NYTimes on Poor Medical Care

World’s Best Medical Care?

http://www.nytimes.com/2007/08/12/opinion/12sun1.html?th&emc=th

"Access. ... even Americans with above-average incomes find it more difficult than their counterparts abroad to get care on nights or weekends without going to an emergency room, and many report having to wait six days or more for an appointment with their own doctors."

"Quality. ... we scored poorly in coordinating the care of chronically ill patients, in protecting the safety of patients, and in meeting their needs and preferences, which drove our overall quality rating down to last place. American doctors and hospitals kill patients through surgical and medical mistakes more often than their counterparts in other industrialized nations."

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There’s an old quip that if you’re happy with your HMO, you haven’t been sick. My former employer ignored complaints from the staff until someone in his own family got sick and he found out first-hand how bad it really was. At the first opportunity, he changed us to a different HMO, which was, um, not quite as bad. Best thing I can say about it. It was still impossible to get them to pay for anything beyond absolute essentials (for example, their stance was that they didn’t need to do specific allergy tests because Seldane fixed the problem, and there was no way for me to completely eliminate that type of tree pollen from my life, so the information of which tree was unnecessary; they were more willing to test for food allergies, because you can avoid foods, but I already know what foods I react to).

In fact, with both HMOs, two different local medical groups, I faced waits of 6-10 weeks to see my own doctor. One routinely gave instructions to go to the ER (which my insurance would not cover for services that could be provided in a doctor’s office) if you needed to talk to a doctor sooner; I was not even allowed to leave a message for my doctor to ask a question. At least the other would have someone call me back to advise whether I should go to the ER or to Urgent Care (or whether therewas something I could do at home). But still, when my doctor pointed out that she was not an eye expert, couldn’t tell me over the phone whether this was or was not serious, her medical group doesn’t employ an eye expert she could refer me to on a weekend, go to the ER to see an eye expert, I had to fight for a couple months to get the ER visit paid for, because, while the infection may have threatened the vision in my good eye, it was not "life threatening" and "could have been taken care of in a doctor’s office" and therefore didn’t require the ER.

Thankfully, my current doctor is self-employed. He keeps a certain percentage of his time available for same-day and next-day appointments, and when I call, he himself returns my call within the hour. He also, without being asked, will take me before patients who’ve been waiting longer, because he doesn’t want my weakened immune system exposed to any more germs than necessary. A far cry from another medical group where I invariably got sick after every appointment because I was left to spend at least half an hour in a room with coughing/sneezing children too young to know to cover their mouths; any attempt to spend less time in the waiting room was met with resistence – they wouldn’t tell me by phone how far behind schedule the doctor was so I could arrive minutes before he was ready for me, wouldn’t put me in an exam room early, wouldn’t let me wait in the hallway.

I took my CFS to a vaunted medical center that advertises "innovative care". As the Times notes, and both activists and doctors have told me, they score very poorly in treating the chronically ill – that medical group is only interested in things that will get them headlines. Since no one there is researching CFS, they could not possibly care less about it. Here’s a pill, now go away. They weren’t interested in learning how the pills work on CFS, because it wasn’t a subject of interest to them, so they are still prescribing anti-depressants eons after research has proved them useless for CFS, and when the patient tells them the pills were useless, the response is to prescribe a different anti-depressant, and another and another, not try an entirely different tactic (as Dr. Groopman’s book recommends when treatment fails).

You can count me as the 1-in-3 Americans who are insured but still not happy with the quality of medical care available.

At this point, there’s not a CFS specialist within several hours of me. Someone who is having good luck with having her hormones rebalanced told me to try that approach, but I don’t travel well over the distances I’d have to go to see someone who knows how to do it, and I don’t know enough about hormones to educate a doctor locally as to the subtle variations produced by CFS and how to treat them.

After 15+ years of handling auto accident cases, I know plenty about orthopedics and neurology, having constant education from our medical experts, but I never had a case involving hormone imbalance, so I never needed to learn anything about that subject. The sum total of my knowledge in that field is that researchers have been finding cortisol imbalance and some are finding adrenal burnout in CFS, and that taking the natural supplements recommended for both prevented me from getting worse, but didn’t cause improvement.