“Doctor, the patient is complaining,” said my secretary in a hush-hush voice. “She has been waiting for 30 minutes.”
“She” had an appointment for later in the afternoon but phoned our office about 2 hours before the scheduled time, and requested to come earlier. No emergency. No acute complaints. We always try to accommodate, and pushed to “squeeze” her in. The earlier time, of course, overlapped with another patient who ran just a little bit late. She seized the moment, and released her stress and frustration by calling us “liars” and storming out of the office after a very ugly scene.
This was past Monday. Fast forward to next Monday.
A discreet knock on the door interrupted my conversation with a patient. “Doctor, the patient is going to leave,” said my secretary quietly. I was running 20 minutes behind. It was his first appointment, and he already rescheduled it twice before through the electronic interface, one time resulting in a no-show. He was referred by his wife, with whom I had a nice, warm relationship.
I asked my secretary to apologize for my tardiness. Despite that, the patient left, slamming the door on the way out.
This was the end of a week that was unsettling. Maybe, it was the warm weather, the weariness of the summer almost gone, the Jupiter moving retrograde in the planetary alignment?
“I am so glad I found you!” exclaimed one of our new patients past Wednesday. She was middle-aged, overweight, a smoker, seen in the local urgent care twice for shortness of breath. She was told she had pneumonia, and given antibiotics. It was suggested that she see a cardiologist to check her heart.
“I do not really go to doctors,” she said, her eyes probing me for a reaction. “I know what I need to do,” she half-chuckled/half-coughed at her own joke. She was happy with our visit, and we formed a relationship. I treated her with blood pressure medications right away, and we ruled out all the sinister cardiac causes of dyspnea with the expeditious cardiac work up. The ball was set in motion for her to stop smoking and connect with a good pulmonologist for further work up and treatment.
Of course, we spent a lot of our time to fetch her blood results and x-ray reports from the urgent care, refer her for a stress test at the hospital, get it authorized, and collect all of the data in one place. When she returned for her follow-up, she mentioned how remarkable it was for her to have an enjoyable relationship with a physician, and not run away from her medical issues. All because she trusted me. She even brought a relative to the appointment, and we all laughed at her jokes, never losing our focus or professionalism. Our medical students remarked how wonderful it was to be a part of such visit. They felt inspired.
She gave our practice very good reviews, rating my bedside manner as 5-stars, our wait time as 4-stars, and her overall experience as … 3 stars?! I have been 1-star once before, and nothing less than multiple 5-stars over the past 7 years.
None of it made sense until I realized that these patients and I are living through our own version of the Hunger Games. Our interactions are reflecting the troublesome realities of the health care delivery in the summer of 2015, and beyond.
In the Hunger Games novels, a very advanced but morally corrupt society chooses to suppress its populace by sanctioning annual mass murder of children and young adults. It is televised, and endorsed as a patriotic, necessary measure to promote peace and equality. Of course, nothing can be further from the truth. The ruling class is simply using the opportunity to suppress the independent thinking, and hold on to the status quo. The populace is destitute, powerless, kept in the dark, buried alive, but its unrest is growing steadily and stealthily. The ruling class prospers, engaging in the ridiculous and pointless show of excess out of boredom, and is oblivious to the growing anti-establishment sentiment until it squarely blows up right in their face. The moral compass fails, and murder becomes nothing more than a glorified spectacle. The human life is devoid of value, spared or extinguished on a whim.
I do believe my patients are troubled. Patient unrest is growing, and we, physicians, are seen as a ruling class that is promoting the excesses of the system. Unifying among my patient occurrences were frequent and persistent references to their out-of-pocket expenses, deductibles, copayments. Our system destroyed the value of patient-physician relationship. Patients and physicians feel powerless to deal with mega-million strong insurance carriers, some gloriously broadcasting their billion dollar mergers. Just as in the Hunger Games, the stakes are rising disproportionally for the populace, and the value is draining from their hard-earned living.
A friend — an educated man and a respected attorney — lamented recently that his child’s surgical fees (for an abdominal surgery done for a chronic condition), as evidenced on the explanation of benefits, were exceeding a hundred thousand. When I pointed out that no professional fees are ever even close to such a number, and asked if it were the facility fee instead, he was caught off guard. Patients may get a hospital bill, but they attribute the charges, and potential income, to the doctors performing the procedure. It’s a simple trick of perception that becomes reality. And it nicely obscures the real situation, as in excessive and opaque hospital contracts with insurers.
Of course, this continues year after year, and multiple stakeholders are entrenched to maintain the status quo. Many would agree that the practice of medicine is currently defined by coverage rendered through insurance carriers to patients and physicians, and, as such, is restricted and unrecognizable.
In the movie version of the Hunger Games, a young, fearless, independent Katniss Everdeen brings down the empire using the oldest of the weapons: her bow and arrow, her iron will, her relentless passion for humanity, and a sense of justice. She accomplishes the unthinkable, and loses love and loved ones. Is value-based purchasing and price transparency our Katniss? And do we have her will to fight and survive?
Regina Druz is a cardiologist and can be reached at Integrative Cardiology Center of Long Island.