“You can imagine them using a different sort of model, where everyone gets a concierge to help them with their health care, to have a primary care doctor be an independent advocate that helps patients navigate the system, not as an agent of the hospital where they have to feed the beast. And then if you need lab tests, an M.R.I., an elective service in the hospital, you would have a health savings account and a marketplace with transparent pricing. And then, if something really bad happens — you get leukemia, you get hit by a bus — the high-deductible insurance kicks in. That’s the way the market is moving anyway, so I bet this is where these companies are likely going.”
There is no doubt that health care is broken and it is a great sign that Amazon, JP Morgan and Berkshire Hathaway are joining forces to finally change the mold. In fact, most are hoping they just shatter the old mold and start from scratch. They are starting with their own employees and if it works out they will roll it out for the rest of us to follow the model and who knows, one day soon we may even buy our healthcare through Amazon. Until that time, however, we are stuck with what we have and need to find work arounds so that our own personal healthcare is safe, affordable and adequate.
This real distills down to the need for advocacy. Without an advocate, the system will not only swallow you up financially, but it could physically harm you or even kill you. I can't tell you how many stories of close calls and poor care I have heard just over the past couple years. In fact, just today I suffered an experience that was almost surreal and clearly illustrates the need for advocacy. Here's what happened.
My friend is in town this week with his wife for an Orthopedic conference. On our second ski run of the day, his wife who is also a physician got clobbered by an out-of-control snowboarder and suffered a mild concussion. We tried to get her to ski down to the base, but after 100 yards her symptoms were getting worse so we bit the bullet and called ski patrol. Multiple patrollers arrived in minutes and were just amazing. They were all young enthusiastic people in there 20s, one was an EMT, another was pre-nursing and couple were still deciding on what to do with their lives. The experience down the hill to the patrol clinic was second to none.
Now for healthcare reality in 2018. The ski patrol clinic at the base of the resort used to be a couple-room double wide trailer, but has since evolved over the years to an actual building resembling a real clinic. Unfortunately, a couple years back, the big gorilla hospital system in town bought out everything and everybody and now the patrol hut is essentially a for-profit instacare owned and run as such.
“The second we arrived in the clinic we were hit with the mindless protocol driven attitude of employees working for the man that often leads to poor care in all but the simplest of scenarios. A friendly clerk and nice nurse did greet us initially but when we asked to just chat with the doc for a minute prior to check in all the walls went up.”
Well, you can probably guess what's coming next in the story. The second we arrived in the clinic we were hit with the mindless protocol driven attitude of employees working for the man that often leads to poor care in all but the simplest of scenarios. A friendly clerk and nice nurse did greet us initially but when we asked to just chat with the doc for a minute prior to check-in all the walls went up. Being three doctors with 75+ years experience and my buddies wife having a rare medical condition that is ongoing, we wanted to get a quick sense if we'd be better off just heading straight to the hospital 2 miles down the road. We were really just trying to get an idea of what drugs and resources were available in the clinic in case we needed a little more advanced care then the typical instacare can provide. We were not asking for a medical evaluation or a professional assessment. What happened next was the first straw.
A young ER doctor came out to the waiting room and gave us the line that he wasn't even allowed to speak to us until she was checked in and that he was risking his medical license and malpractice just by having this waiting room conversation. That was bullshit line number one. I told him to forget he was wearing the hospital coat of arms on his jacket for a second and just have a simple conversation with us, two surgeons who have 50 years of trauma and sports medical experience, so we could expedite the care of my friend's wife. We were just trying to avoid sitting 3 hours in an instacare only to be told we needed to go to the hospital anyway, all the while rolling the dice with a serious pre-existing condition. Fortunately, my friend's wife was stable at this point so we decided to just check in and stay. The ER doctor was quite rude and just walked away. What happened next illustrates how not having an advocate can kill you.
So, without violating HIPAA, I can tell you that my friend's wife has a rare pre-existing condition in which those that are not trained and familiar with could lead to life-threatening hypotension and illness if not promptly recognized. The onset of this condition, which is induced by stress, can be rapid, and if overlooked, a downward spiral can quickly ensue. So, all three of us physicians, my friend, his wife and myself attempted to explain to this young arrogant ER doctor her history and its implication for her treatment today. All he could do was perseverate on the fact that he sees tons of head injuries and repeatedly tell us that concussion is responsible for all her signs and symptoms. Bullshit line number 2.
Yes, she had a concussion, but the constellation of other signs and symptoms were so clearly related to her pre-existing condition that most doctors once alerted, would have been happy to have been pointed in the right direction. I politely said to the ER doc, you don't see this everyday and he immediately cut me off and said actually I see head injuries all the time. Next, I said that I was actually referring to her pre-existing condition, at which point he put up his hand toward my face, turned his back on me and left the exam room, shutting the door behind him.
Never in my entire career have I been shown less respect by another physician. I was furious. He just ignored a vital conversation with seasoned physician regarding the most important part of his patient's care. At this point, my friend decided to call his wife's specialist back home to see if she would speak to this ER doctor and convince him to administer the correct meds to combat her body's lack of stress response that was clearly now making her quite ill. Thank god, the specialist promptly called us back and was adamant that we were correct in our assessment and she subsequently educated the ER doc about what he needed to do for her.
With a collective sigh of relief, we got my friend's wife the treatment she needed, which was exactly the treatment we tried to tell the ER doc about when we first walked in the clinic but he refused to entertain. Fortunately, 10 minutes after receiving the appropriate medication my friend's wife was feeling much better, with just routine mild concussive symptoms. We packed in my truck and went back to the hotel where she was feeling much better and continued to do fine.
“...find an informed doctor that you trust and build a relationship where you both know each other well enough so that in times of crisis you truly have a medical advocate by your side. ”
So, the moral of the story here is that without an advocate, in this case 3 doctors in-person and one specialist on a cell phone, my friend's wife would have gotten inappropriate care and we would probably still be in the ER right now with my friend's wife being admitted for a constellation of symptoms that many of today's cookbook doctors don't understand. Even worse, if this situation had been left unrecognized it could absolutely have become lethal.
My advice today in this state of haphazard quality healthcare is that your best defense is to find an informed doctor that you trust and build a relationship where you both know each other well enough so that in times of crisis you truly have a medical advocate by your side. With today's big hospital systems owning the vast majority of physicians, this may take some effort, but the pendulum is actually swinging back and if you look hard you can find a competent doctor that does really care.