Patient volume and money instead of quality patient care

To everything there is a season and mine comes to an end today. For 720 weeks I attempted to give quality care to my patients. The task was not always easy especially when most of my patients held the unenviable position of having a high risk pregnancy and receiving Medicaid or being uninsured. Babies have a right to be born healthy regardless of their mothers’ income or insurance status.

The memories of my tenure at the county health department are indelible. I remember the woman who paid to be taken across the border only to be abandoned and walked from San Salvador to Texas. And the obese patient who rode a bicycle to the clinic with a blood pressure of 221/110. Of course she refused to go to the hospital because she alleged that they treated her “like dirt.” I begged, pleaded, and personally drove up the street to fill her blood pressure medication prescription to avoid her having a stroke or seizure in my exam room. My nurse found an ambulance company that was willing to take her to the high risk specialty hospital where she delivered prematurely in order to save her life and that of her baby’s.

And then there was dear Priscilla* (name changed) who had a bipolar breakdown and was about to be inappropriately discharged from the labor room triage until I advocated from my home around midnight and found her a hospital bed in my county where she was appropriately admitted, treated and subsequently delivered. There was also Katy* (name changed) who was sent home inappropriately with low fluid and subsequently went “on vacation.” I tracked her down in another state, told her to go to the nearest hospital where she was emergently admitted and delivered via c/s. My advocacy, diagnostic saves and battles with hospital clerks (who practice medicine without a license) continued for almost 15 years. It was difficult, stressful and at times frustrating, especially when the administration’s emphasis was on patient volume and money as opposed to quality patient care.

As this chapter of my life closes, I’d like to think that I’ve made a small but unique difference in the lives of others. I will indeed miss my patients, but I will not miss the stress. Service is the price we pay for being here. I hope I have served humanity well.

Linda Burke-Galloway is an obstetrician-gynecologist and author of The Smart Mother’s Guide to a Better Pregnancy. She blogs at her self-titled site, Dr. Linda Burke-Galloway.

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  • http://natickpediatrics.net Rob Lindeman

    You practiced for 168 years?

    • SueCz

      720 weeks = 168 years? My math says almost 15 yrs.

  • http://mymayhac.blogspot.com/2010/12/help-weve-fallen-and-cant-get-up.html Shereese Maynard

    Dr. Burke, of course you have made a difference, not only to the individuals mentioned in this post, but to the field of health as a whole. All of us, the advocacy-based providers fight a moral fight daily. We make decisions for what we feel are the right reasons and yet struggle with our responsibility to boards and chairmen, and stock holders. I don’t share your exact struggle as I am an administrator, however I do understand it. Soldier on! You may be leaving one environment but as I have discovered, the fight does go on. Thank you for your post.

    • http://www.smartmothersguide.com Dr. L. Burke-Galloway

      Ms. Maynard, thanks so much for your response. It’s inspiring to receive such encouragement from an administrator. I wish I could clone you (lol). Have an awesome day!

  • http://www.drsforamerica.org/ Brandon Green, DO

    It’s a tragedy and evidence of how completely perverted the “system” (if you can call our health care that) has become that a good doctor like you isn’t allowed to do the right thing for patients. You are right to walk away in search of someplace that hasn’t been so thoroughly corrupted by the for-profit mentality, and I predict that your absence will be sorely felt.

    Meanwhile, I hope we all live to see the day when our efforts at reform pay off in the fullest sense and doctors like you can honor their oaths to their patients everywhere.

  • http://www.smartmothersguide.com Dr. L. Burke-Galloway

    Thanks, Brandon. Appreciate your kind words. Our publicly funded community health center and health departments have become “Medicaid mills.” I wish state and federal Inspector Generals would become more involved and halt the malfeasance. It’s repugnant how the administrative miscreants profit in the name of helping the poor.

  • Mona

    Such poignant stories that clearly reveal the inhumanity of our current health care situation. I’m sure you have left an indelible mark in many patients lives. As you say…….a luta continua

    • http://www.smartmothersguide.com Dr. L. Burke-Galloway

      A luta continua indeed, Mona. As always, really appreciate your support. You are such a positive force in our organization and profession. May your light continue to shine.

  • Medical blog

    Wonderful story. Love the passion. What’s the 8000+ weeks. That’s 160 years?

  • http://fertilityfile.com IVF-MD

    In a free market system, the doctors who make the patients happy are the ones who are rewarded. So the patients win and the good doctors win.

    In a model dominated by government and insurance corporation intrusion, the winners are the bureaucrats, administrators and the providers who are best at gaming the system (not necessarily the ones best at making patients satisfied). Of course, the patients lose.

    If there are people who really really love this model, then they should feel free to enjoy it all they want. However, it is only right to give others the opportunity to opt out for an alternative free-market option.

    • http://www.drsforamerica.org/ Brandon Green, DO

      I’m not sure I get your point, IVF-MD. I hope you’re not suggesting what we have right now is the “free market” where doctors who make patients happy are rewarded. If that were the status quo, our friends like Dr. Burke-Galloway would not be pushed out for trying to do what’s best for her patients.

      Ultimately there will hopefully be a viable, truly free-market wing on top of a universal, publicly well-funded health insurance system so everyone gets a dignified standard of care, and those that can afford additional boutique care can have it.

      As it stands however, we have neither. Rather, we have insufficient government commitment to health care for all and a monopoly by a few private companies whose profit motive hurts everyone but their shareholders.

      • http://fertilityfile.com IVF-MD

        We absolutely do NOT have a free market right now. That’s the problem.

        • http://www.smartmothersguide.com Dr. L. Burke-Galloway

          IVF-MD, as long as we have corporations (i.e. insurance companies and managed care plans) controlling health care rather than physicians, we never will. Brandon is right. We have a monopoly of a few insurance companies who control our profession. My patients were satisfied with their positive outcomes (healthy babies) but I had to fight administrators for quality time with patients so that I could give them proper assessments and treatments.

          • AC

            It’s not just the insurance companies controlling the system. There are areas where health systems have a monopoly. Some own hospitals, urgent care, ER, physician practices and ambulatory services (e.g., Inova in northern VA).

            I recently became unemployed and since I can’t afford the COBRA premium I started to make some calls to see how much services would cost if I would pay on my own (I have RA).

            I started by calling a couple rheumatologists offices. In Richmond most physicians work for two health systems (VCU and Bon Secour). The first one told me that she could not tell me how much the visit is because the doctor sets the price. I asked for a range and even volunteer to give her the CPT codes. Still nothing. I kept insisting and after being on hold for a few minutes the woman came back telling me that a new patient visit would cost $202 – $571. The second place told me that I would first have to go to a PCP and get a referral, even though I told her I would pay for the visit on my own. Then she told me that I also have to apply for financial assistance, not quite sure why. Needless to say I could not get a rate from this person.

            I’ve also tried some practices in No VA and found the rates to be a bit better but still much higher (at least double) than what my insurance company paid for my visits in the past. None of these offices offered any prompt pay discount for self-paying patients.

            I then proceeded by calling radiology places and got a couple of quotes for X-Rays. One place offered a very good price. The other was twice as much as an insurance company pays, even though they said that the price included a 35% discount for self-paying patients.

            No luck finding out prices for the lab work, except for the online places where you can order your own tests. Prices are once again at least double than what insurance usually pays for the same services.

    • http://onhealthtech.blogspot.com/ Margalit Gur-Arie

      IVF-MD, how do you think the ladies depicted in this article would have fared in the completely free-market structure you are suggesting?

      • http://fertilityfile.com IVF-MD

        Great question, MG. I respect Kevin’s rule about length of reply. I can get you started on figuring the answer yourself, but you’ll realize that the people in the above examples (and others like them, who have fallen through the cracks of the current system) would do much better if we had a free market system instead. Contrast, if you will, #1 the current bad system that we have today – CRONY CAPITALISM, where corporations employ lobbyist money to “nudge” politicians to mold the rules to favor the corporations in a very unlevel playing field. Note that the politicians derive their unbalanced power via forced taxation, thereby taking a chunk of the decision-making power out of the hands of the working people vs #2 a truly FREE MARKET, where businesses are rewarded/punished directly with the customer as the sole judge, and not by arbitrary political means.
        A free market means that government is very limited in power to only protecting the rights of individuals and not in the business of redistributing wealth through corporate welfare (ie bailouts, subsidies and unfair regulations). This essentially frees up so much money that is now wasted via taxation. Let’s say for the sake of argument that it frees up 40% of our earnings, although the true amount is probably much greater. Now imagine every working person having 40%+ of his purchasing power liberated to do as he judges best. I’m 100% convinced in my heart, based on my circles of friends AND the people with whom I come in contact professionally AND the people whom I hear donate freely from their hearts to the Japan victims that there will be a steady stream of charity that will MORE than cover the needs of the underserved, at least better than how it is today.
        Some estimate that 70% or more of every dollar taxed goes to bureaucrat salaries, waste and corruption before it makes its way to the pockets of the poor. Politicians should get out of the charity business because they do it so poorly. Take out that bloated middleman and you’ll have more than enough to cover the poor, at least way better than how we do it now. And this doesn’t even take into account the greater factor of changing people’s incentives when they are helped by voluntary CARING charity vs being helped by an UNCARING bureaucracy. The best way to TRULY help the poor does not just involve impersonally throwing someone else’s money at them to force them to be totally dependent. This conversation is so important, I could go on and on, but again, I respect Kevin’s length restriction on posts.

  • http://www.smartmothersguide.com Dr. L. Burke-Galloway

    Leave it to my esteemed colleagues to detect my faux pas (lol). Obviously my math is wrong. This is what happens when you write a blog at 2:30 a.m. and have to be up at 5:30 a.m. The correct count is 720 weeks. Mistake duly noted (lol). Thanks for reading the post.

    • Kevin

      I’ll fix it.

      Kevin

      • http://www.smartmothersguide.com Dr. L. Burke-Galloway

        Thanks, Kevin.

    • gzuckier

      Probably seemed like 8,736 weeks.

  • http://www.smartmothersguide.com Dr. L. Burke-Galloway

    I actually worked 31,320 hours in the clinic but whose counting (lol)?