"The health care system in the United States is broken". We hear this daily from patients, doctors, and even legislators. Fifty percent of our nation's bankruptcies are said to be caused by medical bills. Forty-six million people in the U.S. are without health coverage. We are the richest nation in the world, so how can this be? Managed care has become "mangled care". Horror studies abound with vivid descriptions of greedy administrators of HMOs and insurance companies, disinterested doctors, and excessive drug company profits. There are still some wonderful, caring physicians, but they have to work harder and harder to keep up with the ever increasing paperwork and their decreasing incomes. Insurance premiums keep rising, as CEOs and administrators want to make more and more money. One man with a five-figure income said, "Pretty soon all I'll be working for is to pay my family's medical insurance." Until there is a national uproar demanding a change in health care, each of us must learn how to work with the present cumbersome and grossly inadequate medical system.
RULES TO LIVE BY
1. Always insist on the best medical care possible. It could be a matter of life and death. Roger, Jane's husband, was desperate to get help for his wife. He waited outside the emergency room and when someone went in who looked like a doctor, he stopped the individual and pled his case. His fighting spirit got his wife faster care and may have saved her hand. . No patient should have to fight to get good medical care, but that is what is happening in the U.S. Ideally, a patient would have a patient advocate, a physician, or attorney to help fight HMOs, insurance companies, and hospitals to get needed medical care. Now it is the responsibility of each of us to educate ourselves about ways to get the medical care we need. If you are very wealthy, you can pay private companies large sums of money to be your advocate. That seems unreal to me when part of my work as a physician has been to help patients and friends find the best medical care possible. To get this kind of medical care, my recommendations are the following:
Don't accept care from a non-physician, unless there is direct supervision by a doctor. Some medical offices allow untrained personnel to do procedures or tasks.
I was referred to an ophthalmologist to get a prescription for glasses. The young man who did the actual testing said he had no medical training, but was a high school graduate. The eye doctor came into the room after the untrained technician had done the examination and written the prescription. He smiled, was pleasant, signed the Rx, and went on his way. It turned out the prescription was completely wrong. (Yes, my insurance was billed the full amount for the eye doctor's time, not the low rate of the high school graduate who did the actual testing!) I tried two other ophthalmology offices and was told their doctors also had individuals without medical training do their examinations for glasses. Thus, I traveled 600 miles to see my previous, excellent eye doctor. He was amazed when he looked at the Rx given to me by the untrained technician. The Rx had no relation to the one my tried-and-true ophthalmologist gave me.
Sometimes you have to see multiple physicians before you find one who is interested in you and not the money your visit will bring. If you have signed up for care in an HMO, you are greatly restricted in your ability to find the best physicians. Thus, before a decision is made to sign away your rights with an HMO, careful investigation needs to be made about the physicians in the group. Do they use personnel without medical training to do procedures or examinations and what rights do you have to leave the HMO or appeal their decisions?
******* This true case history of a hard-working professional shows how a single illness can change your life unless good medical care is received.
A fifty-year-old single woman, Bernice, developed severe chest pain and shortness of breath. She was seen in the emergency room of the health plan facility and given an electrocardiogram (EKG), but was not hospitalized. Instead, she was sent home with medicine. The next day, she drove herself to see her health plan physician who told her she had an inflammation of the lining of the heart (pericarditis). She was not referred to a heart doctor (cardiologist) and hospitalization was not suggested. Again, she was sent home. With no close family or friends, the woman tried to care for herself, as best she could. She did survive, but paid dearly for her inadequate medical care by losing many months of work. She did not feel well for several years afterward.
If this patient had been hospitalized and received proper rest and care, the outcome could have been very different. Instead, she had to try to feed and care for herself when she had a potentially life-threatening heart disorder. If she had been hospitalized, as she should have been, health care aides could have been provided on discharge. This would have taken a prescription from her doctor. The physician would have had to ask the patient about her home situation and contact a discharge planner to make the necessary arrangements. This could have been done in five to ten minutes.
3. You know your own body better than anyone else and how your body reacts to different medications and situations. If a doctor won't listen, a serious problem could develop. 4. If a doctor or other health care professional says nothing is wrong with you and you know there is, keep looking for answers until you find them.
5. Don't let doctors or their office staffs intimidate you. If you do, it will be difficult to get the best care. If you find it hard to stand up for yourself, take someone with you.
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