It is all about the “small” stuff (part 1)

Sure, healthcare for everyone sounds great.  I am not arguing with that.  It would be wonderful if everyone could get the same level of healthcare no matter who they are or their status in society.

What other part of life have we been able to achieve such equality especially in a particular service?  What makes us think that we can achieve this goal in healthcare?  What makes the government think they can do this?  The government and the politicians do not have the best track record.  Below is a quote that I found on Facebook from Donald Trump.  I have not spent hours researching to confirm that the quote is in fact from Donald Trump.  Still it is an interesting statement.

“Let me get this straight . . .

We’re going to be “gifted” with a health care plan we are forced to purchase and fined if we don’t, which purportedly covers at least ten million more people, without adding a single new doctor, but provides for 16,000 new IRS agents, written by a committee whose chairman says he doesn’t understand it, passed by a Congress that didn’t read it but exempted themselves from it, and signed by a… President who smokes, with funding administered by a treasury chief who didn’t pay his taxes, for which we’ll be taxed for four years before any benefits take effect, by a government which has already bankrupted Social Security and Medicare, all to be overseen by a surgeon general who is obese, and financed by a country that’s broke!!!!

What the hell could possibly go wrong?”

Here is an excerpt from a talk radio that I think makes some good points.

Local talk show hosts and a doctor talking about Obamacare

Don’t get me wrong.  Some of the ideas are good:  not being able to be dropped from your insurance when you get a disease, being able to keep your insurance when you leave a job, and everyone gets healthcare.  It is way this policy went about it that concerns me.  In the next couple days I will share some other “small” parts that I have issues with.

A free taxi ride included in Obamacare?

Hopefully it will not be around for long.

What next — everyone will have to buy a car because having a car is “a right not a privilege.”  Because they must have a car to get to their new healthcare.  What good is having healthcare when you cannot use it?  Oh that is right, they will just call the taxi with flashing lights that was once called an ambulance.  The taxi even has a special number to dial  9-1-1.  Much easier than the longer numbers.  I have already had people do this when gas was higher.  They would come into the ER by ambulance because they stubbed their toe.  When I asked “why did you call the ambulance?”  They replied, “it is cheaper than gas.”  Confused, I said “What?!”  They smiled saying, “I am not going to pay for the ambulance.”  I hope I am not having a stroke or heart attack when the ambulance is being used as a taxi for someone with a cold.

Where I see healthcare going if……….

I know, I know.  If someone could look into their crystal ball and see what the future held for healthcare especially American healthcare, that same person would also be able to win the lottery by knowing the numbers.

But this is my take based on what I have seen from other places and what history has told me and even a little from the “future”.  To even think about creating a true healthcare system where everyone would get the same upper level of care, the world would have to become like Star Trek.  Sorry if you  are not a Trekkie.  I will quickly explain.  In the Star Trek Utopia, hunger and poverty were done away with.  Everyone lives happily, eagerly and joyfully going to work everyday.  Do they earn money – no.  They do it for the greater good of humanity and to fulfill themselves.  Everyone has their dream job.  Everyone is treated “fairly”.  Based on this, everyone gets everything they need and want just because….  Now lets step back into reality for a second.  Will this forever satisfied existence ever happen??  I really do not think so.  I love what I do as a profession. But would I jump up out of bed everyday, commute 1 hour to my job, work my tail off for 12 hours, joyfully missing out on what my family is doing that day?  NO!! and I doubt you would also.  With that said, the world will not become like Star Trek.  We need to work with what we have.

There are pretty decent socialized medicine systems out there that provide good care to the patients.  The first that comes to mind is Austria (just my experience).  What happens when you take a capitalism society (USA) and try to create a socialized type medical system.  You get the VA system or the Indian Health Service.  Both of these are run by the government.  I am not saying they provide horrible care.  But not many people would argue with the statement that they are not the pinnacle of medical care.  I do not think of a government facility when I think about where to go for top-notch care.  I instead think about Mayo, Hopkins, Duke, etc….  Many people see the government getting involved in healthcare as the way to bring everyone up to the top of healthcare.  When in all actuality the exact opposite happens.  Just take a walk inside a government medical facility.  On the whole, it does not compare with the private sector.  Where do most of your government employees get care if they can get treated at a private or government facility.  They go to a private hospital.  Why??  Because healthcare under the government actually gets brought down to the lowest common denominator for their patients. Nevertheless, the government still is getting more involved everyday with healthcare.  They are doing this mainly by trying to control to reimbursement to hospitals, facilities, and the people who work there.

Will this get rid of the private healthcare facilities? To be continued………

It is all about the paperwork

I just got back in the ER after pulling a postictal guy out of a car  .Once in the ER, the patient starts to have another seizure.  I order 2mg of Ativan and that quiets the seizure.  Talking with the family further, it appears that the patient was diagnosed with a seizure disorder 2 weeks ago but did not get the seizure medicine filled. SMART!!  Well, that explains why she is having the seizure.

Once we got the patient to the ER, my first thought was “Man, I better go and start the patient’s note.” I did not want to get behind on paperwork.  In medicine, the chart and the paperwork is everything.  It is what saves you when you get sued, it is what the rest of the hospital uses to see what happened, but most importantly (at least to the hospital) the note is what is used to get paid.  Because of all this, there is a tremendous pressure to get your notes done.  A lot of times, the importance of the note takes priority over treating the patient at least in the administrations eyes. Due to this, it comes down on the pit doc.  Stabilize the patient and then get your note done and make sure you word it in a way that the hospital can optimize billing.  It is crazy that I can see and care for a patient in less time than it will take me to complete the note about this same patient.  This electronic health record thing just makes this time longer.  EHR was supposed to be the cure all.  Instead it is a disease in and of itself.  Paper is much faster with less typos.  This is coming from the most computer savvy doc in our ER – me.  And this is at the government hospital where time and through put does not matter.  No one at Uncle Sam General cares about speed and how fast things are done.  Think about how much worse it is at the private hospital where each patient is more money for the hospital.  The private hospital is all about seeing more and document while still trying to provide “quality” care.   How many emails do I get from the private hospital about the care I provide to my patients – NONE.  But I get at least 1 email for every chart that I have not completed at the end of my shift.  Why is this? Because for every incomplete chart, the hospital looses money.  They do not care that I might have been busy all day caring for sick patients or spending a little extra time with a family explaining a diagnosis.  In the end, “Forget the patient, it is all about the paperwork!”