Doctor’s Offices/Hospitals Are Bureaucratic Swamps
A Commentary by J. D. Longstreet
Have you been to see a medical doctor lately? If you have not had medical attention in a good while allow me to warn you. The manner in which medical care is delivered has changed significantly and NOT necessarily for the better. In fact, in this “semi-professional patient’s” opinion it has changed for the worst, much worse.
Before I prattle on about the medical community from this patient’s point of view, allow me to present my "bona fides."
I am a Crohns Disease patient. I have been all my life. At the tender age of twelve years I was present when a doctor told my parents that I would not live to see my 21st birthday. I must tell you -- that is a difficult thing for a child to hear, to digest, and carry around forever in the back of his/her mind.
I recall standing there -- and doing the math -- and realizing that I had nine years left of my short life. That conversation between the doctor, my parents, AND ME, lasted only seconds -- but the SCAR has endured my entire life.
Now in my seventies, my eighth decade on this earth, my body has been rather badly battered. At times, when I look at the scars and feel the internal stainless, it is difficult, even for me, to believe that, somehow, I have survived this long.
Having been hospitalized over eighty times since I was 24 years of age, I have had more than my allotment of experience(s) with the medical community. I have been fortunate in that I have had the attention of some of the finest medical doctors this country has to offer and I have benefited from the services of some of the finest hospitals in the country. (That is MY opinion, of course.)
But the way medical services in America are delivered has changed, and changed drastically, over that time and I have had a seat, right in the middle of it, as a partaker of those services and -- as an observer. I have watched, often with deep concern, the deterioration of the manner in which the patient is served. What I have seen, and experienced, is more than a little disturbing to me -- especially as a patient.
The personal touch between the physician and the patient has eroded into near non-existence. That means that the element of trust between the two has also eroded.
For nearly 40 years I saw the same physician. Over time we became more than doctor-patient, we became friends. There was a bond. There was trust. I could speak as openly to him as I could a priest in a confessional. He has recently retired and I miss him sorely.
None of the physicians with whom I have met since have been as accomplished at "the art" of practicing medicine as my former doctor. All of them have been fine men/women, highly trained medical professionals, and fantastic human beings. But -- and this is a big one -- I don't feel the necessary connection to make our association work. It is a cold, sterile, professional relationship -- no more and no less. There is absolutely no bond between us, at all. Without that bond, that connection, there is zero chance that I will share information concerning my health, on or off the record. When I visit a doctor now, I go through the motions and then -- go home.
For me the barriers went up long before admission into the inner sanctum of the examination room.
Here is how, in my opinion, the de-linking of patient and doctor begins: Even before I get to actually SEE the doctor, I have to jump through all sorts of hoops for the government, the health organization that now owns the practice, their insurance company, and my own insurance company. All humanity is removed from contact with the doctor. A visit to the doctor's office now is akin to visiting a deli and taking a number. And, truthfully, I feel as if I am little more than a number.
My local hospital is a modern regional hospital. I played a very small part in assisting the hospital gain the funding necessary to build it. I was at the ground-breaking ceremonies many years ago and during construction I often stopped my car along side the road to watch the pile drivers pounding pilings down to the bedrock upon which the foundation of our modern medical facility would be built. I was there at the grand opening and toured the sparkling new facility. And I have been there dozens of times since as a patient. The latest stay was just last month.
Until just a couple of years ago, my own physician treated me and over-saw my treatment while I was a patient in the hospital. I was extremely comfortable with that. He knew my condition, he knew my state of mind, and he knew what I would allow -- and what I would not allow -- in my treatment. Most important -- There was an unbroken chain in that treatment process with someone (my doctor) in charge having all the knowledge necessary (about me and my particular case) to see that my recovery was swift and as near complete as my disease will ever allow.
All that has changed.
Now my own physician cannot see me or treat me in the hospital. Now the hospital has staff doctors referred to as “Hospitalists.”
While I am sure the Hospitalists are highly trained and experienced medical professionals, they are not MY doctor -- and I will never be at ease with them. So far, I have managed to bar them from treating me. In fact, I went so far as to refuse to allow them entry into my hospital room.
See, I have concluded that all they know about me is what they have in the hospital’s files and the medical records they have access to from my personal physician. As anyone who knows me can tell you, there is a hell of a lot more to me than appears in a recorded file somewhere. The same goes for EVERY human being/medical patient.
So far, I have managed to avoid an all out confrontation between myself and the medical staff of the hospital. I have found a way around it. It is a painful process but at a point in an episode of my disease it switches from a medical emergency to a surgical emergency. If I am able to endure the pain -- until my body makes that switch -- then I will be seen and treated, throughout my hospital stay, by a surgeon whom I know, trust, and respect. Allow me to quickly add: I do not recommend this process to others. It is quite dangerous and depending upon your condition -- could result in death.
I cannot get past the thought that I have seen and experienced the future of medicine in the US – and I hasten to add -- I do not like it. In my estimation it has absolutely nothing to recommend it in caring for sick people. However, it DOES seem to compliment the business aspects of the medical community, the insurance companies, and, of course, let us not forget --the government.
The humanity, that human touch, is being, if it has not already been, lost. As I said above, I am a “semi-professional patient” and I can attest, from experience, that the human touch is as important to a patient’s response to medical treatment as are the pharmaceuticals sloshed into his blood veins from those plastic bags suspended like Damocles Swords above his bed.
If I am right, and I believe that I am, the method of delivering medical care to American patients is going to hell in a handbag -- and at a breakneck speed. I have been an observer much of the time lying flat on my back on a bed inside the medical care system. I am a witness. I have seen it -- and, as I have said -- I do not like it.
I haven’t even touched on the way medical records of private individuals/patients are handled today. I will do so briefly.
Everything is now on computers. If you know anything at all about computers and the Internet, then you know that the moment you connect to the Web, all privacy, or even a reasonable expectation of privacy – is lost.
If you are a regular reader of my scribbling then you already know how I feel about Obamacare or the Affordable Care Act. So, all I will say about that is this: It is my belief, based on my experience(s) within the system as a patient, that Obamacare will only make the delivery of medical care in the US much worse. And that is to the detriment of every living American.
If you have managed to stay with me this far you are probably thinking I am an old fuddy-duddy who would be far more comfortable visiting a doctor whose office is located downtown, over a drugstore, accessible only by way of a flight of dark rickety wooden stairs. Even though my own dementia may be looming, I am still bright enough to recognize the truth in that. I suspect I WOULD be more comfortable with such an ancient scenario. But then, I have always been far more comfortable in the past, or the future, than in the present.
Be that as it may, one of the many things I have learned -- over all the years I never expected to live -- is that change is not always good, nor, in some cases, even to be desired. I have also learned that change comes, often unbidden, and we often have little to say about it. Too, I have learned that it is true that forewarned is forearmed. If we know change is coming, occasionally, we have an opportunity to influence that change by guiding it in such a way that the least amount of harm is done to those affected.
For nearly fifty years I have been right in the middle of that change process and I must tell you, I have seem little, if any of that change that would offer benefit to the patient.
(Here I want to stress that my complaint is concerning the DELIVERY of medical care, not the medical care itself. There is a HUGE difference.)
While I agree that medical care in the US is the best in the world, I would quickly add the caveat that the manner in which that excellent care is delivered, these days, has been badly damaged by what appears to be bureaucratic bungling on the business and government sides of the delivery system, and an absence of any consideration as to how their business and regulation decisions would affect the patient, the ultimate recipient of the medical care they offer.
THAT is inexcusable.
J. D. Longstreet