New Blog Series from Dr. Ed
We Are All Patients: The First in a Series for the Empowered Patient
Once upon a time we all lived in a mythical city much like Lake Wobegon where the men were hardworking, the women were strong, and all the children were above average. And almost everyone had a primary care physician: Marcus Welby, MD, or Dr. Kildare.
The family doc delivered the children, cared for the entire family from cradle to grave, showed up at the doorstep the same day you phoned, his black satchel in hand, and was a beloved member of the community.
Most were men, in solo practice, and they handled the vast majority of general medical issues. Everything you needed for what ails you was contained in that black bag. And in his gentle manner. Sometimes the doc was paid in cash or chickens. Or promises. Nobody was denied care. No insurance company decided a course of treatment.
For a complex problem there was the infrequent referral to a hospital for an X-ray or to a specialist, typically in a nearby city, and surgery, if necessary, was performed by a general surgeon. In most cases, if you were hospitalized, the family practice physician would see you in the hospital in the morning and then return to his outpatient practice and then make rounds in the evening.
There was a sense of comfort and security seeing that familiar face walk in the room. The skill set in terms of medications and diagnostic testing was relatively rudimentary, but in most circumstances, patients and families were satisfied and life was good.
But then something changed.
It's difficult to remember exactly when, but I suspect it was sometime in the 1980s. At that time, an explosive development of imaging interventions such as the CT scan and other technical advances dramatically accelerated the cost of care. With such exponential growth of medical information came an armada of highly technical subspecialists, many of whom performed some type of intervention and who often knew very little about the patient as a person.
Rather than seeing that familiar family practice doc, hospitalized patients would be evaluated by hospitalists—a specialty practice of physicians who worked only in hospitals. So now we have a situation where that patient/physician relationship has been devalued because it is not a cost-effective method of delivering care. And life-and-death decisions about management take place between relative strangers.
Let’s say you have a bad knee or cancer tumor that requires surgery. A surgeon walks into the hospital room or exam room. You’ve never met this surgeon. Yet over the course of just a few minutes, in some circumstances, the surgeon outlines a procedure that could have significant short- and long-term risks including death and disability. No options are presented. No less-invasive physical therapy for a knee, just a whisk away to total knee replacement. No chemo or radiation options to shrink a tumor first.
How can a patient make such serious decisions, in minutes, without Dr. Welby, that family doc who knows your whole family, with an insurance company peering over your shoulder and determining what is covered and what is not? With pressure to decide? Now.
I am adding a new dimension to my blog posts. I will take you on a tour behind the curtain of healthcare. I’ll give you a look under the hood of medical practice today. We are all patients, and we need to understand the hierarchy of the medical establishment. We need to understand the thought process and the decision-making of physicians, and we need to understand the financial incentives or disincentives in the delivery of healthcare. Your life may depend on it.
This series of blog posts (and an eventual book to accompany my previous book, How Not to Be My Patient) is not an indictment or critique of the system. This is an MRI scan of the healthcare profession so you, an empowered patient, can make responsible decisions for the most precious gifts you have: the gift of health and well-being.