Pulitzer Prize-winning journalist Saul Friedman (bio) writes the weekly Gray Matters column which appears here each Saturday. Links to past Gray Matters columns can be found here. Saul's Reflections column, in which he comments on news, politics and social issues from his perspective as one of the younger members of the greatest generation, also appears at Time Goes By twice each month.
None of the proposed health reforms will fix one of the most troublesome problems for patients and their families – reaching a doctor after hours or on a weekend. That’s a major reason emergency rooms are packed at night and on weekends with sick and feverish people in great distress and getting sicker.
And that’s not going to get better anytime soon. According to the American Academy of Family Physicians, there is a shortage of primary care physicians and it’s likely to get worse in large part, ironically, because the health insurance reforms will increase access to care when there will be fewer family doctors to provide basic and timely care.
Even now if you really need your doctor, after, say 4PM, it’s likely you will get this message: “If it’s an emergency, hang up and dial 911...or call 555-4444 and ask for the doctor on call.” In that case, while you’re waiting anxiously, if or when he or she calls back, you will be told to go to the emergency room anyway.
It used to be that you could get your doctor on the phone to ask his or her advice. Or there was a time when your physician, who you assumed was primarily responsible for your care, would meet you in the emergency room to see to your needs, or at least call ahead (as one of my doctors did a few years ago) to clear the way through triage.
No more. Now you’re passed, like a buck, to the emergency room physician on duty or to a “hospitalist,” your doctor’s designated hospital representative, neither of whom ever laid eyes on you.
It’s difficult to get through to your doctor even during office hours (“Your call is important to us”). And it used to be that you did not take a crying child running a high fever out in the cold. Now you have no choice. It’s either a walk-in clinic, where you may have to pay cash, or the emergency room.
I’m not blaming doctors or the medical profession. We all have our doctor stories but today, beleaguered physicians as well as patients have become the prisoners, or victims, of corporate for-profit medicine and the demands of insurance companies (including Medicare and its regulations).
Doctors work under great pressure, accepting too many patients, often in large practices owned by a corporate entity, trying to keep up with the latest drugs and developments, and dealing too quickly with each patient no matter their needs. Many abandon individual practices that they can’t afford for multi-physician specialties that operate like factories. And although they have lives in their care, most don’t get rich. Last time I looked, doctors earned on average about $200,000 a year, nowhere near what a Wall Street trader makes for producing nothing.
No wonder thousands of doctors, including most of my own, favor single-payer national health insurance. Not surprisingly, a survey last year by the University of Indiana School of Medicine found that support for such a system was particularly strong among emergency physicians (69 percent), pediatricians (65), and family doctors (60).
“Across the board,” said Dr. Ronald Ackerman, who helped direct the survey, “more physicians feel that our fragmented and for-profit insurance system is obstructing good patient care.”
I’d go further; under these circumstances, present patient care can be downright dangerous or frightening especially or if you are really in trouble or you’re older, like me. I don’t ordinarily become personally involved in these columns, but permit me to cite a couple of my recent experiences, because they are not untypical and relevant.
On a Friday evening, a usually routine urological procedure which many older men undergo, went awry with bleeding. Stuff happens. But the doctor’s office was closed and the emergency room –where the wait was less than an hour – was the only recourse. Further complications, included blood clots in the catheter and great pain, which mean a night in the hospital attended by strange doctors. And there were two more night time trips to the emergency room that week.
The surprised urologist was dismayed by my problems and shocked that I had to wait hours in the emergency room for help, but he did not come to the hospital to see to my care. One of his nurse-practitioners told me later, “We can’t be on call 24 hours for every patient.”
Actually, I’m told by a doctor friend, they are responsible for my care – for 24 hours or however long it takes. The total bills, for Medicare and my secondary insurer will come to more than $8,000.
One more story about the same time: As some of you may know, I am a survivor (nearly five years) of esophageal cancer. But during my last checkup, my oncologist suggested a new endoscopy to find the cause of some internal problems. That was done in early November by the gastroenterologist who had discovered my cancer in 2005, and he reported finding “causes for concern.”
He ordered biopsies, the results of which, he said, would not be available for nearly two weeks. Why so long? There were others ahead of me, he said. The doctor’s report would be available via phone recording, but not for two weeks.
You can imagine my anxiety, especially because the oncologist reading the initial report sent me an email suggesting one possibility was a recurrence of the cancer. But he too was puzzled by the long wait for the biopsy results. And in response to my pleas, late on a Friday afternoon, he reached the gastroenterologist. The biopses were available – and negative; apparently I had had a mild stomach inflammation.
Why hadn’t he let me know sooner? When I complained, he told me he had been busy with other patients. “The ideal is not always achievable,” he wrote. “I got no call of alarm from the pathologist about you.” So it was not necessary to call. He had 100 patients and could not notify all of them, he said.
National health insurance, if it ever comes, will not solve all such problems in modern medicine. But perhaps it may relieve the pressure of having to make enough money to support large factory-like practices so a urologist and gastroenterologist could pay closer attention to their patients. When you are too busy to do that, you are too busy.
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