That sounds sadly similar to this tale:
Last week, at the MD's office, I had dutifully filled out the list of all the drugs I am taking as requested. In the exam room, the doc asked "Who prescribed this medication for you?" as if I were taking some monstrous poison. "You did, doc!"
I've noticed lately with new doctors that they spend most of their time looking at a computer screen. I doubt if any of the specialists I saw last week could pick me out of a photo lineup.
I have had my auto insurance bundled with my home owners insurance with a million dollar rider attached for decades. My insurance co. does not advertise on TV. Metropolitan.
State Farm alleges that they paid to replace the windows of a guy who followed the advice in a severe weather warning--to "crack" your windows.
It will get worse if the ObamaCare people get their way. They will force doctors to put everything "into the computer", that's the way the VA seems to be now. So instead of looking at you and talking to you they will be looking at the computer screen and typing notes. Anyone who has ever attended a meeting and gotten fingered to "keep the minutes" knows that keeping the minutes actually makes it less likely you will be an active participant and really understand what's going on... you're too busy writing stuff to really be listening. That's been my experience...
The President isn't "forcing" doctors to keep computerized notes. This has been the standard for several administrations back, despite the conservat ive health care system's original reluctance to adopt new technology.
There are MANY favorable aspects of computerizing patient records. One of the most important is being able to share information between doctors in va rious facilities. The pros & cons are easy to research on the Web.
Judging from your stated experience, you seem to be politicizing your exper ience by blaming *what you perceive* as doctors' apparent disregard on the President. There's nothing to stop you from politely but firmly asserting yourself by asking the doctor to go over [subject] with you "as I'm not sur e I understood". If he/she doesn't cooperate, you may need another MD.
Dcctors are under pressure from Big Insurance to get you in & out in a few minutes. Good doctors HATE this pressure, but often their jobs depend on making Big Brother's bottom line. It's a scathing indictment of the way U. S. medicine (including Big Pharma and Big Insurance) is structured, vis-a-v is most other developed countries.
In some European (and maybe elsewhere) countries, medical school is paid by the govt. in exchange for requirement to work 'n' time in 'y' area. Tha t way the doctor doesn't have to start out with a crushing load of debt, w hich forces him/her to cave to Big Insurance's demands to bring in $$$ rat her than give the patient the necessary time care.
Which in turn means that MDs who would prefer to practice the BADLY-NEEDED primary/family care -- one of the lowest-paid specialities -- may be forced into a glamorou$ field like cosmetic surgery just to pay off their debt.
HB
The use of computerized medical records seems to create much greater concern than the use of computerized lawyers, accountants, or general business records. Having "been there", I could spend hours describing my personal experiences with the problems of pen and ink paperwork that jeopardize good patient care from "missing" paper medical records, illegible handwriting (sometimes my colleagues couldn't even decipher the notes they admit to have written!), pharmacy disasters from misread prescriptions, etc. The indifferent physician will be indifferent even if using pen and ink - writing notes in the chart rather than making eye contact and carefully listening to the patient. The arrogant physician will be insulted by patient questions whether typing, writing, or even paying attention. Let's not use computerized medical records or politicians as scapegoats and ignore the real, core problems with the US health care system - greed - at all levels.
+1 I much preferred my last medical group, where the doc had all my info on the laptop, and my primary care doc was immediately informed - via laptop - when a specialist suspected I had a condition unrelated to my visit to him. My primary care doc called me late the same night and set up a visit to a different specialist. This specialist knew my complete medical history, just by looking at her laptop. I had to leave that group, because my wife's employer changed insurance carriers. If you have employer provided insurance, don't let anybody tell you your employer can't "force" you to change doctors
- if you want to be insured. That's a myth. The new doc doesn't use a laptop, but a file folder full of paper. He can't look at me and read at the same time. The jury is still out on him, but I'm far from impressed about his record keeping.
My doctor retired. His office sent a note that said that I could have a photocopy of my file for the last three years for $50 in the form of a pdf computer file. OK. It came and was as advertised; but I couldn't read the doctor's writing. I'll take the computer notes please.
Tomsic
[..]
Vic quoth: Let's not use computerized medical records or
You're dead right about "greed at all levels". But the politicians ARE responsible for letting greed run rampant in Big Insurance and Big Pharma. They are influenced by swarms of lobbyists to accept all kinds of goodies in exchange for favoring them, not the people.
Some goodies are cash on the barrelhead (in various untraceable forms); some set aside for when they leave Congress and move through the swinging door to cushy jobs in the very entities they were supposed to be regulating.
Why do you think pharmaceuticals are orders of magnitude cheaper in,say, Europe?
HB
I could care less about any "favorable aspects" of computerizing my records. I do NOT want them computerized. I want them compartmentalized so I control them as much as possible. If a new doctor needs to know something about my health I will tell him what he needs to know. And of course if the doctor isn't paying attention to me I'll ask that he or she does but as obamacare/the gvt sticks their nose more and more into my relationship with my doctor it will only go downhill. All you have to do is listen to the complaints about the VA system to see where health care in the US is heading, straight into the toilet.
One of the most important is being able to share information between doctors in various facilities. The pros & cons are easy to research on the Web.
Before my wife's records were computerized, the file was about 6" think. Today, it is probably over 12". There is no way you can properly control that information yourself and have just what the doctor needs at any given time. Want to compare a scan with one take a year ago and the one a year before that? Easily done when properly computerized and takes seconds.
What do you take with you when you have two appointments, one with the cardiologist, the next with the urologist at the other end of the building?
From what I"ve seen in real life for a few years, there is plenty of control, security, and needed information readily available and not abused.
As for the new doctor, what are you going to tell him? Can you, off the top of your head, give the past results of four different blood tests? Can you immediately give a historic chart of the results?
You have high ideals, but if you had some chronic problems you'd realize you are talking out your ass. I see this in action frequently and it is going to help your healthcare.
I completely agree that the corruption of politicians is a contributory factor to the problems with US healthcare. However, as you correctly note, they could not have done it alone - without the greedy behavior of Big Insurance, Big Pharma and I'll add, physicians who sincerely believe that they deserve to earn a multihundred thousand dollar per year net income. There are non-greedy participants in the delivery system (salaried professionals who receive no fee for service compensation whatever). Most of them are in the military and VA health care system. The only private participants in the health care system who can fully escape the temptation to over-manage are those who adamantly refuse to participate in any private health insurance plans and set their fees on a flat-rate per time period basis. There are very few who do that. And even there, if a patient requires hospitalization, just try to find a hospital that bills flat rate! (The only hospitals I know that bill their patients flat rate per day are in the military and VA.) All other participants in the US health care delivery system are susceptible to the temptation to over-manage because their income will depend on how much they test and/or manage the patient. I strongly disagree with the perception that government involvement in health care is a prescription for bad care. I personally have been both a provider and a patient in the military health care system since 1977, after first completing a first-tier civilian medical education and then serving time in private practice. My military medical colleagues and experiences were every bit the equals (and in some cases superior) to what I experienced in the civilian practice environment. No one is in "it" for the money. Some cynics just have trouble believing that altruism can really exist. It can and it does.
We also can't ignore the 800 lb gorilla.. us. Healthcare in the US is about 80% subsidized (as shown by the annual healthcare expenditures report on the entire system by MCare's office of the actuary). This includes (especially) the out of pocket parts of the premium. When someone is paying for most of expenses, there is little reason to not use, or over use, services. Especially since health insurance has long been tied to the job and viewed as part of a person't pay. How many of us have seen a doc for somethng because they did not want leave any of "me money" on the table?
I'm not sure the high rate of subsidized insurance premiums is a primary cause of over utilization. The military and va health care systems are
100% subsidized, and are much more efficient when measured by per capita costs than the private system. I observed far less over testing and over treatment in the military health system than I did when I was in private practice. Also, the countries that have largely or exclusively single payer systems (aka "socialized medicine") have far lower rates of over utilization. In my experience, most unnecessary costs are due to defensive medicine on account of our litigious legal system added to the greed of practitioners who (1) charge because they know they'll be reimbursed and (2) bill for the exaggerated diagnosis codes that have the highest insurance reimbursement rates. I agree that the U.S. needs to separate the relationship between employment and medical insurance. They should not be connected.
I don't know that I would say what the primary driver is. But demand of the patients is certainly a big one. Just ask one of your private practice docs what happened the last time someone wanted to get an antibiotic for the sniffles or an MRI for back pain and got turned down. Most of the countries have set budgets and you spend until you get to the end of them and then you stop. In Canada for instance, it isn't terribly unusual for hospitals to cut back or even stop elective procedures during the last month or so of the year. Canada and others also hold down demand by other methods such as waiting lists. The 2012 survey numbers estimate that in 2012, across all
10 provinces people are waiting for an estimated 870,462 procedures. This means that, assuming that each person waits for only one procedure, 2.5 percent of Canadians are waiting for treatment. And these are not all elective by any measure. I also don't know how applicable military is to the outside world. It is a whole other social unit with many peer and other social disincentives for abuse of sick call. My doc's gaze of disapproval is much less effective a deterent as a Sgt.'s (grin).
Another thing to watch for is making unwarranted comparisons. He complains about VA care, and from that assumes the Affordable Care Act will be the same. No experience, no basis for making that comparison. Emotional reaction. He is entitled to all the reactions he wants, but they don't take the place of facts.
HB
Amen to that. When I was living in Europe, a member of my family was treat ed, long-term, for a very serious condition, without a penny of cost, even though neither of us was a national of that country.
Allow me to reiterate that physicians in many developed countries -- I only know specifically about European countries, so am extrapolationg -- comple te their medical studies at government expense. No sky-high tuition bills from for-profit universities. No crushing debt load for the first 15-20 y ears of practice. No wild divergence in physician-hospital fees between pr actitioners and institutions. No drive to specialize in big money practice s like plastic surgery. In return,physician obliged to devote 'n' years to (more or less) government assigned practice, meaning often working in unde r-served communities.
Sounds like a win-win to me. In those countries, health care is not consid ered an "industry" --I wince every time I hear that term --but a public goo d.
Those governments must have figured out that $1 spent on preventive health care and affordable care for existing conditions saves $100's of dollars do wn the line in social costs that we pay out of our other tax pocket.
If my Lovenox prescription six years ago had been entered by the doctor into the software system we are using now, I would have gotten the correct dosage instead of half of it. But because a nurse had to decipher his poor handwriting from the faint shadows on the third carbon, a potentially fatal error occurred instead. The good news is that I made it anyway.
The silver lining is that when the INR showed that the Warfarin was working, because I had only had half of what I should have had, the local poor people's free clinic got a donation of eight hundred dollars worth of Lovenox.
If I am "properly controlling that information" myself, it won't help me one bit if Starbuck's puts sugar instead of what I asked for into my coffee and I enter the E.R. unconscious.
Of course, the system can be misused, as can any system. But it's still an improvement over paper.
It's interesting that despite models that show that health care delivery can be substantially improved, we're stuck with a pretty miserable system that makes it impossible to apply standard "free market" competition rules.
Shows that it's almost impossible to shop for medical care based on price because it's almost impossible to ascertain the costs for expensive procedures beforehand.
I personally have been both
I strongly agree with your disagreement. (-: The institution of a single payer healthcare system where everyone gets basic care and those who want can buy supplemental insurance would gore a LOT of very wealthy oxen. Those special interests turned what could have been a very simple universal health care system into the bureaucratic nightmare of the ACA. The VA can negotiate for lower drug prices because it buys so many of them but Congress denied that bargaining power for the ACA. Instead, Americans are ending up subsidizing lower drug costs for *Europe* which I find disgusting and close to insanity. We already provide them an enormous amount of free military protection. Must we pay for their drugs, too?
The VA is, and pretty much always has been, an interesting study in contrasts. Indiana is fairly typical in that the Indy VA is a sterling place, staffed by docs who are all faculty at the Indiana University Med Center, the nursing staff is first-rate largely because of the draw of working at a teaching hospital with Fed Fringe Benefits. Down I-69, the Ft. Wayne VA is in need of paint, a larger percentage of the docs tend to be from foreign medical schools, and the labs and other tools not so great (and getting worse since they are currently in their we are thinking about closing it down phase for this decade).
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