Is Health Care Broken?

This is off the center aisle of grief. I know that Kay's Hospice care could not of been better. I did witness perfection in the marriage of compassion and competence in her team. Eternally grateful seems like a long time but it is not. This topic is in the recognition that we and others are caught in a bind. I wanted the community's opinion. Our doctors are seeing 15 to 20 patients a day. The old rule was 8. They are stressed out and we hardly know how much we can even say in one appointment. The education portion of the family doctor has been long gone. Is this just the new normal ? Do we adapt and do our own education ? Does there need to substantial change? Most likely this is taking on wind mills.

 

My husband's internist died but previous to that he told us he was concerned about it ceasing to be possible to give quality care due to the Medicare requirements with Obamacare. He was afraid that good good doctors would not be able to pay a staff and make ends meet with the new red tape.
After losing this doctor, the new one would not let you discuss a topic that had not been scheduled in advance. You stood a chance to cover the scheduled one if you had notes and of course the ability to self advocate. But where does this leave those who cannot do this?
I have spent considerable time going over and over all the details of my husband's conditions wondering so many things. My conclusion has been that perhaps like the Bible says, there is a time for all seasons.... My husband was spared on several occasions but why was the last one different? I believe there was nothing that could have stopped it just as the previous times, I don't think anything could have prevented his being spared.
But as to the gist of your topic, I agree with you!

 

Julien your point about scheduled in advance. Yes, when I schedule an appointment they ask what is the nature of your appointment. The way you describe it. This is a time management technique. I guess I would ask did the doctor really prep for your topic. I suppose and I have thought about it scheduling a series of appointment until you get the time and answers. How often do we get flustered and after said, Oh I meant to ask? I will advise and you did, that a receiver of care, your husband has a human camcorder like you were. I looked at doctor resumes and they state, be prepared, or you are renting my brain for an hour. My self I will think like a restaurant, one main and perhaps two sides. The bigger picture is our culture to a high fat, large portions, high sugar, and little exercise and a balanced nutrition oriented diet. Add stress reduction and many modern social ills. Then, of course, the demographic bubble. On the plus side are great innovation and advancement. Even our car has been engineered with crumple zones to reduce the impact. The car is totaled but the occupant fairs better. New illness like aids, opioids induced brain damage also passed to the next generation in the form of major emotional and learning disorders.

I to spent a lot of really 20/20 time over Kay's choices or in her case a nonchoice that cost her. Somehow we need to make sense of what happened and why. I have talked to a few doctors candidly about their burn out. So the longevity, of course, has increased with that comes a higher case of dementia. The new modern illness is so many hours with video games and people going to detox for that.

Julien thanks for your response. I was venting a bit but also puzzled over adapting to the system as currently constituted.

 

Paul, I think your question is excellent!
Ted's last doctor said that we could not discuss his headache because medicare forbid that we use the thirty minutes for anything other than the billing code description. I personally may skip having part b medicare when the time comes myself. Many times Ted was told to go to urgent care or ER. I think it may be the new normal. It could make more sense to have an interest bearing account using the money you might have paid to part b medicare to use on the as needed basis. I think they tested things for Medicare to cover possibly because it's become like a blank check. But our person (spouse) was NOT a blank check!
I was impressed with the excellence of ER and EMS. They were valiant.
Have you noticed now how the urgent cares and gp's computer systems feed into the area hospitals. It will be interesting to see if that helps more with coordinating the patient care across specialists, etc. Perhaps the family doctor job IS on the way out.
I enjoyed your response.

 

I just wanted to add to my comment regarding all the points you brought up that I believe fall under the heading of 'emotional intelligence ' and 'spiritual development'. Things like family and relational problems being addressed lag far behind the health of our automobile. It's like a couple of the legs of the table are broken. The comment about living long enough to have more involved dementia, I believe is correct.

 

Julien thanks for your thoughtful replies. With health insurance and all the time, I spent with Kay's Regence PPO. I got an agent who I am so pleased with. I chose a plan that charges 125 first of year out of pocket. No deductibles and I have all the control. Any provider who accepts Medicare I can see, my choice. Cigna administers the plan. I was just done with A list or B list, in the network. I added Dental and needed a lot. My part D is good enough for the generics I use. Really better than my company insurance. I did see an article today that as opioids are being more understood as addictive, not sold that way initially. You see a sharp fall in the prescriptions but a huge rise in Heroin. The human suffering with all the homelessness is overwhelming. Yes, as you state emotional well being and connectedness. If I may ask how are you doing with loneliness.? Really when I think about it so much ran thru Kay on so many levels.

Best to you Julien.

Paul M

 

Hi Paul,
That there is a rise in heroin after reduction of narcotic prescriptions sounds like the ban on liquor reaction of home made liquor. There again guess the problem is one of the heart and not the head, so to speak. As to connections, we had a heart connection with our spouses and the absence can't be filled I guess and only grieved. I have a tendency to try to escape I think but it usually will get me somehow. I appreciate some semblances of connection to a few folks in my area but as you know, "so much goes through" our person.
Glad you did settle with a good plan on insurance. Yes the dental will probably pay off!
God bless your continued journey serving, making sense of things, and maybe even thriving....think that is my goal.

 

Julien, I have been out of town for a few days. Walks on beaches, beach glass hunting, art museums in a small town, were all great. I got out of my head for a while and that is essential. Yes, they are in our hearts. I have spent countless hours defining what a relationship is and what makes a good one. First are companionship and ease of being together. Next is the admiration of our partner. They have a number of Aces in their deck of life. I for one loved her Aces. There are duces as well but we manage those. Then the joint venture of building a life. A big one is, I got your back. I likely have twenty more but those are essential. More to it than using the remote and change the channel. Maybe a question for offline and personal. I think there is a diversion from obsessive thinking but could you speak to escape? Also, how have you manages loneliness? ?Again these are personal questions and can go to the private chat feather of this site. I have done that from time to time. You do present as an intelligent and caring person. Either way best to you.

Paul M

 

Hi Paul, my French Shepherd has my back. Can't get out the door without him. Lol. And mostly aces!
By having mastered holding back emotions (escape), this grief has shown me that it won't be contained. Many of us likely learned that there was no help for many things so we went on with life never resolving feelings. I think another term might be stuffing your feelings. And with our person gone, who would there be that we could open our heart to? For me God is that answer. And that takes some time because you have to learn who he is by reading the Bible but you can ask him to help you learn enough to be able to have him to have your back ASAP.
I have had some break through crying at office visits, with business acquaintances, etc. I discovered that a lot of these people may be more helpful than various extended family, past friends because of their discomfort. I have had some beautiful moments with strangers. It restores your hope for humanity in the midst of rudeness, irrelevance, etc.
Your analysis of relationships is good. Your beach outing sounds like you are being able to breathe a little. This about loneliness....we can be lonely even with people we know. I think we can come to enjoy our own company more than being with others that we do not enjoy. Society holidays put pressure on us to share it. I have read online forums enough to know that countless people do not have others to celebrate with. I personally was all in on any of that anyway. Nobody's business if me and my dog have thanksgiving. My husbands daughter will likely come over and she and I have pets in common, etc. His son may also come sometimes. My daughter will come when they fly to my area. I enjoy texting with some of them and my sisters. It's neat finding some correspondence such as this with you regarding Healthcare. I used to discuss legislative matters online with a group protesting forced annexation in our state's cities. We also obtained correspondences with our state legislators. A few of these people became friends.
Hope I answered your questions any bit helpfully. If you want to send the separate note that's fine.

 

Julian, I am glad you wrote. I am a bit tired from a trip to the baseball stadium. Not really a fan so much. My former employer had an employee night and I happened to visit the office and was given a ticket. I have many close relations with that group of people. Some discussion of part-time. Cognitively not up to it. I do appreciate your candor and clear writing style. I have to give what you have written some thought and I will likely go off the forum to respond. When tired my comprehension is low. Also sorting the direction of our conversation and choosing how to express my self. Sometimes writing comes easier. Gald you are here and I tend to think what you have to say has weight.

 

Paul, after seeing this title I wanted to also offer my own personal opinion about healthcare.

When I was a child, doctors use to actually come to your house and diagnose and treat you personally. I can't ever remember a trip to the hospital until I needed my tonsils out, or stiches in one of my lips for falling down the stairs and injuring myself. Those days were days where you felt you had a close personal relationship with a doctor.

As the years rolled on I witnessed many changes of doctors. But the one real constant was still, even though the doctor could not come to the house because he or she had too many other patients and their tools, supplies needed a place to be. BUT, the relationship we had with our doctor was very personal.

When you talked to a doctor they would of course know your background and family. The most important aspect of doctors in those days was they treated the whole person. Those two words are most important (whole person). Each visit was a literal checkup of you. If anything was wrong the doctor usually would pinpoint it, because they had been treating you over time as a whole person, not piecemeal, where each item you complete is counted. So in those days, you knew your doctor, his staff and he made you feel important when you visited them no matter the reason.

Today, forget about it. When you walk into a doctors office they have so many stupid rules that they will only treat you for one thing unless it is your yearly checkup. Can you imagine all the damage a year can do to a person over the years.

So you are forced to comply and make multiple appointments if another thing is ailing you, or worse still, get admitted to the hospital so they can run a battery of test for whatever reason. I look at my wife when I think of this careless caregiving.

So many things can fester over time in a person with the lack of personal contact. Due to the cost of medical treatments and waiting for appointments that small item you wished to be seen for could grow, even without your knowledge, into something untreatable. The worse part, due to cost, is how we tend to probably hold back our visits to doctors for money and money alone.

At that point, things can be on a one way path to oblivion. When we lived in Florida, it was not unusual to have an appointment and then you waiting for a long time. The day arrives, you go and wait 3 or more hours beyond your actual appointment to be seen. By the time you are seen I would bet you money that the doctor is extremely tired from the steady stream of patients.

In short, this one ailment treatment is ridiculous and probably the reason so many people eventually become sick on down the line. Money, money, money, no good can come from the pursuit of it.

 

David thank you for writing this piece. All of the above is the case. I feel almost I am adding a burden when I do see my doctor. I can see they are overworked. One I was especially was fond of eventually left the clinic over an administrator's policies that he saw as being in conflict with good care. One expressed frustration about his attempts to educate. He was coming from a perspective of two things. One was he felt a minority in that effort in relation to his peers. The other was we the patients often did not follow his recommendations. I wanted to say to him. You are right people can be stubborn to change and not receptive to things in their best interests. I would add none of us have been to medical school and lack the knowledge base that you have. But also wanted to say that whatever your piece of advice that at some point in the future something will happen. Perhaps a heart attack. It may be ten years from now but they will remember they were told and now actually hear that advice and actually use it. The point is that your effort was not wasted. It was your duty to inform your patients. Sometimes it just takes a major illness to have that information hit home and for change to happen. But the bigger point is as you stated. The whole person and proactive and timely intervention. You are correct people may put off or curtail medical check-ups due to finances and only the emergency gets treated.

My wife is an example of both. She was told in a timely manner to have a procedure. Out of fear she did not and paid a huge price for that fear-based decision avoidance. The medical held up their end. But as you stated had the relationship been in place and a true clinician who has both the knowledge and the patient trust and rapport. A much better outcome was likely in my opinion. Thanks for weighing in on this topic.

I will add that in the defence of the medical field they are dealing with a great deal of modern lifestyle choices.
Type two diabetes is a steeply inclined line that is driven by the center isles of our grocery stores and added corn syrup in about every product. Convenience and lack of exercise. Sedentary taking in 44 once big gulps. Countless hours of TV viewing. Emotional sedating in high fat and high sodium consumption. Portion sizes. Kay was none of the above but was fearfull and could have benefitted from a trusted clinician with time to guide her.

 

Paul,

My post isn't necessarily about one doctor or another, it is about how our care is now structured. We no longer can depend on being treated for everything wrong with us medically as a person, but have to schedule each thing we feel wrong for another visit. It is as though you, with no medical experience or knowledge are being asked to determine which ailment would you like to be treated today.

Let me expand on that thought. While you may feel you have more than one thing wrong with you that choice you have to make at the expense of another pain you might have is left up to you so to speak. Then turn around, schedule another appointment for what additionally is also ailing you today. Too often as that date approaches the extra pain you may have had subsides with some aspirin or whatever. But, that pain while you may think it is dormant can be cooking in the privacy of your body slowly building to something more serious than the original pain.

When I talk about how a patient is treated today, I am talking about the insurance requirements, not the doctors. The bean counters are the main culprits who are always looking for ways to save money, and most likely do not have the patients health at the top of their to do list.

The thing that really gets me is this. We were in Florida for 10 years. My late wife Nadine was always going to the doctors even at the beginning of those 10 years and always had to schedule another visit for something else. But between each appointment she had too darn long a wait till the next visit. Did you ever take you car in to a mechanic and he only worked on one thing? When you went out to eat did they only bring you part of the meal? When you went to an event, did the performers leave you short after some act or whatever? No, they provided the whole piece concept.

By the time Nadine had past on, she weighed only roughly 89 lbs. She always followed the doctors orders, she never drank sodas, never ate too much and watched her intake of salt and coffee. She hardly ever drank except for special occasions. In short, she was a good patient, but alas even those who follow the doctors advice can still eventually succumb to disease.

I wouldn't be too surprised that a lot of those people who don't follow good advice, might have stress of life that overrides good sense. Of course, there are also those who disregard good health practices and medical advice and will eventually pay the toll for that.

Paul, I guess what I am saying, in answer to the thread title is a resounding YES, our healthcare system is so broken it is laughable at best. Lastly, when I say healthcare system, I am referring not to the doctors and nurses again, I blame the insurance industry.

 

I just wanted to add, the picture I use of Nadine and I was when she was in her 40's. I didn't have a recent picture available of us to use, as she was always on the go until her retirement at age 65. She lost all that weight you see on her after she started extensively travelling in her job. I am sure some of those weight changes affected her to a degree, but I would be more surprised if it wasn't all the travel she had to do all across the country.

I can hardly ever remember her sitting still in the last 18 or so years of her life. Vacations were pretty much our time to do things.

 

Dave, I think we are in agreement. I have seen PBS interviews that have basically said the MBA is, in fact, driving a good deal of this. An interview with Judy Woodruff and Waren Buffet, Oracle of Omaha has the quintessential capitalist saying the middlemen offer little service for the value. Basic single-payer. To highlight your point. The US along with Japan are the bottom industrialized countries in vacation time. I very much agree with your point about stress and health outcomes. Most doctors are not happy with the status quo and early burn out is a factor for them.

We are part of a demographic bubble. This will put a huge strain on the system. Some people take medical holidays to Thailand for expensive procedures. Oregon has a system that does rate treatable outcomes and prioritizes care. I may consider an Assisted Living Facility in Mexico.

I was a caregiver along with my sister and few I know would go to the mat for our person. Those emotions and sense of love and duty demand it. It is a given that a tremendous amount is spent in the last six months of life per capita. With Kay's level of cancer, we should have stopped and had Hospice drive the last few months or earlier than they did. I was not going to quit. nor Kay. Several accounts I have read here are similar. The situation was just to wet to blow. Our 3rd round of targetted chemo was at best to extend life eleven months, it extended nothing. On this point, I have no idea what I am saying. We do not know how the hand will play. There is a system in Washington for extreme compassionate taking one's own life. I have also known a friend of Kay's in a coma for months that did come out and has a quality of life.

I am not holding my breath for pragmatic change. I am currently reading psychiatric professionals' work in defining trauma incurred in child abuse. Treatments and comprehending the underlying causes of symptoms. Systems have been so slow in adapting and vested interests are an impediment to change. This starts with research with your group of Nam Vets. I just brought up this topic for an open discussion. Thanks for your participation.
My revolution is the dental water pick. Per my dentist, if I wanted to make her services minimal. Oral hygiene was key and the water pick was a core to that at under $100.00. That is about all I can control. That and listening to JJ Cale and your violins.

Paul M

 

Paul, I finally found a picture of Nadine more recent, anything beyond that the cancer had started to take it's toll so those pictures are off limits. Isn't it sad when so many people who might still be here today if only they had received sooner more comprehensive treatment.

The idea that we have to leave our own country to go to another country for help is sickening. You hear and read about all the advances in medicines and biology, and even the science of instruments, and then you come to the sad realization, that unless your pockets are lined with cash, what you are learning about is only for those with fat wallets.

It is bad enough for people to suffer, but it even more shattering to learn you either lose everything you have in the hopes of a cure or you accept your fate and you give in to the inevitability of forthcoming loss. By the time Nadine was on her way to hospice, we had to declare bankruptcy, lose our house and head back to Maine.

Even after Nadine's passing we had a two and one half year wait of having to finally see the house sold. There was all this additional stress of dealing with that for so damn long you were at a loss on how to start to move on. I was actually in the hospital for neck pain the day I got the news the house had sold. When I finally signed the papers (with of course no cash to me), it was as if the current big burden in my life was over.

Thanks God for having social security benefits we (my two sons and me) had at least some recurring funds to find a place to live. My sons were looking for work and we also had life insurance money (not a lot) to keep shelter our heads until we could right our life somehow.

So when I say life stresses above and how they affect your well being, I am here to tell you with life being such an enigma, many hopes, prayers, sweat, stress/unending stress leads your life forward. You could say both my sons and me at times were almost basket cases for the strong need for survival and how to keep living.

I will tell you that today, my son is in the process of now buying his first house, the one all three of us share at the moment. Starting over again from loss after loss is a scary thing. Neither of us will have total piece of mind, and I am sure that once I am no longer there to support both sons with encouraging words that their life will take another spiraling turn downward again.

I guess what I am saying is cherish what you have today for tomorrow it may all be gone.

 

Dave, Your story if nothing else is hardship and perseverance. The current picture of your wife is a good one. Yes, life stresses do lead forward considering the alternative. There were days I too was hanging by fingernails. We had decent insurance coverage and means to at least whether the financial part. There were bills to pay one year out. but those are done. You are correct in cherishing what you have for tomorrow.....What if we hit this in 2009 the bottom of the market and a ton of unemployment and depression looming. Home in foreclosure in mass.

I do pay attention to the hardship endured in the Civil War, WW2, The depression, Nam, Yemen, Many third world war-torn or not, continued domestic hardship especially the effects of opioids. Some Canadians I know say yes universal health care is good but the waiting times are long. So my personal loss was devastating. I owe a tremendous amount of my current version of better to some very solid friends and to institutions like Hospice.

Just some numbers that suggest how resources are prioritized can make a difference. Incarceration rates, Norway 71/100,000, Netherlands 81/100,000, US 781/100,000. With % crime rates much lower. medical much lower. 70% incarcerated in California were once in the foster care systems. 84 billion is spent overall to house this population at 44K per prisoner.

The other side is innovation. I just spoke with a guy who has survived pancreatic cancer. Initial low PSA's but climbed. He was offered either Radiation capsules or removal. He did removal and more was only evident on the table. In short, do not mess with cancer. Early and hard. With good screenings for early detection. Even his doctors were hesitant to recommend but in a more candid moment said they would have chosen the same.

 

I completely agree. Kevin's hospice care, although short, was amazing. However I constantly felt he was not getting the necessary treatment prior to hospice.
He was dealing with multiple problems and even his primary was not comfortable taking care of him. No one wants to make a decision or treat the whole patient. Many times when he was in the hospital, instead of treating additional diagnosis, the hospital would release him and have him come back to see another doctor.
People wonder why caregivers are stressed?

 

Janine thanks for posting. Aways a double standard in this conversation. I am guilty of smoking and diabetes management. So I have been warned and anything in the future is my fault. Kay was told early to just get a hysterectomy and get any hint of cancer gone. Again her's in my judgment was a poor and fearful nondesition. The medical did their job. To your point is also correct. Again the last hospital floor doctor went out of her way to get a competent oncologist. She did just too late and too advanced in our case. Some people had a team of doctors for care and even the most advanced IBM computer was on the team. I have experienced lost records, tests, rotating hospital doctors sometimes to inexperienced. To your point as a caregiver, we have witnessed a good deal of medical perhaps dropping the ball!! On this forum, many have commented on the need for multiple appointments as more issues presented. So much is what insurance will allow. It is some doctors are very competent but overworked. We have to be proactive about our own heath. Having a really solid relationship with our doc's is pure gold. In general, I think a lot of women went more like the extra 10 miles in caretaking. Maybe they express it better. Caretaking tends not to be men's comfort zone as much or skill set. I will say for anyone in a complex and serious illness that extra person to go with is important. Just to remember wh was said or just keep everything clear!!! I think anyone here did their best and it was so difficult.

Thanks for posting Janine and best to you.

Paul M.

 

Hi Paul
I am also guilty and not taking "perfect" care of myself, smoking and a few extra pounds.
I get what you are saying, but... Yes there is always a but... Gone are the days where you completely trusted health care... I feel like I needed to know more than the doctors sometimes.... What will happen to me when I get there? I'm alone now... I won't have an advocate ...
My love passed on November 8 2019. I think to a certain point I am still in shock... Still on alert... Lost...
I'm back to work, but everything is on auto pilot.
Sorry I'm babbling...