My in-laws are in town for my daughter’s graduation.  When I came home yesterday I was greeted with a big smile and vigorous handshake from my father-in-law.  ”I just want to thank you,” he said, standing up from his chair, “for finding us a good doctor.  The one you found for us is wonderful.”

My wife smiled at me warmly.  I just earned myself big points.  Yay!

Her parents and mine are both in their 80′s and are overall in remarkably good health.  When I called my father after he had a minor surgery over the summer, my mother told me he had a ladder and was “on a bee hunt.”  It’s a blessing to have them around, especially having them healthy.

My parents have a wonderful primary care physician, which takes a whole lot of pressure off of me to do family doctoring, and puts my mind at ease.  I’ve only personally contacted him once when my dad had a prolonged time of vague fatigue and body aches.  I try not to use the “I’m a doctor, so I am second-guessing you” card that I’ve had some patients’ children pull.  I called his doctor more as a son who wanted a clear story about what was going on than as a physician with thoughts on the situation.

“I first want to say that I am very grateful my parents have gotten such good care from you,” I said at the start of the conversation.  ”It’s nice to not have to wonder if they are getting good care.”

He was very grateful.  I would be if someone said that to me, and I really meant it.

“About his current situation,” I continued, I don’t want to sound like one of those meddling doctor children who want to second-guess their parent’s doctor….”

“You’ve already blown that one,” he interrupted, clearly pulling my chain.  My kind of guy.

I went on to discuss what has been done, adding some things that had occurred to me, specifically of a condition called polymyalgia rheumatica, which I see with some regularity in my office.  He listened to me, and I made sure he knew that he had no extra obligation to listen to my thoughts because I am a doctor.  We finished the conversation with a few more jokes and I hung up with increased confidence as well as gratefulness that my parents had very good medical care.

A few weeks, after my suggested diagnosis came to be true, my dad informed me that his doctor told him, “your son made the diagnosis; he deserves the credit.”  I earned major points from my parents on that one, but their doctor clearly got high score in my book.

My wife’s parents haven’t been as fortunate with a primary care physician.  Their care has been done a la carte – only when they had problems, and that done with very little explanation.  Being from the generation that doesn’t question their doctor or demand explanations, the extended family was largely in the dark about their medical care.  This meant that my brother-in-law (an internist) and I ended up having to figure out, suggest, and occasionally meddle to get them the care we thought was appropriate.

A few hospitalizations over the past few years and some mystery medical diagnoses brought the situation to crisis earlier this year.  When we went to visit them in the spring, I was given a charge from the family: find them a good primary care doctor.  Given that I am in Georgia and they are in Oklahoma, this was not the easiest task.  I got some names from a fellow blogger (thanks, John), but the best lead was that of a physician who doesn’t accept insurance, charging an hourly rate that made me gasp.  It didn’t seem to be a good match, as my in-laws wouldn’t be thrilled to pay $200 for a viral illness.

Out of leads, I went to the only other source I could think of: Google.  My search quickly led me to physician rating sites.  I had recently hired a roofer and plumber via Angie’s list (with good results on the roofer, and bad on the plumber - as I previously mentioned), so this seemed worth trying.  One doctor seemed good, but his Med School graduation year was in the 70′s, so I doubted he’d be around long.  Another physician seemed OK until I read some of the reviews by patients who complained of wait times and that they didn’t feel listened to.

I eventually happened upon a physician with my training (Internal Medicine and Pediatric) who had trained at a good program and who was young, but not too young. There are very few who get through a med/peds training at a tough program who are not motivated and thorough.  I called, and the office treated me very well, even though I didn’t mention I was a physician (I wanted a true idea of the office’s user-friendliness).  I got her an appointment, sent my mother-in-law the information, and left it at that.

I was thrilled and relieved when I heard their opinion about their doctor.  He had spent time with them, had listened to what they had to say, and made them feel like they were no longer in limbo.  He would take care of her and figure out what is going on.  That’s a big deal for me, as I don’t like having to do detective work and second-guess other doctors.  I don’t like doing it as a PCP for my own patients, much less as a dutifully son-in-law.  Yes, this doctor too won major points in my book.

The jury is still out, as they have only had one visit, but everything points toward a winner.  I find it interesting being on the other end of the transaction of finding a good doctor.  In this circumstance I was a health care consumer looking for what I needed.  The tools I used were the usual: personal recommendations, Google, physician rating sites, and a call to the office.  I had a slight advantage knowing the quality of the program this physician trained at, but it was still took a fair bit of luck.

To both of these physicians, my parents’ PCP in New York and my in-laws’ new PCP in Oklahoma, I give my deepest thanks.  I know how easy it is to cut corners, to get tired, and to be worn out by our system.  I know that it’s easier to not take the extra time to explain, making sure you are heard.  I know that it’s more profitable to see extra patients and spend less time with each of them.  Thank you for doing the right thing.

And thanks for all of those points!

*Extra points to the first person to identify the sport for the scoreboard at the top of this post.

Share

{ 8 comments }

This material, written by me, is free to re-post and share under the Creative Commons agreement. In other words, use it all you want; just give me credit.

Malignant

by Rob on May 14, 2012 · 2 comments

in Health Care - How it's Broken, Rant

Source

“Your system is perfectly designed to yield the outcome you are presently getting.”  - Not sure who said it, but dang, were they smart.

A patient was recently recounting some of her bad experiences with her health care.  I shot back with some of my frustrations with this system that seems hell-bent on making me give worse care to my patients.  We both paused and shook our heads.

“It’s a mess,” she said.

At first I agreed with this simple assessment.  The system that is not a system is disjointed, disorganized, dysfunctional, and frequently makes me dyspeptic.  It seems like a bunch of disparate groups each fighting for its own place at the front of the money line, with patients suffering for this chaotic thing we call a system.  But the cynical, conspiracy theory wielding part of me buried deep within my people-pleasing primary care mind suddenly grabbed control.

“No, it’s not a mess,” I said, getting a surprised expression from my patient.  ”It’s malignant.”

Her surprise turned to curiosity, and she tilted her head, urging me to expound on this idea.

“The problems we’ve got are not problems that exist simply because of a lack of organization; there are people, institutions, and corporations that make lots and lots of money because of that chaos.  There are forces out there who want the system to stay just like it is.  There are lots of people who would lose their jobs, and companies that would go out of business if health care became efficient.  That seeming chaos,” I concluded, “is job security for an awful lot of people.  I don’t think it’s accidental that things are the way they are.”

She nodded at me as I got up to close the visit.  Conversations like this can get me really far behind in my schedule, so I had to stop while there was still a chance.

“Is there anything that can be done about that?”  she asked as she walked into the hallway.

I shrugged.  ”I am sure there is, but I also think any effort at doing so will be met with very stiff resistance.  People may want the system to change, but it’s too big of a cash-cow to go down easily – regardless of what the politicians say.”

—–

There is something about the word I used: malignant, that seems a perfect adjective for the American health care system.  A malignant tumor is a group of a person’s cells that no longer acts in the interest of the whole body, putting its own growth as top priority.  The body possibly can handle a single malignant growth, like a single skin cancer, but when the cancer becomes widespread it is a threat to the survival of the body.  The tumor’s desire for it’s own growth eventually causes its own death, as it kills off the body it once was part of.

Our system has multiple metastases that feed off of the money meant to fund care for people’s health.  These consuming entities will, if left untreated, kill the system entirely.  They don’t want to kill off the system that feeds them, but they can’t see beyond their own profits or political agendas.  Taken individually, they may not bring down the system; but as the overall burden of malignancy grows, the true purpose of the system – caring for patients’ health – becomes increasingly difficult, if not impossible.

I know this sounds harsh, but the reality I’ve seen growing before me over the past 18 years in the exam room is becoming increasingly dire.  People are dying from our system.  Others see this, but offer solutions aimed at the external symptoms instead of facing the cancer that will take all of us down eventually.

The cancer?  The hospitals, lawyers, politicians, drug companies, lobbyists, insurance companies, device manufacturers, and yes, the doctors who continue to plunder a system that is struggling to keep standing.  There are huge profits in ordering unnecessary tests, doing unnecessary procedures, admitting people who should stay home, making a payment system that is intentionally incomprehensible, and paying politicians to see only a small part of the story.

So what’s the solution?  Do we expose the bad people who make money?  Do we get corporations to stop wanting to make a profit?  It’s far more complicated than just pointing at greed and getting on a pious pulpit pretending that we would do differently.  If we’ve left the meat out in our back yard, we can’t blame hungry wolves for coming and eating it.  If our system keeps holding out fists full of cash, we are foolish to act surprised that there are people willing to take it.

Source

Just as chemotherapy is the horrible price to pay for a cell gone rogue, the cure for our system may seem worse than the problems.  It will be a bitter political pill to swallow for anyone brave enough to take it.  The sad fact about health care reform is this: lots of people will lose their jobs, and lots of companies will go bankrupt.  There are far too many companies dependent on a system willing to waste money.  There are far too many jobs that exist because of a payment system that is mind-bogglingly complex.  There are far too few people in the position to start the cure who are willing to face the firestorm that will follow.

It’s going to be hard, folks.  Hospitals will close, people will lose their homes, and the political voices will become increasingly shrill.  I truly doubt that we as a country will have the courage to stick out the long, hard therapy we need to survive.  Can we really become efficient and conscientious if those good qualities bring ruin on an entire industry built on inefficient and haphazard care?

If we don’t, the malignancy will kill us – both figuratively and literally.

Share

{ 2 comments }

This material, written by me, is free to re-post and share under the Creative Commons agreement. In other words, use it all you want; just give me credit.

The Physical Exam: Thighs Matters

May 13, 2012

One of my favorite series of posts I did on my old blog was a run-down of the physical exam.  Some might say I ran down the physical exam as one might run down a pedestrian, I suppose, but it was a fun series to write.  If you didn’t get the chance to read it [...]

Read the full article →

Ten Bad Assumptions Patients Make

April 30, 2012

Don’t assume anything.  Ok, I guess there is one thing you can safely assume in our health care system:  the crash position. Sorry.  Unfortunately, it is more true than I wish. Assumptions can kill.  Assuming something regarding your own health care can cost you money, cause you pain, and kill you.  Here’s my list of [...]

Read the full article →

Medcoach: Use App as Directed

April 28, 2012

The App   When I prescribe a medication, I always have to ask the question: will this patient really take this medication?  This is a fair question, as medical adherence (people taking medications as prescribed) is notoriously low – only 50% of people with longstanding disease take medication as prescribed.  This leads to increased illness [...]

Read the full article →

The Origin of Feces

April 24, 2012

I got this in my email today from “Living Social.” When I first read it, I thought it said, “Your mother always reminded you to wash your behind…”, which makes sense, given the advertising subject material.  I haven’t read the remainder of the deal, so we can only guess what the last sentence reads: “Pay $39 to [...]

Read the full article →

Making Something of Nothing

April 22, 2012

When I look at the television, I want to see me staring right back at me We all want to be big stars, but we don’t know why and we don’t know how But when everybody loves me, I’m going to be just about as happy as can be Counting Crows – Mr. Jones I [...]

Read the full article →

Our Broken System Part 7: Plumbers, Ninjas, and Doctors

April 15, 2012

When my wife told me about her encounter with the plumber, all I could think was: “What a jerk!”  Then I was hit with an eerie sense of familiarity.  OK, it wasn’t exactly eerie, but there was some creepy music in the background. Source We had a shower fixed about a year ago, costing us [...]

Read the full article →

Autism’s Rise | Flirting with Pandora

March 29, 2012

Source Hello, Pandora.  What do you have in that box? Yes, I am going to talk about…autism.  The last time I did so I was inundated with people trying to convince me of the dangers of immunizations and their causal link to autism.  I really, really, really don’t want to go anywhere near that one. [...]

Read the full article →

Compliance

March 27, 2012

Compliance - noun 1 compliance with international law: obedience to, observance of,adherence to, conformity to, respect for. ANTONYMS violation. 2 he mistook her silence for compliance: acquiescence, agreement, assent,consent, acceptance; docility, complaisance, pliability, meekness,submission. ANTONYMS defiance. (New Oxford American Dictionary 3rd edition © 2010 by Oxford University Press, Inc.) “Why aren’t you taking your cholesterol medication?”  I asked the woman.  With the coronary disease I diagnosed a year ago, my discovery that she had not taken her medication was very [...]

Read the full article →