By Stephen Schimpff MD, MACP: For Complete Post, Click Here…
American Medicine Treats Them Poorly.
America has the providers, the science, the drugs, the diagnostics, and the devices needed for outstanding patient care. But the delivery of care is dysfunctional at best and far too expensive. Primary care doctors, who are trained and experienced to care of those with chronic illnesses, spend too little time with their patients to have the time necessary for a comprehensive history, too little time to listen, and too little time to think. The result is an excess of referrals to specialists and overuse of diagnostics and pharmaceuticals. Together, these drive up the costs of care.
My friend Susan in the first article of this series was a good example. Presenting to her PCP with a somewhat unusual symptom, she was sent from specialist to specialist without ever learning what was causing her symptom, much less resolve it. It was a true waste of time, money and her emotions when the answer was there if only a doctor spent some time to listen to her.
To further exacerbate the problem, the doctor and patient no longer have a “contract;”. The patient and doctor are bystanders to the decision-makers. Frustration by doctors and patients is high, and physician burnout has become rampant.
Add to this is a significant change in the common serious diseases — complex, chronic illnesses, mostly preventable, for which American medical care has not established suitable methods of prevention or adequate methods of care. In addition, what should be the role of the primary care physician has been compromised by the insurance industry (both commercial and government-sponsored) that puts the incentives in the wrong places. The result is a sicker population, episodic care, and expenses that are far greater than necessary.
Our current delivery system was designed early in the past century with the expectation that the patient would pay the doctor a reasonable fee for the effort, skill, and time involved.
Insurance developed during the past 70 years initially to pay for unexpected, highly expensive care, such as surgery or hospitalization. But over time, insurance transitioned into what is essentially prepaid medical care and along the way eliminated the financial “contract” between you and your primary care physician (PCP or Nurse Practitioner.) The contract today for both you and the doctor is with the insurer The patient and doctor are bystanders to the decision-makers. Frustration by doctors and patients is high, and physician burnout has become rampant.