Part 2 of The Battle for Justice: 'Sickcare' vs. 'Health-Owners' Series.
The 5-part blog series reflects on one patient’s experience and unravels the complex and mind-boggling factors surrounding American patients. I aim to shed light on the extent of US healthcare troubles, explore the reasons behind the current state, and, ultimately, challenge you to rethink healthcare and consider doing things differently.
Haven’t read Part 1 of the series? Check it out.
Already back in 1963, Walter Cronkite famously described the US healthcare system as “neither healthy, caring nor a system.” Since then, as people live longer and more advanced expensive care becomes available, a myriad of large corporations have entered the field.
The result is a gigantic mishmash of a Business Enterprise that pursues its purpose - making a profit - while providing healthcare-related services with little consideration of the economic and social determinants of health, nutrition, and lifestyle!
Because healthcare involves so many touch points - patients, providers (e.g., doctors), insurers, facilities (e.g., hospitals), pharmaceutical companies, drug distributors, device companies, health information technology vendors, the federal government, and the state government, etc., its problems are often highly-complex and multi-layered.
Before exploring what patients like Jack can do to receive better care without financial ruin, let's decode the healthcare challenges that impact patients’ experience in the most direct ways.
One thing to remember about healthcare is that it always involves critical decisions that can significantly impact everything that follows. And those decisions must be made only by the patient or his or her providers, hopefully together! (Although, very unfortunately, insurance companies have been interfering with these decisions these days, but that’s a separate discussion for another day!)
Because the patient and the provider are the central players in every healthcare encounter, this series examines the factors surrounding these two players. In this volume (part 2), I delve into the provider's perspective—exploring their current situation and how systemic issues have affected both their practice and patient care.
A side note: this series uses the word ‘provider’ because these days, patients are often expected to see a nurse practitioner or a physician assistant, instead of a doctor/physician (that’s their business decision, and you could still request to see a doctor, and often wait longer, if you think that’s in your best interest). However, in this series, these terms are used interchangeably, except in a historical context.
The doctors have (mostly) lost their autonomy
In the good old days, doctors used to have complete autonomy in their practice. They used to know their patients personally, provided most of the care needed and spent as much time as necessary with their patients. These days are long gone, as medicine has become much more complex and specialized.
Along with the complexity, independent medical practice has become extremely burdensome and expensive. These include cumbersome requirements from governmental regulatory bodies as well as from the insurers (even though these offer little value to the patients). The insurance industry even charges doctors to receive their reimbursement.
As a result, many independent doctors abandoned their practices or stopped taking insurance altogether. Currently, almost 70% of them work as employees for hospitals or other corporate entities. Consequently, most doctors no longer enjoy complete autonomy, as their corporate employers dictate how they practice and what they can do for their patients.
Burnout, Medical Errors, and Fragmentation
Doctors and other clinicians typically enter the field because they want to help people. But their managers often want them to focus on profit-maximizing activities (even if the institution is ‘not for profit’). This tends to create internal conflict within them. The complex and unpredictable nature of healthcare work and the often extremely high workload make it almost impossible for them to carry out their responsibilities at the level they set, which pushes caring healthcare professionals into burnout.
Especially since the pandemic, the situation has gotten to a dangerous level. A 2023 survey of 9100 physicians by Medscape found that 53% of physicians reported burnout—a significant increase from 42% five years ago.
When clinicians (beyond providers) are burned out, they are prone to miscommunication and errors, which further exacerbates the problem. Not including the pandemic, some studies show that medical errors are the third leading cause of death in the US. Experts also say the figures are likely grossly underestimated due to the secrecy culture of the medical community.
Fragmentation and lack of care coordination is another big problem. There are more than 160 specialties and subspecialties of medicine in the US now. However, providers typically don’t collaborate with providers in other institutions or different specialties on a case. Primary Care Physicians (PCPs) used to coordinate care, but nowadays, they simply don’t have time to do that.
This causes patients deep frustration and potentially grave danger. It seems as if patients are supposed to understand everything that each specialist tells them and coordinate their care plans with other providers. This situation makes no sense!
Considering these factors above, here is the simple truth: American people can never assume the US healthcare system and the providers will always do what’s right for the patient!
Next week, in Part 3, the focus will move to the patients' and healthcare consumers’ situations and their challenges. I will continue to dissect the underlying reasons why the system seems to fail patients like Jack.
Here are some questions for reflection until next time.
Have you or a loved one experienced miscommunication or lack of coordination between healthcare providers? How did this impact your care?
Do you feel your doctors have enough time with you during appointments to fully explain health issues and answer your questions?
What role do you think patients themselves should play in improving healthcare? How much responsibility lies with the system vs. individuals?
How might we build a healthcare system focused on whole person care rather than perverse incentives and profit? What needs to change?
About Kayoko Corbet, RN, BCPA
Hi, I’m Ky! I assist people in navigating the healthcare maze and complexities to get the care they need and deserve with full benefit. I also help people better manage their health to have a better future.
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