Rant

As a family nurse practitioner, I'm in the trenches of health care. As my family and friends know, I work with several ex-pat Canadian physicians who came to this country to escape socialized medicine. I do support president Obama on many things, but socialized health care is not one of them. There could be many benefits to socialized health care, such as more emphasis on prevention, ie, free immunizations and low cost colonoscopies and smoking cessation meds. You know, spending health care dollars on the things that really make a difference. However, I also know from personal experience that the American public has a long, long, long way to go before accepting the realities of socialized medicine.

I'm quoting another one of our physicians here, not a statistic, so I can't vouch for its validity, but he says that we've got to get our priorities straight...that 80% of health care dollars are spent in the last 2 weeks of life. Before we adopt socialized medicine, we have to have a national discussion about prolonging life at any cost. For example, today I saw a very nice woman, with non-Hodgkins lymphoma, somewhere in her 70's, who told me that her oncologist wants to do a stem cell transplant after she is done with this round of chemo. (5 weeks in the hospital and hundreds of thousands of dollars). She didn't say so, but I could tell she is ready to throw in the towel. And I say, that is an honorable and perfectly reasonable decision. One that should be supported with every loving resource we can provide to her. Death will come to us all. Expensive cures for cancer and transplants only delay the only certain outcome for all of us. Where do we draw the line? Should we do cardiac bypass surgery on 50 years olds- 60 year olds - 70 year olds - 80 year olds?

Should we even do a stem cell transplant on a 70+ year old woman if she wants it? Who is going to pay for it? She is Medicare age, so every working American pays for it. Don't even get me started on Octu-mom. In socialized medicine, we will have to pick and choose how we spend our precious tax dollars and that does not mean that patients will get everything that they feel is their right. Seems to me that none of the politicians are addressing this most important question. They tried to address these questions in Oregon once (land of the liberals). They said that there was only so much Medicaid money and they rank ordered medical care according to the least expensive/most productive (immunizations) and the most expensive/least productive (providing medical care to a baby born without a brain). Then they drew the line at #100 (or something like that). Guess what? People couldn't live with the lines being drawn. The lines were declared unconstitutional. So everybody had the right to full medical care. Now, people on Medicaid seem to get the most medical care. People who do not have insurance often go without or go begging. (I'm thinking of my young diabetics patients who call me up begging for insulin or test strips they can't afford because they work somewhere where that doesn't provide medical insurance. They need those $100 bottles of insulin to live!

I have been dealing with a patient who came to her first appointment with me five weeks ago defiant and confrontational and demanding a MRI after a fall that caused painful sensations in every limb of her body. She had a perfectly normal neuro exam. I had no doubt that she hurt. I gave her pain meds. But what would I MRI? When something goes wrong after a fall, there is pain on one side or one limb and there are usually neurological changes. An MRI costs 1800 dollars. When the insurance company said she had to try conservative treatment (PT or chiropractic, and NSAIDS) for 3-6 weeks, she wrote them an angry letter and threated to sue the insurance company. Then, she said I pissed her off because I ordered an electrodiagnostic study in an attempt to try to pinpoint where her problems were coming from in order to order the right MRI. It cost her $900 and she has a $3000 deductible so she had to pay for it. She wants an MRI! Well, she can have an MRI if she wants, but her insurance company is not going to pay for it. I have spent lots of unreimbursed time on this situation and she is not any happier.
I think its like homeowner's insurance. We can't just call up our homeowner's insurance and say...I want a new roof. I'll sue you if I don't get a new roof. You can get a new roof if there is objective evidence that you need a new roof.

So many people are angry and demanding. I get that times are very hard. However, many people demand antibiotics for viruses and x-rays for painful knees. (Even though time and ibuprofen take care of most things). They often bring in a 5-6 item list of problems they want to discuss (in addition to the problems we need to discuss, like their blood pressure or diabetes) because their visit will cost them a $40 co-pay and they want to get their money's worth. But they are scheduled for a 15 minute visit. After the appointment, which goes long because we are trying to deal with everything, we rush into the next patient room and that patient is upset because we are late! Frequently when the patient hands in their carefully considered prescriptions, we will receive a rejection notice from their insurance company, because the medication is not on their formulary. Of course, we don't know what the patient's formulary is because they don't bring it in, but often the patient is angry when he or she can't fill the prescription we gave them. Actually they could, but they would have to pay for it. People forget that they can have anything they want if they are willing to pay for it.

Health care has become so contentious. Some patients say..."well, you should just see fewer patients. Then you would have more time for me. Why do you have to see so many patients every day? " Because the first three patients an hour pay for overhead. The forth patient is when you get paid. If there is 1 cancelled appt or no show in an hour, the doctor or NP works for nothing. I'm told that in Canada, physicians see 1 patient every 6 minutes.

When socialized medicine comes, patients will have to make an appointment for everything and only 1 problem will be discussed. If the patient wants to bring up another issue they will be told to make another appointment. How do I know this? Because they is how it is done in Canada.

My Canadian doctor collegues say that this hell that we are working in now reminds them of what happened in Canada before socialized medicine began. And we are mixing this time of social change with the Baby Boomers growing older and needing more medical care...the Baby Boomers, who grew up thinking the world revolved around them and that they are entitled to the best of everything.

But there is simply not enough money to go around.

I made a similar comment once on Fat Doctor's blog. She wrote me back personally and commisserated. But my comments received several angry responses from people who said I should get out of medicine if I felt this way.

How I feel about this has nothing to do with caring for my patients. I've grown very fond of most of my patients and am priviledged to share their trials and joys with them.

But I'm pretty sure most everyone in health care is feeling this way lately. And I sure do not know what the future will bring.