My Journey Into the Future

I am currently in the process of completing one of the greatest experiences of my life.  I am completing my educational experience to become a family nurse practitioner.  I Just got done with pediatrics and have already done family medicine, Ob/Gyn and will soon start the residency portion which has some optional rotations alongside more family medicine.  To set the stage of this post I will drop just a little info about me here real quick.  I love to study human nature.  I enjoy interacting with my patients and getting to know them.  I also love to study the politics and the structure of health care.  I love it so much that I intentionally did all of my rotations in facilities that offer medicaid and or medicare, basically government funded care.  I felt that this had the greatest parallel to the stuff coming down the pike for ALL of us.  That is all of us unless you are a senator or representative.  You know - the guys that are actually making the laws that the rest of us live by except them.  Anyway, I wanted to taste the reality of what the future holds for me when I'm old and broke down, or placed in a socialized model against my will.  I also want to include that this post is really not about following a party line, or reacting out of emotion, it is simply a brief recall of my experiences.  So here it is. 

I'm totally frightened at this point.  I noticed several things.  The first thing I noticed is that people, regardless of income, nationality or gender do not and will not completely appreciate or embrace their health and well being if they are not personally investing anything into it, especially money.  I noted time and time again that those who got everything for free saw no need to do anything to prevent the breakdown of their bodies.  They avoided educational information, they did not take their drugs, they do not show up for appointments and getting a large percentage of them to do anything that equaled disease prevention was impossible.  For instance, a lot of the patients I observed simply would not take their insulin.  As a result, they got tissue ischemia, renal failure, retinal damage and profound peripheral and central nervous system changes.  This triggered incredibly expensive diagnostics, surgical procedures and often the need for long term care and ultimate disability.  That patient who had the 75 dollar office visit and the 20 dollar bottle of insulin turned into a patient that cost close to 250 thousand dollars very quickly.  I noticed this time and time again during my rotation.  I finally asked one of the patients, "hey, how would you treat yourself if you had to pay for some of the care that you get." The patient replied, "I would do more to prevent this in the first place, because I would not be able to pay for all of this otherwise."  It hit me at that time, when people do not have an invested interest in something, they just don't seem to care as much.  In conclusion to this observation, people should invest in their health. In particular, they should invest in wellness and prevention before the you know what really hits the fan and things get expensive.  Those that do all they can with what they have should have premium reductions and offered assistance.  Those that elect to not take care of themselves and decide to smoke, drink, never exercise and not take the advice they are given should clearly have higher premiums.  The problem is, it seems to be the other way around, that hit me as very strange.  Doctors who also elect not to educate their patients so they know more about what is wrong with them should not be paid as well. 

Next, the patients never got what the needed other than some generic meds and very basic labs.  Here is a good example.  I had a patient that I diagnosed with a severe ulnar nerve lesion.  The patient was getting hand weakness, a claw deformity and profound sensory loss.  I told the attending doctor that the patient needed an immediate surgical referral and he laughed at me.  I was a bit surprised.  He told me that it will take months.  He was right, it did take months.  It took six months to be exact.  This was a medicaid patient.  The office worked diligently to get the referral.  By the time it was made, the patient had permanent loss in hand function.  This equals disability which equals more cost to the total amount that this patient is going to accumulate.  In addition, they now cannot work which is a whole other deal all together.  I saw this time and time again.  There were limited specialists taking these patients also and those that did were slammed with patients and the red tape to get the patient to the specialist took tons of man hours and is an added over head to a system that is reimbursing up to 25% less than major med. 

This leads me to my final point, time to cost ratio.  If reimbursement is cut up to 25%, that means that I as a family doctor has to see more patients in a shorter time frame to pay the bills.  So, now I have a patient taking ten medications and has four different conditions and I realistically get five minutes with them.  This is insane.  It is so insane that it starts to prematurely burn out the providers that practice in this environment and it simply is not as safe as having an environment where the provider can slow down, think, take some time and do better work.  I foresee this as being an enormous problem.  Practitioners are going to be pushed into seeing more patients then they can safely and realistically see in a given day or period of time.    

In the end, I spent time with some great doctors, I met some amazing people and I realized a few things.  Nothing, absolutely nothing is better than a doctor that holds their patients accountable, makes them invest into their health, educates them on everything and pushes them to strive for disease prevention verses luring them down a path of chronic illness and debilitation by just throwing a lot of drugs at them.  Some patients need that, but not all of them.  I love being an educator and wellness doctor and teaching people to prevent the illnesses that is epigentically hiding out in their systems for as long as they can.  I encourage all of you that treat patients to do these things.  I encourage all of you that are patients yourself to practice prevention.  I encourage the government to also hold patients accountable as well as offer adequate access to diagnostics and necessary procedures when medically necessary.  In the end, I do not think socialized medicine will accomplish any of these things, so get ready to invest into yourselves when you can.  Also, do not be surprised when this system falls totally into place to see America become much more unhealthy and do not be surprised when the cost of healtcare sky rockets, despite everyone getting a cheaper more watered down version.  Don't be surprised when your doctor spends less time with you, is less thorough and you get more generic meds.