Healthcare: Is it really about me, the patient?

Because of the way the healthcare system is now, few doctors have the time to see a patient as a whole. It isn't profitable when inequitable reimbursements for primary care physicians (PCPs) force them to see a certain number of patients a day to remain a viable business. In turn, many are turning to specialties rather than primary care. But as a "zebra" patient, I see poor healthcare because of this. No one is there to see me as a whole.

Recently, when communicating this online with a physician in a discussion about "zebras" in healthcare, he made several points which eventually led to a discussion of reform. Each made sense from his point of view and I understood what he was saying. But I wanted him to see my point of view as a patient.

First Point: "An unusual case is more likely to be an unusual presentation of a common disease, rather than a rare disease itself."

Perhaps that is true. As patients with Cushing's (and I believe other "zebra" diseases), we are more a conglomeration of "usual" presentations which are treated piecemeal rather than taken as a whole. Together, these should give a physician an "aha" moment. But most of the time, in our experience, they do not. And part if this is due to the way each symptom is farmed out to a specialist. Many PCP's don't take the time to see the "whole" and put it all together.

Second Point: "As a patient, you can provide information for other patients."

Mary O'Conner had Cushing's in the 80's with no support whatsoever; she had no help or information other than what she gleaned at her library. Thanks to her hard work and dedication, she founded the cushings-help.com website and message boards, which she still single-handedly runs with it's thousands of members. Without those message boards (forums), many of us would be dead or suffering with the disease. (In fact, several we have known have died from it.) It's strong, vibrant, and supportive community. We know how to test, where to test and when to test due to that. We know who the specialists are (and I don't mean those who profess to be, but those who actually practice like they are), and they know us.

Mary Shomon has been instrumental in sharing and coordinating information about thyroid disease with patients. She hosts an active support board as well as several web sites. Other groups with other diseases do the same.

There is a growing group of patients providing support and information through blogs. Our Cushing's group is one. I know there are many others about other zebra diseases. Each group will tell you that they have gleaned much more support there than in a doctor's office.

What influence does this have on healthcare? We take in recent journal articles, research, and whatever else we can find to educate our doctors. We "fire" some, and "hire" others. We spread the word about both sets of doctors. Yes, the internet is a fabulous tool. Which brings me to the next point.

Third Point: "The internet itself is helpful in dispensing useful information for patients."

I did a reader's take for KevinMD a while back on that very thing. I often fight that battle with doctors who say I "read too much on the internet" as if they are the only smart folks in the world. (I realize not all doctors are like this.) I am able to find and download recent research about my disease. Sadly, though, not all patients have the resources or the background to do that. This means those of us who do need to share with those who do not.

Fourth Point: "As a doctor, the biggest obstacle to thoroughly investigating some cases is simply having enough time to do so."

Some doctors have overcome the time restraints by going to coincierge medicine. Kevin Kelleher is using a business model which reduces the volume of patients he must treat to be a viable business. While he says he can give patients more adequate care with more time for each, this is no assurance of quality just because he is a doctor who wants a guaranteed income stream with less work. If enough doctors did this, however, perhaps the competition would guarantee better healthcare. I think the fifth point, below, will help with this if/when we can do it.

Fifth Point: "Reform the system."

This same physician with whom I was communicating had ideas about how to reform the system: Health Savings plans, changes in tax codes, eliminating government purchased healthcare (i.e. Medicaid and Medicare), etc. In other words, get rid of a controlled, third-party system.

I'm a fiscal conservative, and I would very much love to choose how and where I spend my money, since I now have to spend it where I'm told I can by insurance, plus spend out-of-pocket because the "where I'm told" isn't cutting it. If I choose to travel to those who truly do understand my disease, I have to pay. I made a conscientious and life-saving choice to do just that. That has financially limited other things in my life due to my adjusted priorities, but it has been worth it. Sadly, not everyone has that choice due to circumstances in his/her life.

I often ask, "When does the business of taking care of patients really become about the patient?" I realize it's only possible if those providing it get something from it, too. Yes, they need to make a decent living. I know that. Otherwise, I jokingly say sometimes I forsee a nation of pharmacists with no one to prescribe the medications.


I recently wrote an article about profitability in the business of healthcare. I said:

Where does this put those who cannot afford health care? That's the ethical quandary...Other folks really do have a dilemma between eating and shelter vs. insurance and health care monies. Where will they go? In a "for profit" system, seeing them isn't profitable. What happens then? In my naive eyes, I would hope there is some charity left for them. But even if not, it looks like offering tax breaks to those who serve the indigent may be a cheaper, win-win situation for all involved. Yes, that includes Uncle Sam. Besides, it doesn't seem fair to expect charity for nothing from a tax-paying business just because it's a healthcare industry when we wouldn't do that from our auto-repair folks.

Our Cushing's blogs, including the two with which I'm associated, are to help those veering down the same path as we have gone or are going. Even more, they have a second objective: to hopefully make more folks in the medical community aware that we are people who suffer when we aren't tested, diagnosed, and treated correctly. Finally, it seems they are also being used for a third objective--the need for change in our healthcare system. This was not an intended objective, but I'm realizing it comes with the territory of the other two.

To read more:

From a patient's eyes: Healthcare for profit?

Dear Doctor, I can help....

Healthcare Crisis? Reform? What the medical blogosphere has to say.

It’s not our fault , says Dr. Rob....

Running a hospital: What does it take?

Running a hospital: What does it take?

Well worth the read and in desperate need of patient input. Thanks to e-Patient Dave for leading me to this. I've read Paul Levy's blog before, but hadn't seen this post.

So, take the time to read it and comment. Folks need to hear what patients think.

From a patient's eyes: Healthcare for profit?

In October, I wrote about our healthcare system in Healthcare Crisis? Reform? What the medical blogosphere has to say. As a patient, understanding what doctors and other healthcare providers face with the deepening and widening regulations is difficult.

It's not that I don't want to help. I do. It's to my benefit. I wrote about that in Dear Doctor, I can help.... But I find it disheartening to read more and more about the problems in various medical blogs with no guidance on how to "fix" it. Yes, I very much understand THERE IS A PROBLEM. Now, why isn't someone (anyone) in the medical arena (i.e. doctors) organizing and using the huge patient base to help?

So, what do I do? I peruse the blogs, read the news, and try to discern what is important. I've found some interesting information. I need to know what you, the doctor/healthcare provider thinks about it.

Businessweek highlighted the Institute for Healthcare in Donald Berwick: Curing the Healthcare System. According to this article, Berwick is a huge proponent of applying business best practices to health care.

"Other industries had long ago started managing for continual improvement in
products, services, cost structures," says Dr. Berwick, who toured Bell Labs, NASA, and Toyota (TM) in the late '80s to see how those organizations approached quality control. "I soon realized that there was a need for this knowledge on a national level."

Does what he says help us? Does this make a profitable business? Is making the practice of medicine "profitable" what we want or need? If it means that a doctor who does better, is better, works harder, and cares more is more profitable, then by all means, YES!

What does that mean, then? If I understand the economics correctly (and feel free to correct me!), then this will lower waste and decrease cost. Technologies which are expensive but often unnecessary won't be implemented without due thought.

Where does this put those who cannot afford health care? That's the ethical quandary. If you watch the video in my previous post (mentioned above), Healthcare Crisis? Reform? What the medical blogosphere has to say, you'll see that a lot of folks don't prioritize spending. They put health insurance at the bottom of the list of spending priorities rather than nearer the top.

Other folks really do have a dilemma between eating and shelter vs. insurance and health care monies. Where will they go? In a "for profit" system, seeing them isn't profitable. What happens then? In my naive eyes, I would hope there is some charity left for them. But even if not, it looks like offering tax breaks to those who serve the indigent may be a cheaper, win-win situation for all involved. Yes, that includes Uncle Sam. Besides, it doesn't seem fair to expect charity for nothing from a tax-paying business just because it's a healthcare industry when we wouldn't do that from our auto-repair folks.

(The big question I have as I write this is how in the heck do we spell healthcare (or health-care or health care)? I've seen it written umpteen ways and even looked it up. Is there a rule? Yes, there is! Healthcare and health care are synonymous as nouns. Health-care is an adjective but may also be written as healthcare. Please don't hold me to this. I'll inadvertently err when I write.)

Comments, rebuttals, teachings, and such are very welcome. I'm all ears...uh, eyes....

Patients aren't smart enough? Savvy enough? What?

I've been reading a few blogs lately. Among there are several medical blogs. I'd like to point out a few where I've been active in the dialog/comments. As a patient, I think they are important to the healthcare problems in the U.S.

Dr. Rob writes about being "The Backstop" for his patients. He says,

But there is a catch. Despite the fact that I am not the one ordering the test, once I have it in my chart I am responsible for the information. Many of the abnormal mammograms state specifically that “the patient has been notified.” I still don’t trust it. If I put a mammogram that is suspicious into my chart on the patient and don’t call the them up to make sure they have been called, I could potentially be prey for malpractice attorneys. So I call every woman whose mammograms are suspicious. I take over the responsibility. There have been times when I am the first one to tell the patient.

I hold the premise the patient should be his/her own repository. You can read our dialog here. I hope you have some insight into it and will share.

---

KevinMD posts about Searching for health on the web often leads to the most dire diagnoses. Kevin quotes the article, saying "To no one's surprise, 'self-diagnosis by search engine frequently leads Web searchers to conclude the worst about what ails them'." He was quoting the article to which he linked, but that article did not correctly represent the study it was using. The study,
Cyberchondria: Studies of the Escalation of Medical Concerns in Web Search did not exactly say that. You can read my statements about that here.

I've previously blogged about cyberchondria on this blog: Speaking of "googling"..... and as a "reader's take" on KevinMD's blog: Robin S.: A marriage made in heaven

---

Dr. Wes had some good points on "Why Hospitals Like Robin Hood Economics" and was very supportive of my comments there.

---

Another KevinMD article caught my eye: A real Dr. House, or did this physician benefit from prior studies?

David, a physician commenter on that piece was open and candid, which I appreciated. Again, some great dialog there. Take time to look over it and comment if you wish.

Mexico Medical Student - Hostile HIPAA

Enrico, blogging at Mexico Medical Student, writes about trying to get a report about some minor surgery he had done a few weeks later. Like so many of us, he was confronted with the conflagration so many of us face when trying to do the same.

Adding to my new experiences as a patient, I have now run into heretofore unforeseen side of the HIPAA monster. As a patient, it should be protecting me, right? Of course not! Legislated in part to protect privacy, HIPAA is one of the most misunderstood and abused laws by healthcare personnel, particularly clerical staff at the front lines of the patient-physician records interface who may not have much of a healthcare (or all that much educational) background to boot.

His insight into the enforcement of HIPAA is an excellent read.

To read the full post: Mexico Medical Student - Hostile HIPAA

Caught in the middle....

The specialists are crying "Robin Hood" and the PCP's are whining undercompensation. The hospitalists are gloating. A feud to rival the Hatfield's and McCoy's is a-brewin'. And the patient (that would be me)? Oh, I'm caught in the middle of all this.

So, do I take cover, take a side, or run for the hills?

I commented over on Dr. Wes' blog:

Hey, Dr. Wes... you know I deal with this as a patient where I live. I see my PCP who doesn't have time to do all that needs done, so I'm farmed out (I believe the word is "dumped" in medical-ese)to a specialist or specialistS. That specialist only deals with his/her area of expertise, so I'm farmed out again (dumped) to another specialist for another symptom, etc..etc...

Well, no one ties together all the symptoms. I end up in the ED or hospital and I get either a wonderful ED doctor or hospitalist who does just what you said above, and nobody has a clue what is really wrong. I have great insurance, but I still pay hundreds of dollars (or thousands, depending) with co-pays and the like. Not to mention I pay for my insurance.

What do I do? I go see someone who gives a damn on the other side of the continent. He doesn't take insurance. I pay out-of-pocket. He does give me a bill to submit to insurance which is reimbursed at a percentage. But I get great overall care. I can test at home. He and his [very small] office [staff] help coordinate all that but I'm the middle (wo)man. The problem with that? I can't afford the travel [very often].

My point: It's bigger than shifting funds. It's bigger than paychecks and "Robin Hood" economics. It's my life. I don't mind paying what is due. I just want something from it. I hate piecemeal. I want a doctor who can put all the puzzle pieces together and then figures out what needs done.

What happens with patients like me? Dr. Rob points out what happened to one patient in Overmedication. We get fragmented treatment with the variety of specialists, hospitalists, and ED doctors. Our PCP's don't have time to figure all that out without a proactive patient (or caregiver) pointing it out.

So....what's the answer? I don't pretend to know. I just know I'm willing to do my part to make it better.

Dear Doctor, I can help....

The demise of the PCP

Tonight, as I watch the results from the polls come in via internet and TV, I have other things on my mind. Yes, I’m intensely concerned about the outcome of the election. Why else would I have the repeated drivel pouring into my ears and eyes? But one topic really bears weight because it is close to my heart (and pituitary gland, and thyroid and…). Well, you get my drift.

Healthcare has been a topic of much discussion with this election. The medical blogs are full of discussion about it and it seems everyone has an opinion. The PCP shortage is at the root of the problem according to many of the blogs, and poor or inequitable reimbursement is the culprit. The problems are in black and white for all to see.

But who is reading these blogs? Who is listening? Frankly, I’m afraid the very folks who are affected most by this are the last to read and know. Yes, I’m talking about me. And I’m talking about everyone else. I’m talking about “The Patient”.

I suspect the percentage of everyday patients who read medical blogs is very small. The percentage of patient readership of the New York Times health blog might be a bit bigger than the normal, everyday blog. But when there are millions of patients affected, how many actually know the core of the problem?

Sure, ask anyone. They can tell you there is a healthcare crisis. But ask them what caused it. They’ll say “big insurance”. Or perhaps a politician or politicians. Or the influx of immigrants. You name it, they’ll have a reason. Nonetheless, how many do you think will name the PCP shortage and the crisis it will (and has) caused?

I took a poll. I asked 22 people today why there is a problem with healthcare in the U.S. I got umpteen dozen answers, with the most popular being “insurance is too expensive”. Not one person mentioned there was a shortage of PCP’s. Not one person knew that PCP’s were reimbursed at a much lower rate than specialists, and not one person realized PCP’s didn’t make “big money”.

No, I didn’t define big money, and no, the poll wasn’t very scientific. But it does bring home my point. If you want change, you need to tell those who are affected by this crisis what is really wrong! Dear doctors, writing blogs targeted to other health professionals is all well and good. Banding together and working together is a great strategy. But it’s only half the battle. It actually is probably less than that. You need to get us (the patient) involved.

How? Ok, good question. I have a few suggestions:

1. Target patient groups: The Cushing’s online community/support group is a very large one. Diabetes, MS, and other illnesses have large, vibrant support groups, too.
2. Draft a letter or some ideas for patients to use when talking to others, including their representatives in D.C. Help the aforementioned target groups tailor them to suit their patrons.
3. Target your posts to a wider audience. (Dr. Rob at Musings of a Distractible Mind does a great job of that.) Speak in “patient-ese”, not “doctor-ese”. Plain language with a strong message. No whining. Just facts.
4. For those target groups who have newsletters and/or BlogTalkRadio shows, get on the shows and send in articles for the newsletters.
5. Band together. Form a group. Wait, insert “organized” into that. Sure, you have all sorts of “organized” groups for blogging. But do you have one for educating the masses?

I’m sure there are other ideas I haven’t thought of, and I’ll probably come up with more myself if I think hard enough. My point, though, is that YOU need to come up with some ideas and act on them. And involve me, the patient. I do care.

---

Patients, for more information:

From Dr. Rob:

Holes in the bottom of the boat
What is an Ounce of Prevention Worth?
The Good Guys Sometimes Win

From Dr. Theresa Chan:
Why I Left Primary Care, Part 1
Why I Left Primary Care, Part 2
Why I Left Primary Care, Part 3

From PookieMD:
Resuscitating Primary Care, Part I
Resuscitating Primary Care: Part II

Miscellaneous:
How much should I make?
Red Hot Hospitalists And Expanding That Fixed Pot.
Black Tuesday For Primary Care: Why Physicians Would Rather Do Anything Else
Great health care--getting it is getting harder
Why primary care doctors are a dying breed

Various and sundry linked from KevinMD

Healthcare Crisis? Reform? What the medical blogosphere has to say.

Are our politicians really talking reform or are they glossing over the same ol' rusty problems? The blogworld is full of opinions and ideas about our "healthcare crisis" and reform. Rather than trying to make up your mind for you about this issue, which I think is in poor taste, I thought I'd share some of the information I've been reading. You can make up your own mind!

Dr. Wes compares the Health Care and Cronyism in his blog. He has an original cartoon, too, which says a lot. Love the cartoon, Dr. Wes.

At "Fingers and Tubes in Every Orifice" (yes, that's REALLY the name of the blog!), Charity Doc talks about Fixing Our Broken Health Care System . It's a long read, but chock full of information. He also has another post which includes a video. It's a non-partisan, must watch video which I'm going to include here:

Dr.Val talks about how Chronic Disease Is Driving Healthcare Costs. She was in the middle of a blog move, thus "homeless" for a bit, so she crashed at kevinmd's for this post.

Speaking of kevinmd, he has written quite a bit about the healthcare crisis. Here are some of his posts: Ideas for Healthcare Reform (which points to another blog post by Dr. Pector titled A doctor's prescription for healing American health care), Reforming health care in the current economic climate, Bailout for health care, Will universal health care lead to a physician shortage?

GruntDoc talks about Canadian Healthcare Author Writes a new Ending, which shows our neighbor's failing universal health plan. He also has some great comments from readers with his article We Need Free Trade in Health Care - WSJ.com . "Free" trade may not be free at all.

The distractible Dr. Rob has oodles of pertinent posts. Two of the latter ones are Holes in the Bottom of the Boat and What is an Ounce of Prevention Worth?. Others you might want to peruse are Is Wall Street Preventing Reform? and It’s not our Fault .

Alan Katz talks about McCain’s and Obama’s Inconsistent Health Care Reform Principles in his blog, The Alan Katz Health Care Reform Blog: Reform From One Agent’s Perspective.

The Buckeye Surgeon has some thought-provoking questions in his post One man's take .
Last, but not least, Brain Blogger give his take on both sides of the political fence regarding healthcare reform: Health Care and Politics I - The Republicans, Health Care and Politics II - The Democrats.

There is much, much more out there, so don't hesitate to go look! If you find something good, how 'bout letting me know. Thanks!

It’s not our fault , says Dr. Rob....

So, who's fault is it anyway? Why is it so difficult to find a doctor who will spend time with us? What happened to the "old-time" care we used to get? Dr. Rob explains it from his side of the fence.

Dear Patients:

I know you get frustrated with our office. We make you come in for visits when you think we should handle things over the phone. We seem more focused on your chart sometimes than on you. Sometimes you may even wonder if money has become more important than patients.

To this, I say: I’m Sorry. It’s not our fault.

We are part of an insane system that requires us to do things in a way that makes life harder for us both. We would love to practice medicine differently, but we simply can’t.

When you read the whole article, be sure to focus on the problem, not what you may perceive as a "whine". It isn't. There is a PCP shortage, and we are paying for it as patients. Why is there a shortage? Well, that's what Dr. Rob and others are trying to explain:

About a year ago, Health Care Finance reported on the PCP shortage:

"If real incomes for primary care physicians continue to decline, there is a risk that the migration of male physicians will intensify and that female physicians may begin avoiding primary care - trends that could aggravate a predicted shortage of primary care physicians," said Paul Ginsburg, president of HSC, a nonpartisan policy research organization funded principally by the Robert Wood Johnson Foundation

Today, JAMA published an article Factors Associated With Medical Students' Career Choices Regarding Internal Medicine in which the disparities between the salaries of PCPs and those of physicians in a specialty were outlined.

What is the answer? There isn't a short answer. But we need to find one.

To read more....
It’s not our Fault Musings of a Distractible Mind

Chaos

PHS Launches Task Force to Address PCP Shortage

Are hospitals purposely causing a PCP shortage? (kevinmd.com)

Primary Care Physician Shortage Linked to Lower Income

Dr. Leap on Customer Service

Look at one physician's experience as a patient:

Dr. Wes: Part I, Metamorphosis

Dr. Wes: Part II, Access

Dr. Wes: Part III, The Opportunity

Dr. Wes: The Psychopathology of Healthcare Reform

Dr. Wes: The Psychopathology of Healthcare Reform

"We believe the homeless person should get the million-dollar cancer treatment and we also believe Aunt Molly should be able to get the best health care possible because she's earned it. We believe lots of things. All of these are on the table right now as we continue to gorge ourselves silly with the latest technologies, unfettered hospital construction projects, and limitless end-of-life care.

We have not had a serious national conversation."

More on the demise of PCP's...."As psychiatry goes, so will primary care"

(Kevin, M.D. - Medical Weblog) Matthew Mintz: As psychiatry goes, so will primary care

Those paying for primary care with insurance should expect (in the not too distant future) limited access, routine care delivered by PA's and NP's, and rushed visits with the MD, whose primary focus will be medication management and directing you to non-physician providers for counseling and discussing your various health concerns. Health care reform that does not address the central issue of low reimbursement for cognitive service and high reimbursement for procedures and diagnostic studies will only encourage this shift.

Ouch........that hurts, Dr. Rob....

I've been following some medical blogs lately, which you already know if you read this blog, and Dr. Rob's has been featured prominently here. His latest series on the doctor/patient relationship has been an interesting give-and-take from both sides of the issues. The New York Times even picked up on it.

Just as it was getting interesting, I chose to go visit my parents. I was torn, trust me, but my parents always come first. And since they have dial-up due to the rural area in which they live, accessing anything of importance is moot. No, even the wireless broadband cards won't work there consistently unless one stands at a certain angle elevating laptop to such a degree that....yeah...you know what I mean. I have to sit in a certain chair turned a certain way just to use my cell phone.

I came back to another post by Dr. Rob with a response to the comments on the NYT's article. Frankly, it made me sad. In fact, when I tried to comment about it on Dr. Rob's blog, I typed and wiped umpteen responses. In the end, all I could say was "Ouch".

Why? Because it made me despair more for those attempting diagnosis and treatment for Cushing's. For anything, really, but this is the cause I have taken on because I have been there. Am there, and will be there.

Ask Lisa....she knows:

At some point during my long and ongoing illness it occurred to me that it might be a fault of my own for not getting answers for my ailment.

And now she's dealing with umpteen specialists who all say something different. And no one the same. Who is going to mediate all this? Her PCP? No way....

This brings me back to what Dr. Rob just wrote:

But the real reason things are hard to improve in most offices is that there is no financial incentive to do so. With a primary care physician shortage, there are no shortages of patients. Customer service won’t determine how busy physicians are. It is unusual for a PCP in our area to have any problem filling their practice.

Ok, so, PCP's can still get plenty of patients without improving anything. Ouch.

Reengineering the office will cause a drop in revenue that they cannot afford. This is one of the reasons computerized record adoption has taken so long; medical offices can’t afford the drop in income needed to adapt to a new system.

Ouch.

There is not only no financial motivation to do a good job, there is a disincentive to do so. You earn less when you do right by your patients because you spend more of your time doing things you aren’t paid to do. Either that, or you spend less time with your family.

Ouch.

I'm feeling less like a person and more like a number. Object. THING. Commodity. OUCH!

To give Dr. Rob credit, he does say he tries to do a good job because "it is the right thing to do and because I want to take care of my patients". I'm sure there are other doctors out there like that. I want to believe that, anyway. I really, really do. (Hunting my rose-colored glasses....hmmm...they need some cleaning....)

Does it all boil down to a PCP shortage? Who is at fault? Is it the PCP's? The specialists? Us? It's one thing to gripe as a patient, but it's another to try to do something about it. Sadly, as a Cushing's patient realizing this dilemma, one tends to not feel much like doing anything when the most needs done.

So what is the problem? You can get all sorts of answers to that, and I found umpteen dozen when reading pertinent blogs. I'd like to point out two which are well-written and to-the-point.

Kevin Pho on kevinmd.com comments with his article, Shortage of primary care threatens health care system.

The key is how doctors are paid. Known as "fee for service," most physicians are paid whenever they perform a medical service. The more a physician does, regardless of quality or outcome, the better he's reimbursed. Moreover, the amount a physician receives is heavily skewed toward medical or surgical procedures. A specialist who performs a procedure in a 30-minute visit can be paid three times more than a primary care physician using that same 30 minutes to discuss a patient's hypertension, diabetes or heart disease. Combine this fact with annual government threats to indiscriminately cut reimbursements despite rising office and malpractice costs, physicians are faced with no choice but to increase quantity to maintain financial viability.

Roy M. Poses, MD, writes for Health Care Renewal, and in his article "On Disparities Between Reimbursement of Primary Care and Proceduralist Physicians" he neatly outlines the problems and what PCPs, specialists, researchers and patients can do to improve health care. The main points in his synopsis include the pay-gap between PCPs and specialists and the role of Medicare's Resource-Based Relative Value Scale (RBRVS) system of reimbursement.

Dr. Poses goes on to quote an article in the Annals of Internal Medicine and comment on it:

"primary care practice is not viable without a substantial increase in resources available to primary care physicians." Yet primary care is an extremely important, albeit neglected part of the health care system. Most patients value "having a primary care physician who knew their medical problems." Furthermore, "patients with a regular generalist physician have lower overall costs than those without a generalist physician."

The best part of this whole article, though, is the outline of what each group involved can do:

WHAT IS TO BE DONE -

1. If you are a primary care or cognitive physician, realize why your financial position is becoming untenable and stop feeling guilty about protesting an unfair system.
2. If you are a procedural specialist, realize that you are in the same boat as the primary care and cognitive physicians. If our part of the boat sinks, yours will not long stay afloat.
3. If you are a health care researcher, think about addressing this elephant in the living room which many of you have so long ignored.
4. All others, tell your political representatives that fair physician reimbursement and a viable primary care system are both worth having.

While Number 3 is somewhat pertinent and I'm trying to do that here, Number 4 definitely applies to me. And to you.

I can do that. Can you? Actions do speak louder than words, even when the word is an "ouch".

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Kevin, M.D. - Medical Weblog: Robin S.: A marriage made in heaven

Kevin, M.D. - Medical Weblog: Robin S.: A marriage made in heaven

“Dr. Google, meet Ms. Cyberchondriac. Ms. Cyberchondriac, meet Dr. Google.” Just about every physician reading this is nodding his/her head. They know what I’m talking about...

About patients....from the side of the physicians: Do they get it right?

It's been an eventful day in the patient/physician blogworld.

If you've kept track of what's going on over at Dr. Rob's Musings of a Distractible Mind, you already know he's raised some thought-provoking topics lately that have touched a nerve in the patient populace. Frankly, I've been a respectful thorn in his side with my comments and posts because he's touched a nerve with me, too. Well, Dr. Rob posted another one today: Getting along: Part 1 - Doctor Rules. You have to admire him. He boldly goes where no physician has gone before. (Hum the Star Trek theme here...) Ok, slight hyperbole, but you get my drift.

He wasn't the only one who posted about patients. Over at Brain Blogger, What Makes A Good Doctor? - A Patient’s Perspective, gives a patient's point of view.

Dr. Shock, M.D. responded on Brain Blogger and linked to his recently posted Patient Doctor Relationship: Humanism and Medical Professionalism.

I hear some common themes in all three, especially in the area of respect. I think just about anyone can agree with that. Respect from each to each is important. Respect is earned, and one office visit usually won't get either one there. However, something must happen at that visit to make the patient want to come back. Dr. Rob seems to understand that for the most part. I think Dr. Shock does. He waxes eloquent a bit more in his post.

There are two things that keep popping up at me, though, when reading the physician's perspective versus the patient perspective.

1. Physicians do not expect the patient to be learned/knowledgeable.
   
2. Patients do expect the physician to be learned/knowledgeable.

And thus the conflict sometimes begins. I tried to come up with a useful analogy the other day when discussing this. I thought about choosing someone to work on my automobile and how I can, as a female especially, get "taken for a ride" sometimes if I don't know enough to choose wisely. For example, I was told I needed a new air filter at the tune of $37 when I had my car checked and oil changed. Thankfully, I knew they only cost about $7 at the local parts place next door and that all I had to do was open a plastic cover, pop the old one out and pop the new one in.

I thought about when my auto mechanic told me there was nothing wrong with my car, but I knew that when I accelerated above 45 mph there was a definite vibration and the steering wheel actually shook. My auto mechanic was flat-out wrong and when I asked him to take it on the road, he realized he was. And yes, I spent a while convincing him I'm not a stupid female. Ahem...

So, where does that get us in the analogy part? Well, it works to a point. But here is where it breaks down: How can I get Dr. Rob, Dr. Shock, and Dr. Whomever to "ride my automobile and feel it vibrate"? I can't. They cannot try out my heart, feel my 'roid rages, know my pains, etc. They have to ultimately take my word for it.

With my mechanic who says, "My machines say there is nothing wrong. All the tests come back negative", I can say, "Take it for a test drive." Uh, well, I don't think anyone in medicine has quite figured out how to do that yet with the human body.

Thus, I shop for a doctor who will listen. And I shop for one who will treat me like I have a brain. And most of all, I shop for one who keeps up with current research and advances in medicine.

How do I know if my physician keeps up with the current information? Because I keep up with it. It's not hard to figure out if s/he does.

There is a lesson we all can learn through this. I'm learning it, too. Human beings, no matter what walk in life, need to be treated as learners and teachers. We all have something to learn, and we all have something to teach.

~~~~~~~~~~~~~~~~~~~~~~~~~~