On a scale of dreadful things, searching for a new family physician ranks up there with hunting for a divorce attorney. Unlike divorce, pursuit of a new doctor has become nearly an annual punishment. What’s worse, the triggers for this torture are increasing.
▪ Elections: It was called the Patient Protection and Affordable Care Act when it became law in 2010. But political demonization quickly lopped off “patient protection.” It’s not hard to imagine that repealing/replacing Obamacare will hugely upset the patient-physician relationship.
▪ Networks: Insurers annually rejigger their accounting Rubik’s cubes, and our favorite docs quietly disappear from “the network,” leaving us “physician du jour.” Patients lose in the caregiver numbers game. The California Health Care Foundation found 40 percent of California physicians provide 80 percent of Medi-Cal visits.
▪ Life cycle: Physicians die or open wineries in Paso Robles. The Physicians Foundation found that 46 percent of 17,000 doctors surveyed are accelerating their retirement, cutting back on patients or getting out of direct, hands-on care. For those who remain, morale is tanking.
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▪ Bad habits: Injecting 20 million newly insured into a chaotic industry has encouraged the Dickensian viper pit behavior of the worst medical practices while leaving unmet the need to educate new patients. Doctor shopping is the opposite of speed dating. Docs aren’t standing by the window with shades open. This is more a mandatory trial marriage or the luck of a mail-order spouse. It comes with a whole built-in family of doctor/insurer-preferred relationships – the preferred hospital, X-ray services and pharmaceuticals.
I’ve rarely seen it happen, but it would help if doctors and patients openly aligned their expectations from the start.
▪ Timeliness, courtesy, clarity and follow-up. Mistakes ought to be rare and acknowledged. Dishonesty and evasiveness, unacceptable.
▪ Bring a script or crib sheet reminding you why you’re seeking medical help. Also, bring a list of medications, surgeries. And take notes while the physician is assessing you.
“Patients need to be more sophisticated and do more homework,” said Dr. Alan Kelton, a Fresno primary care physician and faculty member who specializes in internal medicine at the University of California, San Francisco, Fresno medical education program.
▪ “There’s less touching than in the past, and fewer head-to-toe exams,” Kelton said. Patients need education on routinely self-monitoring chronic conditions such as high blood pressure and diabetes. More physicians are engaging in email follow-up with patients, although payment and liability concerns remain. A patient’s after-hours call needs a better mechanical engagement than “call 911.”
▪ The need and value of medical tests needs to be weighed, especially given disputes about mammograms, PSAs and others.
What will insurance cover – and what may happen with the results? Still more tests, involving a specialist?
If there is truth to “patient-centered” care, then we must vaporize the dehumanizing institutional maze. Patients are not “the 2:30 appointment.” Often underdressed and sometimes dehydrated, they are cold-shouldered into an overly bright room encountering someone whom they see rarely and briefly but always in the most vulnerable times in their lives. The feel is like slipping into a crevasse.
Doctors are not typically coddled craftsmen who flash through patients like FBI mugshots while whining about burdensome paperwork that rewards them comparatively lavishly. In slivers of time, they must repeatedly sleuth a remedy based on what patients say, how they look and act and what new evidence can be uncovered. Success and satisfaction aren’t assured and rarely arrive in tandem.
For both parties, access remains the No. 1 issue. A backed-up waiting room may well signal a compassionate and involved physician – someone who has trouble turning away need. Physician and patient are wholly interdependent. Both need to get their acts together because every failed audition ultimately can turn tragic.
John G. Taylor, a former Fresno Bee reporter and editor, is owner/operator of The JT Communications Co. LLC. Write to him at email@example.com.