
love, we, in a sense, become the SOS Medecins of America. But oh if we could only import a bit more than French baguettes back to America.
