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Sickest [and chronic!] Patients Expose Health Systems' Flaws

Posted by Sharon W on 5/06/03 at 12:24 (117914)

I thought some of you might be interested in this news story from Reuters Health, discussing a study of the main problems with health care - particulary as they concern 'heavy users' of health care services:


By Karen Pallarito

I included some excerpts, below:


'For heavy users of health care services -- whether they live in Australia, Canada, New Zealand, the United Kingdom or the United States -- the problems they encounter with the delivery of services and access to care are strikingly similar, researchers report in the May/June issue of the health policy journal Health Affairs.'

'The study, the fifth in a continuing series that gauges patients' perceptions of their countries' health care systems, focuses on the recent experiences of 'sicker' adults. They included people with chronic health problems or who were hospitalized or had major surgery in the past two years.'

I think MOST of us can probably relate to these next two paragraphs:

'Sicker adults are also particularly at risk for 'breakdowns' in care coordination, the study found... One in five respondents in the UK and about a quarter in the other four countries said they'd received conflicting information from different doctors and health professionals.'

'Physician-patient communication also suffered in all five nations, although the greatest difficulties were reported in the U.S. Thirty-one percent of sicker Americans said they left the doctor's office without getting all their questions answered.'

'Access was another trouble spot. Half of Canadian respondents said it was difficult to see a specialist when needed. A third of U.S. adults with health problems did not fill a prescription because of cost.'

Re: Sickest [and chronic!] Patients Expose Health Systems' Flaws

Ed Davis, DPM on 5/06/03 at 18:13 (117949)

A lot of systems are designed to treat as many as possible so procedures and practices are aimed at the center of the bell curve.

Managed care patients are easy to treat if one can so something simple, clean and neat. It is hard to give patients requiring intensive ongoing care good care under many manged care systems.

I have an HMO patient today with difficult PN. She was originally scheduled for TT surgery but after a second opinion with me, I informed her that she has PN, not TT and thus should not undergo surgery. We tested her fro all the common causes of PN but nothing came up positive.
Our next step is to formulate a plan of attack to look at the numerous causes that make up the other 10% of PN, which she is in. The patient informed me that she wants symptomatic treatment only until December when she can switch from her HMO to a non-managed care insurance plan since she finds the process of wrestling with her HMO to get the necessary care to be exhausting.

Re: Sickest [and chronic!] Patients Expose Health Systems' Flaws

Sharon W on 5/06/03 at 18:38 (117957)

Dr. Ed,

I agree completely -- and I do know that doctors get as frustrated with the insurance/health care situation as anyone! I've never fully understood the extent to which managed care seems to favor surgery over other treatments... but perhaps it's just as you said,managed care works as long as you can do something for them that's 'simple, clean and neat'. (Otherwise, the system tends to break down...)

I certainly wish your new patient the best of luck in her quest to find the cause of her PN! %%- It's a VERY difficult situation that she's in...


Re: Sickest [and chronic!] Patients Expose Health Systems' Flaws

Bev on 5/07/03 at 08:03 (117998)

Ed, You sure sound like such a good and caring doctor. Why can't all of us find 'you' out there? Can we clone you?

Re: Sickest [and chronic!] Patients Expose Health Systems' Flaws

Ed Davis, DPM on 5/07/03 at 10:52 (118014)

Thank you. There are many caring doctors out there. I think that the managed care system and the malpractice crisis has 'hardened' the hearts of a number of providers. I am awaiting the day that we have a managed care 'bill of rights' and meaningful tort reform so doctors can be doctors again and not structuring their practices around the insurance industry and trial lawyers.