The health care debate has begun, and most of the current debate centers around the concept of universal coverage, private vs. public insurance, and mandates. These are the “sexy” parts of the debate, but sometimes it causes us to miss the larger point: health care as a whole, is broken.
Let’s start with the obvious, and it’s something people rarely think about unless it happens to them: it’s hard to find a doctor on the weekend unless you go to urgent care or the ER.
Now I know everyone loves the weekend, and everyone deserves a break, but something has to be done to improve the quality and availability of care not just on the weekend, but in general. This is just another health care story:
Last week my wife went out of town with a group of fifty students on a school trip. This trip involved a 9-10 bus drive to the destination, and a 9-10 drive back. A bus trip that long with students in the last throes of winter is inevitably going to lead to illness, and sure enough, there were several students on the trip with diagnosed illnesses: flu (which was diagnosed the day before the trip; thanks), pneumonia, and bronchitis, not to mention general coughing, sneezing, etc. On Friday, right before the bus drive back, she started running a small fever, just over 99. When the bus arrived very early Saturday morning, she was coughing often and achy all over. The coughing was worrisome because she has a history of constricted airways when she gets sick. She went to bed and woke up later Saturday morning feeling a little better. Thanks to some over-the-counter medications, her coughing and fever had gotten a little better. Until Sunday morning.
Sunday morning, she couldn’t stop coughing, her fever was over 101, and she felt like barely moving. What are the options on Sunday morning? The ER, which would cost a fair bit, or the local Minor Care center. Hoping to avoid a long line and get care quickly, we opted for the Minor Care center (it’s worth noting Minor Care used to be Urgent Care, but they laid off all their RNs within the last year). Minor Care was supposed to open at 10am. By 10:10 there was a line outside (we were third), and the doors were still locked. A staff member soon came to the door: the security system didn’t note the time change, and the door remained locked. We entered the center, still third in line. It took about 20 minutes to be called for insurance information. We had to pay our co-pay up front, and we sat back down for another 20 minutes. My wife was called to the back to see the doctor, and fifteen minutes later she was out. We (my mother-in-law, who is a nurse, came by as well) asked her what the doctor said was the problem. He didn’t say anything. He looked down her throat, listened to her breathing, and wrote two prescriptions: a steroid to help with throat inflammation, and an anti-biotic for…what, we weren’t sure. He had also given her a steroid shot. He didn’t look in her ears or up her nose. When he listened to her breathing, he heard a “rumbling” of possible fluid, but didn’t order a chest x-ray because the Minor Care center either didn’t have an x-ray machine or it wasn’t functioning (they announced this while my wife was in the back, causing two people who came in on crutches and had been waiting for nearly an hour to leave). The doctor offered no explanation for her illness, no head cold, no bacterial infection: he wrote a prescription and sent her on her way. It was now 11:45am. Not bad time wise, but my wife still felt terrible and still didn’t know what was wrong with her. She knew the steroid would probably help with her throat, but given her history, and the fact that she was on the bus with sick children, the doctor was remarkably inactive. Additionally, my mother-in-law looked at the prescription, saw who wrote it, and was immediately dismayed. She knew the doctor’s reputation, and it wasn’t good. We decided we better head over to the ER.
We got to the ER at 12:15pm. We were triaged by 12:40, during which the nurse discovered my wife’s temperature had spiked to 103. We paid our second co-pay of the day (thank god my wife has good insurance). They gave her some Motrin and Tylenol to try to break the fever. The ER is staffed with mostly Physician’s Assistants (PAs) and one doctor (again, cost) who is legally bound to see the Medicare patients, which meant if we wanted to see the doctor, we’d likely be waiting 3+ hrs. As it was, we’d end up waiting over an hour for the PA. Before the PA came in, she had the nurse administer a Flu Drop test to see if my wife had the flu. This test, simply done with a long swab that goes up the nose and down to the throat, took all of 30 seconds. Why it wasn’t done at the Minor Care center three hours earlier, we still don’t know. They also decided to administer a chest x-ray. When the PA came in with the results, my wife was diagnosed with Flu type B (it’s worth noting my wife did have a flu shot; however, flu shots only contain what are anticipated to be the 3 most common strains of flu for a given region). Luckily, when the PA listened to her breathing this time, she didn’t hear any liquid “rumbling,” although she was warned to look for signs of pneumonia as she struggled with the flu. We showed her the prescription from the Minor Care center. The PA said to fill the steroid, but the PA said she was unsure why the other doctor prescribed the anti-biotic. She asked my wife if she had any bladder trouble, as the drug was most commonly prescribed for bladder infections, UTIs, and ear infections. My wife had none of these. The PA warned against filling it, saying the drug would most likely make her feel worse (the PA did everything but say the doctor didn’t know what he was talking about). She prescribed Tamiflu, Robitussin with Codeine, and the previously prescribed steroid. We left the ER around 2:40 By the time the prescriptions were filled at CVS, it was 4pm, and my wife was finally able to go to sleep.
Now, this story may not seem like a big deal. In fact, our relative waits in the Minor Care center and the ER were short, and we had health insurance, so we only had to pay our co-pays. However, it didn’t feel simple at the time.
In order to get a diagnosis, my wife had to be seen twice.
The first time, the doctor prescribed a drug that, while admittedly inexpensive, wouldn’t have done anything and would have made my wife feel sicker.
The first doctor didn’t do a simple test that would have told him, and us, what the problem was. His negligence was especially startling since she point blank told him she been exposed to someone with flu in the last week in a confined space.
We had to pay twice for one correct diagnosis. While the initial co-pay wasn’t that expensive, we’ll have the inevitable follow-up bills that we’ll have to pay.
The first doctor didn’t really do his job, and he didn’t offer any explanations to us. We were left mystified and guessing.
My mother-in-law summed it all up by offering a piece of advice: “In health care, you have to fight for your care.” She also basically acknowledged that if you don’t know how to ask, you probably won’t get the correct care.
This is wrong. My wife was lucky. We have insurance. Her problem was relatively minor since she had the less serious strain of flu. We were able to get her prescriptions, and luckily she has sick days so she’ll be able to stay home and get better. But we have a system that makes it difficult to get health care 29% of the week. We have doctors who don’t try to help their patients and don’t bother to try to explain what the problems are.
Yes, this was just an ordinary health care story. And that’s the problem.
Cross-posted at http://filibusted.net