My wife recently retired from a distinguished career as an
RN, and I have been alleged to know a little bit about health care.
So, like the proverbial doctor at a cocktail party, we get
asked about health care issues and health services. We gladly give the best
advice and best referrals we can.
We are also are the recipients of a great deal of venting
about problems in the health system. Lots of venting. And lots of venting about
the failure of the system to be even a little coordinated.
Some of the venting is shocking. The lack of coordination in
oncology care in some systems is almost scandalous. But oncology is not alone.
The era of hospital employed physicians is clearly causing
some problems.
Patient: “When will I see my doctor, Dr. Smith?”
Nurse: “You won't see Dr. Smith until you are discharged,
here you will see the hospital doctors.
Patient: Well, who is that?
Nurse: “ Dr. Jones will be your cardiologist, except on
weekends when it will be Dr. Brown, but after 8:00 pm it will be the cardiologist
on call. Dr. Clooney is your hematologist and Dr. Pitt is your gerontologist,
except of course for after 8:00 pm and weekends and their day off.”
Patient (slowly): “Oh... my... God.”
And we wonder why patients are confused? Are we close to
violating informed consent standards with this parade of physicians?
Surgery patients are a little luckier, at least they know who
is in charge of the parade, usually.
And it can be worse after the discharge. Something even
worse happens when patients are referred to physicians willy-nilly, and after
the fact discover the physician is out of network. How do they find out,
usually when a huge bill comes in the mail three weeks later.
So who is to blame for this? Everybody and nobody.
The health care system has been evolving rapidly since 2010,
and most providers are trying to evolve and accommodate the change.
The September 2016 edition of the Annals of Internal
Medicine gives us a grim report – the employment of physicians by hospitals
has not improved care. The alleged benefits of better coordinated care, well,
are not benefits so far.
