March 25, 2014

The Groups Keeping You and Your Doctor Apart

This blog author uses more rhetoric than anything to push for a single payer system. She tries to convince us that it is not the government that comes between us and our doctors.

The agencies, organizations, and others that make it difficult for patients and doctors includes the following:

#1. The government The Department of Health and Human Services (HHS), the Centers for Medicare and Medicaid Services (CMS) are just two of the government agencies that are creating problems and coming between patients and doctors. CMS is mandating, especially for seniors, what can't be spent for medical necessities when this may be the only thing that will save a life. I am not talking about those near the end of life, but those that could be treated and have quality of life for many more years. The government agencies issue new regulations that create more paperwork.  This in turn reduces the time for doctors that they have for spending with patients.

#2. State Medical Boards and Medical Associations They help limit beneficial programs and work to promote faulty medical guidelines that the doctors have to follow. They lobby state legislatures to hobble new forms of medical practice like telemedicine and practice across state lines.

#3. The insurance industry Since managed care and pre-approvals came into existence more than 20 years ago, the insurers have delayed doctor treatments. And I mean in the emergency department and for operations. The insurers move drugs in and out of their formularies to reduce expenses. They have to keep their profit margin don't they? The worst part is they follow what CMS does and almost lock-step.

If isn't one of the above, its another. There could be other agencies and medical groups involved, but these are the main cast of characters. Now we arrive at the supporting characters.

a. The medical schools The doctors will deny this, but the medical schools do not teach some of the skills needed by doctors. Communication is a missing topic, the importance of the patient is also missing. Doctors graduate thinking they are god-like and infallible and that patients should rely on them as the source of all knowledge about what ails them. They can't explain things coherently to the patient or the patient's family. The doctors can only use medical terms and wonder why the patients do not understand them.

Then when the patients desire to have some part in their treatment, the doctor gets all up-tight and won't listen to their wishes. When the doctor writes a prescription, he expects the patient to fill the prescription and take it per directions. However, the doctor does not explain what the medication is, any side effects to watch for and what to do when they happen. When the patients asks questions, the doctor becomes angry that any patient would question him. All the courtesies are not part of the education doctors receive and some would ignore this anyhow.

b. The doctors themselves And you thought I had said enough about doctors. There are a few good doctors and even fewer great doctors. If doctors did not have this big fear of patients, they would not need to practice defensive medicine. It is their complete lack of communication that makes patients wonder what they are hiding and why. The doctor-patient trust is lacking and when patients are suspicious, everything a doctor does is analyzed.

c. The patients and their families How I hate saying this, but sometimes patients can be their own worst enemy. Also, when a spouse becomes too insistent, then the best doctor/patient relationship is in jeopardy. Even the best defensive medicine won't work when a spouse thinks something is amiss.

It is really a shame the when everyone points a finger at someone, they don't realize that they have three fingers pointing at back at them. There is a lot of blame to go around and each character plays a part.

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