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Sicko - Is the American health system leaving us doctors sick, in addn to our pts?

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12 years 2 months ago #63344 by sisriver
I will try to explain that I had an Aha moment watching the film. I understood that it was centered on the inadequacy of our system for the patient, the likelihood of falling through the cracks -- but my Aha was about us doctors working within this inadequate system. That it is leading to doctor-distress/sickness as we are dumped on with its inadequacies, and as we sort through how we identify personally with training, working, teaching, and advancing a career in this inadequate and unethical system.

I mentioned in the Gen Disc post that there are 2 interviews on the DVD with Harvard professors including Marcia Angell. This adds to ones insight about the film.

I have a lot to say, so will try in additional posts.

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12 years 2 months ago #63345 by sisriver
I lived in Scandinavia for 2 yrs, while doing research. I wasn't fluent in the language, so wasn't able to practice, and I was newly trained, so I wasn't as in touch with these ideas.

Additionally, I have a Cuban-American mom friend who filled me in on what was missing from the film about Cuba's health system. I understand that the film was skewed to show its point about patients. But I am talking about us doctors.

My feeling is that we need peace of mind. Many of the women on this website, those who posted in Help-Want Out, are really in distress about our system. And I don't think it's just a mom issue.

I think a large part of it is our faulty system. That these executive type men (I am sticking neck out here with generalization) are happy to operate within it and run our hospitals, insurance companies, big-Pharma, and make exorbitant salaries and be seen as powerful. Some of our doctors are doing high-tech as well as some unnecessary procedures, also making big salary.

While us women are mostly in the trenches doing clinical care. We do not wear blinders - we see the need to take more time with pts than is allotted, to work around the rules to get them treatments they need that aren't covered. I think in going into medicine (posted in Gen Disc) we were seeking financial security, intellectual stimulation, respect, with opportunity to help others. Do we have that??

Because we don't talk about our system generally - Other than complaining, as if it's something we can cope with if we find the right process, get faster, learn how to pick one of the pt's 20 problems, set up our clinic profile better,wait it out until it improves.

What if we just hold that this is Unethical. America must do better. Health is a human right, and is constitutionally-based. As a physician, we cannot tolerate sending pts away from our emergency rooms, allowing inner city women to get their prenatal care in ERs, see children get care where their mothers cannot, collecting stories of pts who can't get needed scripts filled or can't get certain medical care because not covered.

i think if we bring this out, we might see that it is contributing to the experience of physician-moms, that it becomes an easy choice to choose to stay at home if one is financially able, rather than pursue an unfulfilling career where one can be out of control, being told what to do by insurance company and working late to get things done around the system.

When I watched the film, I thought of my needy patients, which is most of them. And I thought of their fear of illness, and how they bring this fear into the clinic. It leads to more time to reassure, sometimes unfounded physical complaints that can lead to unnecessary tests. And then I thought of how Health Insurance is really only for the healthy, and what kind of outrageous concept is that.

I also wondered, in watching the doctor-aspect of the film, how much of our system has seeped into me. And have I given it enough thought? What do I think of myself when I dread the visit of the multiproblem patient, or when I am caring for an inpatient that is really only there because they are homeless (another american problem) or because the coverage will fund inpatient but not outpt treatment so that is what I have to work with, but I still feel bothered. And did my tolerance of all this begin in medical school?

So I am definitely willing to pay more for this to be resolved, for a system where we can have peace of mind, not just for pts, but for us. I could see that if we all had reassurance that healthcare will be provided, all that need could begin to dissolve.

I see women physicians as having the intellect, compassion and motivation to achieve this.

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12 years 2 months ago #63346 by Conflicted
Ack! My computer shut down in the midst of my post! Denmark article, FYI: www.time.com/time/magazine/article/0,9171,1684528,00.html
Also there are two articles in this weeks NEJM on the Netherlands system.

I am feeling flight of ideas, so bear with me. Last night I read another article from JAMA. It was on Genetics and Modern Medicine. There is another thread here where you can post what worries you and I felt too science fictionny, histrionic to post about my fears of genetic medicine. I was amazing to read some of my ideas fleshed out in this article.

jama.ama-assn.org/cgi/content/full/298/22/2670
______________________________
Four paragraphs from the article:

The emergence of individualized medicine will amplify inequities of birth so that those born with a disease-predisposing mutation will bear the brunt of increased costs, whereas those without such predispositions will seek less expensive care. One's attitude might be: "I’ll take my savings and run." Setting aside the unsavory ethical implications of such an attitude, it is flawed by one of modern genetics’ most piercing insights: every individual has mutations.

Each individual carries (eventually identifiable) genomic risks for something. With an ever-growing ability to link genotype to risk, all individuals will likely discover that their risk for some future malady is increased; every person has preexisting conditions. This inevitable bad news for individuals is actually good news for the common lot and represents a compelling inducement to share risk: because all are flawed at the level of the genome, all people need each other.

.....individualized medicine has the potential to reduce the aggregate cost of health care by enabling better preventive strategies. If such cost-savings materialize, they will be primarily population-based and thus most readily realized within a health care system that is not fragmented. Whether individualized medicine will result in cost-savings or not remains an open question; what can be predicted is that either outcome will provide potent stimuli for universal care and shared risk.

Embracing individualized medicine without a corresponding commitment to broadly shared risk runs the risk of creating a genetically defined underclass which, because of inheriting more than a fair share of disease-susceptibility genes, is unable to afford adequate care. This new genetically defined underclass could transcend all social strata and, except for a tiny number of individuals with truly exceptional resources, the cost of medical care will be beyond this group's reach. To prevent a blossoming of irrational rationing and the emergence of a biologically defined group precluded from obtaining proper care, it will be necessary to share risks and pool resources to ensure that, regardless of genetic makeup, a humane and basic level of medical care will be available to all.
_________________________________

I have a fear of my family becoming part of the genetic underclass. My husband and my incomes combines put us at the top 1% of income earners in this country - and I still fear it will not be enough for our family. What if my husband develops ALS in his 60s like his father did? Or earlier?

I have written before about my CF carrier state and my brief fears that my son had mild CF. The number one predictor of survival in chronically ill children is employment at age 14. Why? Because they have hope of getting health insurance through their employer when they turn 18. So the best life for a kid with a chronic illness is in a clerical position at age 14 in a company that hopefully won't go bankrupt or outsource its jobs to india? makes me almost cry to think about it!

I am heavily influenced by my chistian faith/upbringing. I went to bible study last night were we are studying Jesus healing stories (wish there were some prevention stories, I am looking). Our priest is in another group where they are reading the whole bible in a year. She said they have the same discussion every week -"why were the so many unwilling to believe what was happening before their eyes? why were they so unwilling to change and hostile toward change?"

I am fearful of change in the medical system because it provides my livelihood which is my biggest protection against my and my family's future health hurdles. I can see that I perpetuate problems in the system because of my fears for my own family. So I think that having the courage to change things is what is needed.

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12 years 2 months ago #63347 by plum
All these posts are very thoughtful. I watched the movie this past weekend. As someone who is fiscally conservative but socially liberal I was surprised to find myself very depressed about being an American afterwards.

To me the most glaring difference between the US and the countries profiled is that we live in a culture of fear and lack. We fear severe illness, we lack faith in our government to accomplish anything for anyone. I think we just feel let down. While it seemed (in the movie) that the people in the countries profiled had a sense of security that absolutely does not exist here in the US. We don't feel cared for, by anyone, the government, the healthcare system, our schools, daycares, etc. As a a newer mom I was drooling at the scene of that new french mom who had "help" for four hours a day. Wow, how awesome would that be for mom's mental health.

This year in addition to our health insurance premium sharing at 225$/ month we have had close to 4500$ out of pocket (C-section, baby in NICU x 20 days, appendectomy for me). That is 2700+4500=7200$!!! I would gladly have paid my fair share of taxes and not sweated the bills.

The whole thing bummed me out. Universal healthcare is one issue that I have always been pretty liberal on, i.e. I think it needs to happen. This movie made me feel all the more strongly about it. The problem is I think Michael Moore lost a lot of credibility with Farenheit 911 amongst the conservatives. And his little anti-war tidbits tossed in here and there didn't help.

And I was super bummed to hear that Hilary now has the insurance industry in her pocket. It seems that that means it will never happen (I guess I am assuming if a dem. wins it is her) In my mind the insurance industry is the biggest barrier. They won't go down without a fight.

Gotta Go
Plum

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12 years 2 months ago #63348 by Sweet
Conflicted has hit one of the biggest nails on the head - courage, and Sisriver has helped me find some clarity in my own thoughts. :)

Physicians are among the most intelligent and well-educated members of society, and the slipping reimbursements notwithstanding, are still close to the top of the socioeconomic ladder (as a group), so how could they/can they stand by and allow the health care system to become the trainwreck that it is now?

One reason is that most physicians did not go into medicine to be social or political activists. However, what we must realize is that if one truly intends to heal and better the life of her fellow humans, then wielding a scalpel may not always be enough - at times we must find the courage to trade scalpels for pens and microphones.

Another is that physicians, as a group, are conservative (I don't mean this in the GOP sense of the word) and reactive, since the club is still run by old white men (no offense intended here), so maintaining the status quo (as irrational as this seems) has become a part of medical education - by the time people graduate from med school, most have bought into the ideology of the "club". It is human to cling to what we know, to protect our interests and to avoid change... to be open to change means to have the courage to face the unknown.

Another reason is that physicians, just like members of other high-stress and altruistic professions (e.g. police, fire rescue, military), have an "us" and "them" mentality. I can imagine that it begins forming sometime during the undergrad years - the eager pre-med who has to devote his/her time to studying while "they, the others" are partying or "enjoying" life, then it intensifies during med school - the endless studying, the intensity and intimidation of the training, then it is amplified during residency - like boot camp in the military, the hours are brutal, the demoralization from superiors can be devastating, the patients and their problems can be overwhelming, etc. etc. etc. .... so physicians as a group come out of this soul-grinder often feeling like they exist in a world of "us" and "them"... and for many physicians this mental transformation has been so gradual that they may not consciously realize what has happened to them.

As an aside, I do know that I am generalizing heavily, and I do admit that I am basing this solely upon my experiences with friends who have gone through or are currently in various stages of medical education, and physicians whom I have met while working in various places and as a patient/family member.

The problem is that the person who initially set out to become a physician - the person who wanted to help her fellow man, to do something amazing and miraculous like finding what ails another human and relieving their pain, giving a total stranger the chance to live a happier life, etc., while making a decent living for her own family, has been systematically shut out and is barely a part of the person who is now doing the actual practicing of medicine. To me, this is a significant cause of physician discontent. Another, less significant contributor is a sense of entitlement and snobbishness that is also a byproduct of the education and training program (the "us" and "them" again). Physicians often begin rationalizing the amorality of the system, in order not to loose their sanity, but at the same time the decent, conscientious and altruistic human is suffering inside.

What we are missing is indeed courage, and a bit of idealism (at least in my amateur studies of history, these seem to be the two elements that precipitate all things good and magnificent).

Who is going to change the health care system --
Insurance companies? :rotfl:
Politicians who have insurance lobbyists in their ears and insurance dollars in their pockets? :rolleyes:
Patients? Yes, but they cannot do it alone.
Physicians? Yes.

Ultimately, the people most negatively affected by the system are the patients and their doctors, so I am sure I am not solving Fermat’s last theorem when I say that these groups should be the ones working to improve the system. No?

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12 years 2 months ago #63349 by AnnaM
Oh, I agree that something needs to be done about the obscene profits and salaries in the insurance industry, but I'm not sure that a Danish-style system will work here, and Conflicted's link to the article about the economy in Denmark reinforces that conclusion. I have spent time in Denmark and I have several relatives there. The article that Conflicted linked points out that the Danish people are unique. They have an overwhelming sense of personal responsibility that you don't see in the U.S. There is a distinct lack of the entitlement mentality in Denmark. It's everywhere in the U.S. Much of the expense of the U.S. health care system is currently due to the malpractice crisis. You don't see much of that in Denmark at all. The Danes take responsibility for their own health (except for their rate of cigarette smoking, which is finally falling.) It's interesting that the Danish economy didn't turn around until the government cut unemployment payments to 4 years from 8 and made job-training mandatory. I would be willing to bet that if the president went on the air tonight and told the country that there would be free health care for everyone, free daycare,free education, and adequate public transportation everywhere, but that taxes and prices would rise to the levels we see in Denmark, that very few people would be interested.
BTW, it is illegal to hit or humiliate a child in Denmark (which I think is great but many people in this country would see as excessive government interference), and it is also illegal to give your child any name that is not on the government-approved list of 20,000-some names. If you wish to deviate from the list, you must petition the government in writing. I'm guessing Americans would NEVER put up with that one (though some of the names I see people saddle their kids with might change my mind on that one too).

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