The Survey To Fix American Healthcare

Health insurance does Not equal actual, functional Health Care, as so many of us have discovered. We need to move away from a model that requires anything more than catastrophic coverage, and coverage for the very poor, but still allows affordable access AND allows for real care, instead of the 15 minutes of insurance-mandated malpractice that currently functions as the standard.

1. Regarding suggestion #12: Reduce incentives for doctors to order unnecessary tests. In order for this to be successful, there must be more reasonable regulations around malpractice and the litigious environment within which physicians practice. I would argue that much of the “unnecessary testing” done by physicians is caused not by their desire to profit directly, but by their inherent worry about being sued, the extremely high and sometimes unrealistic expectations from patients seeking care in the US, and the limited amount of time physicians are able to spend with patients these days because of declining reimbursements – it takes far more time to develop a trusting relationship with patients and discuss why certain tests are unnecessary than to simply order the tests patients desire.

2. Regarding the idea to focus more on prevention in primary care: I cannot agree with this more. However, focusing on prevention takes a commitment of time and resources, without the expectation of recouping resources for many years. For example, healthy adults start with healthy children. Yet pediatric obesity and is an epidemic with minimal funding or attention on spreading best practices – because it takes time and money with no obvious immediate results. Another example is the opioid epidemic. We are focusing on legislation and controlling physician prescribing practices rather than the underlying problem. What about focusing instead on expanding our mental health services so that patients receive treatment for the underlying problems in childhood and early adulthood before they turn to drugs for self-medication. Again, this requires tremendous resources upfront without any hope of results over many years.

I believe that medical education, using the scientific biomedical model without the principles of what it means to be a compassionate healer, is one of the primary failures in health care over the past 50 years. Study after study supports that outcomes are better,compliance higher, utilization and litagation lower when there is an effort to care for the person recognizing they are not just a disease or biomechanical problem. Yes, it takes more time but the outcome will both give better care, but more efficient effective care. I think this is what Dr. Atul Gawande is trying to communicate to the medical community. I have first hand experience in changing practice patterns, reducing utilization with modeling these principles in a moderately sized ER with a large geriatric population. We decreased 30 day readmission rates, ICU mortality of those over 85, decreased in hospital deaths, and medical staff encouraged and happier overall as we made sure the goals of care matched the treatment plan.