Eight Feet Deep

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.