A perfect storm is brewing in the U.S. health care system, and we must prepare to counter the rushing waves. America is facing a potentially catastrophic physician shortfall. All indicators point toward unprecedented times ahead. If I were an attorney, I would state my case something like this.
According to the Association of American Medical Colleges (AAMC), the United States is facing a projected shortage of between 37,800 and 124,000 doctors by 2034. Take a deep breath and let that sink in. In nearly 10 years, your state could lack thousands of physicians to care for its citizens. When this happens, how long will it take to secure a coveted appointment to see a doctor, even for a routine visit? Then, when you get an appointment, how much time will your doctor have to spend with you?
Americans are living longer, which means there are more people over the age of 65 than there were in times past. In addition, as we age, we are more likely to experience chronic diseases and complex illnesses like cancer. So naturally, a physician will need to spend more time with a typical 70-year-old patient than a typical 30-year-old one, which can significantly reduce the number of open appointments on any given day.
Physician burnout, stress, and the COVID-19 pandemic have all contributed to countless doctors rethinking their careers. Many are retiring altogether, while others have opted to redirect their course and work in nonclinical settings. In addition, a high number of doctors are aging out of clinical practice. As older physicians leave the practice of medicine, there are not enough young ones to take their place.
While other factors will play a role in the chilling scenario we will face in the not-so-distant future, these are highly significant ones.
So, what can the average person do to protect herself and her family? Become empowered. Patient empowerment can take many forms, but this blog post will focus on making the most out of every minute with your doctor.
America has traditionally had a very paternalistic health care system. The doctor told his patient what to do, and he did it (or privately declined).
Fortunately, these days patients are savvier health care consumers. They realize the importance of partnering in their care. One little-known but highly impactful way to empower yourself is to prepare a brief “elevator speech” to explain the new symptom that prompted the visit.
When a patient provides a concise yet detailed explanation of the reason for the appointment, it helps the doctor mentally rule out some diagnoses. More importantly, it allows the doctor to pinpoint the most likely causes of the symptoms, translating into a briefer, more focused examination. It can also drastically reduce the need for excessive tests, procedures and medication trials. The result is an expedited, less expensive diagnosis that often results in an abbreviated illness. That may sound good, but how does a person with no medical training achieve this lofty goal? I’m so glad you asked.
Whenever you see your doctor for a new problem, he will want to know various details about that problem, a historical account, so to speak. This is called your history of present illness (HPI) in the medical world. There are eight key elements to the HPI. These elements help your doctor narrow down the potential causes of your symptoms. In addition, they are a significant component of national evaluation and management (E/M) guidelines which direct reimbursements from health insurance companies to physicians.
Doctors cannot haphazardly charge your insurer any amount they choose. Instead, they must be able to substantiate the reason for each charge by clearly documenting the level of detail and intensity of service associated with each medical visit. Failing to do so could result in fines or even criminal penalties for insurance fraud.
Below are the key elements to remember, along with examples.
1. Quality – ex: The pain in my stomach is sharp, like someone is sticking me with a fork.
2. Timing – ex: My stomach aches last a couple of hours each time.
3. Location – ex: It hurts just below my navel.
4. Associated signs/symptoms – ex: Whenever I have a headache, I feel sick in my stomach.
5. Context – ex: My back pain started a few minutes after I moved the sofa.
6. Modifying factors – ex: A hot compress reduces pain within 30 minutes.
7. Duration – ex: My knee pain has been constant for three days.
8. Severity – ex: This pain is almost as severe as childbirth.
Once you know these eight elements, you can craft a brief, information-packed account of why you made the appointment. Then, be ready to explain your problem when the doctor walks into the exam room. Realize not all eight elements may be needed for any given illness. Still, it is always better to be over prepared than underprepared.
We, as a nation, are headed toward uncharted waters. While we may not have an advocate in high places, we can learn how to be our own successful health advocate. Waiting until the storm is upon us is not an option. Preparing for what lies ahead is our best chance to weather the storm that threatens the safety net many Americans take for granted. You’ll need more than excellent health insurance. If appointments are hard to come by and very short, you can help your doctor help you efficiently and effectively by preparing in advance for each visit.
Ann M. Hester is a board-certified internal medicine physician with over 25 years of experience and can be reached on Twitter @Patient101Book, TikTok @patientempowerment101. She is the author of Patient Empowerment 101: More than a book, it’s an adventure!