Migrating to the U.S. as an international medical graduate, I was shocked by the health care culture of excess. Initially, it felt good to order a CT scan on everyone who had a fall or cardiac enzymes on anybody who had atypical chest pain. I felt powerful and light years ahead of the system I left behind, where you would have to very cautious about ordering diagnostic tests as, mostly, they were being paid off by patients with very little means.
After the initial shock wore off, a sense of dread at the waste set in. My seniors taught me to order tests before thinking and practice defensive medicine. Having a conservative nature, I was always put off by one of my residents who would order unnecessary tests on patients. The biggest issue was that these tests were not ordered for the wellbeing of the patient but rather to satisfy the appetite for defensive medicine.
Most of the physicians I met were afraid of the medicolegal system, which in American healthcare has taken the guise of Voldermodt: he who should be named. Absent from any health care reform, the system haunts honest physicians who mean well and gives nightmares to some of the most competent physicians and surgeons.
The culture of health care excess is not limited to diagnostic tests. There are many other ways by which the system is bankrupting the most powerful economy in the world. Another aspect is the culture of doing more when less is needed. To give another example: there are too many specialists in the U.S.
A typical American elderly patient could be seeing an average of more than five physicians a year and be more than five medications. In typical primary care practices, it is routine to see patients seeing a cardiologist, pulmonologist, nephrologist, and endocrinologist. We all know that there is a rise in obesity, diabetes, and heart disease in America. Yet, most of these diseases can be treated by competent primary care physicians. We have built a culture where everyone feels like they need a specialist, and unfortunately, this culture is enabled by the subspecialists. Congestive heart failure, stable coronary artery disease, chronic obstructive lung disease can be managed by front line physicians.
Also, there is now a plethora of visiting nurse services, home care agencies, and other ancillary services who want a piece of the pie. The culture of having the government pay for everything also absolves the consumer of responsibility and leads to waste.
I am not saying that there are opportunities where access to diagnostic testing, subspecialists, ancillary services is necessary. However, choosing wisely and doing less rather than more can have better outcomes. It is important to find that balance.
The way I see it, the U.S. health care system based on capitalism has become extremely corrupt. Corporate medicine, greedy administrators, handpicked physicians and nurses, and Big Pharma and giant insurance companies are leeches sucking the money out of a morbid health care system. A culture of doing more fits in with the greed of getting as much out of the patient as possible. This is particularly worse when the bill is paid by the taxpayers in the form of government-run health care insurance plans. My friends who are salivating on the idea of Medicare for all, are in for a rude awakening, as the government writing a blank check for the excesses of health care will make the system even more morbid than it already is, and take it to life support. Nationalized health care shifts the power of health care delivery to administrators leading the physician burnout and replacing the workforce with mediocre health care extenders who are cheap and can dance to the tunes of the rule-makers.
In my opinion, bending the cost curve would need a complete overhaul of the systems. We need to identify and target culture of excess. This would need a hybrid of government-run health care for those that cannot afford it and private health care. We must not lose sight of personal responsibility. We need to have a public policy that promotes wellness and cuts down our addiction to fast food. We need to slow down as a society. We need to understand that the pursuit of happiness is built on a foundation of health. The basics for wellness include social connection, adequate sleep, movement and exercise, and access to clean food and water. We need to look at innovative systems like tax credits for wellness like those used by car insurance for having a safe driving record.
The cornerstone of our health as a society will lie in setting up strong primary care systems. These systems need to be empowered and supported. We need to create a system so as the best medical student choose to go into primary care. Cognitive specialties need to be valued, and innovation should be encouraged so that the physicians of tomorrow are happy to serve and not being injured by administrative excesses and bogus quality measures that do nothing to improve the health care of the country. The solution is not top-down in the form of forced bills like the ACA. It is bottom-up, by empowering the front like workers of health care to partner with patients to challenge the system of excess. “Health Care 2.0” will not be solved by technology giants like Amazon, Apple, or philanthropic foundations. It needs to come from local physicians and allied health professionals using the hybrid of tradition and technology to serve the community.
We do not need to copy everything that Europe does to be successful. Americans ran away to this brave new world as we wanted to do everything better. Let us not stop now, and continue to show leadership in health, only as we can.
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