Diary of a Bad Year, continued

Mark heard me (see previous posting) and made an effort to lift the black veil, but then we were again caught up in the maelstrom of the medical industrial complex, with two trips to the emergency room, a terminal diagnosis, a nine-day hospital stay, and finally, a stent surgically placed in his duodenum.

All the horror stories about emergency rooms are true. To UNM Hospital, the only public hospital in the city, go all those who have no health insurance. There, too, go those with emergencies that are not dealt with by urgent care centers or doctors’ offices but are not dire enough to require an ambulance delivery, with entry through a different door (although when we were there several people who had been brought in by ambulance and seen in triage were then deposited into the waiting room). There are those who have insurance but can’t get doctors’ appointments at UNM in any timely fashion so they have to go to the ER to get the treatment they should have been getting from a doctor who would then admit them to the hospital. One of the ER doctors actually told us that his wife had been waiting four months for an appointment at one of the UNM clinics. And then there are those who are very confused and don’t know why they are there.

Once you actually get out of the waiting room and into the examination room, in this fancy new ER wing that was recently added on to the hospital, you may find yourself there for three days. We were there for 16 hours our first visit, then sent home. On the second visit we were there for about 10 hours before Mark was admitted. If he had actually been admitted during the first visit we wouldn’t have had to visit the ER twice, for a combined visit of 26 hours, for the same illness that finally got us admitted the second time. But the ER must adhere to a strict hierarchy of diagnoses that allow the most critically ill admission first, while the rest linger in exam rooms (or on the floor, where many prisoners in orange jumpsuits and shackles spent many hours) because there are not enough beds in the hospital.

Why are there no spare beds in the hospital? Because the health care system is broken beyond repair. People with preventable diseases end up in the hospital for any number of reasons. They have no insurance so they don’t go to see doctors or health care specialists who might be able to screen for early detection of these preventable diseases. When they do see a doctor, it’s not like the doctor we grew up with (those of us over 50) who came to the house, treated everyone in the family, often socialized with the family, and was able to integrate medicine with lifestyle choices and an intimacy that no longer remotely exists. When they do see a doctor, it’s usually at a for-profit clinic where the doctor’s salary is based on how many patients he or she can see in a day. So it’s in and out the door, no follow up to see if the patient is taking the doctor’s advice, taking his or her medication, or seen by whatever specialist he or she might have been referred to. And if the patient is referred to a specialist, that specialist might say to the patient, you need to go back to your primary care doctor and get a referral to see a different specialist, but no one checks up to see if that happens, either. In other words, there is woeful communication between doctors and woeful care for patients who cannot successfully navigate the complicated primary care/referral/specialist terrain of the medical industrial complex.

Even when you act as your own advocate, or have someone act as your advocate, and make every effort to work through the system as efficiently and expeditiously as possible, you are out of luck. You can’t get through by phone to doctors who are already overworked and not inclined to return phone calls. If you question their diagnosis or prescription for tests, such as the enormously expensive CT scans and MRIs, you are labeled a troublemaker and sent off to someone else or just dropped from the system. If you happen to get sick on a Friday, you know you’re going to spend your weekend in the ER. You have to get authorization from your insurance company for procedures you and your doctor decide are necessary, and if they turn you down — because, after all, don’t for-profit businesses know more about health care than you do? — you have to appeal the decision while days or weeks go by when you should be getting treatment. Health insurance rarely covers alternative treatments that patients have discovered work for them and they end up paying out of pocket fees that certain doctors or HMOs would much rather put towards a diagnostic test from which the HMO or doctor gets a kickback.

During the debate on the health care bill all of this dysfunction was argued out in Congress, in the White House, in the mainstream media, on blogs, and among those of us who have to work through the system, which is all of us at some point in our lives.
But until health care is not managed by for-profit HMOs and insurance companies the argument is moot. The ER doc who told us about his wife having to wait four months for an appointment summed the situation up very aptly when he said, “There are two kinds of health care being delivered in this country: the kind Steve Jobs gets and the kind everyone else gets.”