Today I have been watching, on and off, the health care reform summit between the president and congressional leaders. It seems just the same old same old. It is clear the Republicans do not want any kind of reform that is going to cut into the profits of big insurance. I say, more and more of the majority party should sign onto reform through reconciliation.
I certainly think Obama has got huevos letting all the steam rise in full view of the public. At least the Republican leadership is being afforded the opportunity to help forge a workable deal with the majority to reform the system. It seems they are content to “just say no.”
While the politicians go through the motions of our health system at the macro view, I have seen it this week on the micro level. My experience has been both with socialized medicine — at the Department of Veterans Affairs — and in regular civil care at a local hospital-system owned minor care clinic for an on-the-job injury. One might think one type of care may be preferable to the other. One might be right. And, one might be wrong.
With the VA. I sometimes have long waits. That is for both for a scheduled appointment and for scheduling an appointment. My wait at the doc-in-the-box clinic was two hours plus an hour to see a care giver, have a lab sample taken and to get an X-ray. All of that took another hour.
Today, I tried to get in touch with two VA medical specialty clinics in Houston. It took me an hour of unanswered phones, voice mailboxes that were full and could not accept calls. This type of activity, trying to reach one specialist or lab or billing at the VA, is the norm and not the exception.
I will have had three medical visits — so-called “doctor’s visits” — this week by the end of tomorrow. I will not have seen a doctor in any of the visits. One visit will have been with a physician’s assistant, another by a licensed counselor and the other a nurse practitioner.
There is no doubt in my mind that these paraprofessionals do reasonably good jobs at what they are allowed to do. However, I believe that these care providers exceed the bounds of what laws intended them to perform.
I like my PA, the care and the knowledge that person has of my medical situation. I would just as soon keep that PA because I know if something comes up, my VA care giver will seek assistance from a medical doctor that is overseeing that care. The care that I received at the minor care clinic is a different story.
The nurse practitioner I saw clearly believed she was medically a legend in her own mind. The doctor was just a name on the stationary they use to write notes for work or school. I spent three hours at this clinic for a sprained ankle and strained back. The back problem was in my thoracic region — mid back between spine and underarm — and she ordered I wear a splint and use crutches. It only took 30 minutes of using crutches that both my foot had been blistered by the splint being too tight and the crutches aggravating my back strain.
I got into an argument with the NP before leaving because of the wording that was used on my back-to-work note. It clearly wasn’t what she had told me it would be and denied saying what she told me. Of course, when you talk to any medical professional or paraprofessional, their word is always accepted, not the patient’s.
I have been to doctors many times in my life, probably more than many people. I think now, here I am at 54 years old and I have what seems to be a lot wrong with me, yet here I am pretty much fully functioning, though not as physically able as I was. I chalk that up to having been to a doctor so many times — both through their health care and because of their health care.
The Obama side of the health care debate is that a number of Americans cannot afford that care. The Republican side is pretty much, we’ve got ours, period. The GOP says loudly and proudly that we have the best health care system in the world. The whole World Wide World! But sometimes, you have to just step back and ask yourself, do we?
Way gone are the days of the doctor making house calls. What? Doctors did that? They didn’t in my life time, at least they didn’t for most people in places I have lived during the past half-century. I have seen doctors, a good number, but increasingly I have seen non-doctors. This goes for even visits to specialists.
Perhaps you can chalk up a lot of the care by non-doctors to my dependence on the VA for health care. But it’s not just the VA.
Don’t get me wrong. I don’t think that doctors are all that one should see when they “go to the doctor.”
Especially in smaller practices, competent PAs and nurse practitioners are certainly qualified to provide decent, limited, medical care. But the thought of doctors being the Wizard behind the curtain that you never see is both unwelcome and unhealthy. That is just one concern I have with our medical care but there are more.
Maybe we need to look at the whole of medicine in country and look at some of the gaps that make us question whether our care is truly the best in the world.
