As painfully revealed by the coronavirus pandemic, the American health care system is ailing, plagued by the inefficiencies and greed of big business and for-profit medicine. It is not unlike the virus, attacking vital organs one by one until the whole is weakened. In more grave cases, the severely ill can’t survive. In much the same way our health care system is killing Americans. The sickness is proving incurable, for the doctors who are leaving and for the patients who need them. Our health care system is failing America.
It’s failing rural America, where resources are few and small hospitals are closing, making limited access even more scarce. It’s failing American children whose families can’t afford preventative treatment or early intervention for health problems that aren’t their fault. It’s failing our elderly, who are forced into nursing homes and long-term care facilities because their loved ones can’t afford the astronomical expenses of keeping them home. It’s failing the mentally ill, who are unable to get desperately needed therapy or substance abuse treatment because of shortages in the behavioral health field. It’s failing minorities, who are becoming sick and dying at significantly higher rates than the general population from coronavirus and nearly every other disease. It’s failing the poor and the uninsured who can no longer see a doctor when they are sick, even when the office visit fee is waived because they can’t afford testing or treatment offered.
This diseased health care system has also spread to patients’ relationships with their doctors. Patients no longer see their doctors as partners in preserving their health. Trust is rapidly becoming a thing of the past. Add to this the availability of information (and misinformation) on the Internet and the advertised promise of expensive drug “cures” that never quite deliver, and it’s easy to see why patients are frustrated. Finally, examining the exorbitant deductibles charged by private health care insurance companies that force patients into the hands of bill collectors and bankruptcy makes it clear how patients can be dying of treatable conditions rather than seeking care. The American health care system is failing patients.
It’s also failing doctors.
Doctors can’t change many of the external circumstances that impact the health and wellness of their patients, like poverty and quality of education. They can’t change the lack of clean water, healthy food, and natural spaces known to be protective of health. They feel powerless to address social and cultural forces like racism, sexism, and xenophobia eroding physical, mental, and spiritual health. Doctors can’t escape the cold, hard truth: one of the world’s wealthiest nations doesn’t guarantee health care for all its citizens. Instead of helping Americans who need it most, idealistic doctors work for a system focusing more on revenue generation, data-gathering, and quick fixes. Many doctors fall out of love with medicine.
I know this because, for many years, I did too.
Seasoned doctors, who used to spend as much time with their patients as necessary, are retiring early to escape a volume-based system that forces them to push the very people they want to help out the door. Doctors find little joy in prescribing pills (for lack of time to educate) as they shuffle patients in and out of exam rooms, argue with insurance companies, and eat lunch mindlessly over their computers. Idealistic people who became doctors because they wanted to make a difference are burning out and leaving medicine, contributing to great shortages in primary care. Most primary care doctors who stuck it out aren’t happy people. They have lost their spirit and true purpose in becoming doctors: to help and heal.
There is hope, though. Doctors are a resilient lot. Most will forge forward in their mission of service despite disease in the system. And, fortunately, most patients are not mortally ill or dying. Most are just desperate for someone to hear their story – to see them as a person worthy of care. Even in a dysfunctional system, doctors can do this one small thing. They can listen. When we take the time to truly hear their stories, it’s impossible to deny the worthiness of our care.
We need this human connection just as much as our patients.
Jen Baker-Porazinski is a family physician who blogs at Pound of Prevention.