Does Your Doctor Have Time To Touch You?
By
Leonard Zwelling
https://www.nytimes.com/2024/12/04/opinion/ai-tech-human-interaction.html?searchResultPosition=1
https://www.nytimes.com/2024/12/08/opinion/health-care-anger.html
https://www.nytimes.com/2024/12/06/opinion/united-health-care-ceo-shooting.html
These three editorials from the pages of The New York Times summarize what I, as both a physician and patient, believe is wrong with American medicine today.
First, the initial question asked by many patients after a doctor visit and a plan for additional lab tests or imaging studies is, “will my insurance cover this?” Usually, the doctor has no idea because he or she is unfamiliar with the many insurance plans out there and their complex systems constructed to deny coverage.
Second, doctors, as with so many other professionals who used to be trusted to do their jobs, are now on the clock like everyone else. They have to see a certain number of patients in a specific time frame no matter what is wrong with the patient. As an oncologist who cared for complex patients with cancer, I can assure you that such a thing was impossible. At least once in an afternoon clinic of ten or more patients, I would find something requiring further investigation, additional time, and perhaps a consultation with another physician. Doctors simply cannot be on the clock. Yet, they are.
Finally, I often tell the story of my short tenure at Legacy Community Health as the chief medical officer. One of the benefits I was given there was that I could become a patient. During my brief time, I heard many complaints from the physicians I led that they had inadequate time to evaluate and care for their patients. So, I did a trial with an N (number of patients) of one. I was the human subject.
I signed up for an office visit with one of the young female docs. I filled out a huge document before the visit that summarized my lengthy health history. The doctor I saw never saw the form. Instead, she asked me all the same questions that were on the form. When it came time for my physical exam, she didn’t even have me undress and barely touched me, listening to my heart and lungs with her stethoscope on my shirt. She wasn’t allotted enough time for a real exam.
Needless to say, I was appalled. This was the level of care being delivered on my watch? I was fired shortly thereafter for being unwilling to go along with this being called health care delivery. I hope things are better at Legacy now. I am not a patient there, obviously. In fact, I was so concerned about the state of the health care I was getting that upon the retirement of the physician who oversaw my care, I signed up with a concierge practice where I am never rushed, I get a real physical exam, and my doctor actually touches me.
Old-time physicians like me are very concerned about the state of health care delivery in the United States. I suspect that many with means get good care, but most people are victims of assembly line care, zoom calls, and uncaring insurance companies.
The on-line response to the murder of Brian Thompson of United Healthcare, a large insurer, has been anything but sympathetic. The running joke is that he was not preapproved for care from a gunshot.
As a long-time proponent of the single payer system with a parallel option for pay-as-you-go or concierge care, I am appalled at what has happened to my profession. As a physician and as a patient, I am deeply concerned.
What is even more concerning is that improving health care access and affordability does not seem to be high on the list of the people President-elect Trump has named to oversee our health system. I don’t think Robert F. Kennedy Jr. really gets what the average American patient has to do to navigate the system he is about to lead. But, if I am wrong, and if he does, I would like to hear his solution. Decreasing the number of vaccines and asking people in food deserts to eat better will not fix the problem.
Given that there is not a senior citizen in this country who would give up his Medicare card, perhaps we should consider Medicare for all. It may be pricey and we may need to raise taxes to pay for it, but what could be more important than improving the health of the American people.
