Common Sense Healthcare New Year’s Resolutions:

A dose of common sense by Dr. Robert Kornfeld

     It seems that the majority of people agree that the health care delivery system in this country is badly broken and in need of revamping. I must admit I am extremely dismayed at the huge numbers of people who point a quick finger at “money hungry” doctors as the main reason that the system is failing. Until you have run a medical practice and have paid the expenses necessary to run it, that opinion is baseless and dangerous.

     While we can all agree that there are “bad apples” in every line of work, the “bad apples” in medicine simply are not the reason that we are in the crisis we find ourselves in. This is a gross over-simplification of a complex issue and one that is extraordinarily unfair to the dedicated physicians that serve the public. However, I will also say that physicians have every right to earn a great living and, just like everybody else in a capitalist system, deserve to be paid commensurate with their expertise, commitment and drive to succeed in their field.

     Health insurance companies interfere in the practice of medicine by creating a standard of care that should be established by physicians themselves (but is now set by insurance companies!). This is the main reason why doctor/insurance company relations have become contentious and adversarial.  Unfortunately, there has also been a rise in contentious and adversarial doctor/patient relations. This is an ever-increasing problem and one that exists for what I believe to be 2 main reasons. Firstly, the new managed care insurance format has conditioned patients to believe that they can avail themselves of all the health care services they need for the price of a co-pay. That means that they are not willing to pay more than their co-pay, even when the services they need are not covered by their plan. Instead of seeing the limitations in coverage that they are paying premiums for, what they choose to see is that their doctor is trying to charge them extra for services that they ‘deserve’. 

The second reason that there is an ever increasing dysfunction in the doctor/patient relationship due to the decrease in available time that a doctor has to spend with his patients. The irony is that most patients will only go to doctors that accept their insurance. What they fail to realize is that doctors who participate with insurance companies get paid very little per patient encounter and therefore must see a large volume of patients to make ends meet. So the very reason why patients are choosing physicians is the very reason that they resent them. This is a lose/lose formula.

     It seems that all discussions about “fixing” the system have to do with limiting fees paid to physicians, holding doctors accountable for expenditures (ACO’s) or re-defining the standard of care to include only those therapies dictated by insurance companies as acceptable and medically necessary (the catch-phrase for what they are willing to pay for…or not). Is it solely the responsibility of doctors, insurance companies and legislators to fix the system? I, for one, do not believe it is. Perhaps patients (i.e., the general public) share responsibility for fixing our medical delivery system.

     So how can patients do their part? There are a number of things that are clearly the responsibility of patients:

•        do not rely on check-ups to stay healthy. Checkups are designed only to identify, categorize and treat illness and disease. They do not keep you healthy. Taking responsibility for yourself will keep you healthy…. Eat a health-conscious diet, exercise regularly, learn to moderate your stress, have good sleep hygiene, improve your relationships with good communication skills, etc. In other words, be responsible for the epigenetic effects on your health.

•       do not reach for a pill every time you feel under the weather. Spend some time learning about your body and try to discover the reasons why certain symptoms occur. If you discover the underlying mechanisms, you can relieve your symptoms and improve your health at the same time. Use medicines only when necessary and only under proper medical supervision.

•       redefine the importance of your own health. I find it absolutely incredible that so many people will waste all kinds of money on going out to eat (mostly foods that are not good for their health) but withhold spending on their own health. The next time you are faced with a recommended therapy that isn’t going to be covered by insurance and you feel it is the right approach for you, re-allocate your spending so that you can make your health number one. Decrease the spending on those things that do not serve your life and your health in a positive way (ever wonder why there is only one aisle in your supermarket for ‘health foods’? What are they selling in all of the other aisles?)

•       Be the most important person in your life. You are worth it.

•       challenge your insurance company when you are dissatisfied with their determination of payment. After all, you are the one paying their salary.  Let them know about therapies that have helped you that they have disregarded…. Be persistent. It is no accident that insurance policy premiums are steadily rising as are policy deductibles, while access to care is decreasing along with reimbursements. In today’s healthcare system, insurance companies are in the driver’s seat. They are controlling the game. But remember, without your premium dollars, they are nothing. Make them work FOR you, not AGAINST you.

•       be understanding and respectful of what your doctor is up against. He or she is there for you. Doctors commit arduous years of ‘over-achieving’, education and training to healing. It is our current medical system that makes it difficult for them to be the best for you. Make it your business to communicate with your doctor’s staff. Do not leave the office with unanswered questions. Be an advocate for your best health care. It will only benefit your outcome and help you to be a healthier person.

•       Please be careful not to condemn all health care professionals in one breath. Choose your doctors wisely. There are plenty of doctors out there who will give you the time and dedication it takes to truly understand your problem and properly heal you.

From all of us at America’s Medical Society: May 2012 bring happiness and a successful, healthy New Years to you.