Saturday, October 18, 2008

Sick America, Very Sick America

Right now, I have a patient dying from an infection that is eating away her back bone very slowly. It's an infection that could have completely cured, but her insurance company did not approve the expensive antibiotic that she needed.
A doctor ordered that excellent antibiotic a few months back, but the insurance company automatically switched that antibiotic to a much cheaper drug with much less efficacy. They knew it wasn't going to work as well, but it was cheaper. Theoretically it works for this infection (and maybe that gave them the guts to do what they've done) but clinically we know it does a very poor job. Most physicians would have seen that coming.

There are many medical conditions that used to be deemed incurable in the past that are more easily managed these days because some of the new drugs we have. I sometimes prescribe these drugs to my patients only for them to be rejected by their insurance companies. I have to get on the phone for a long time and sign different forms in order to convince the accountant of the insurance company that my patient needs that drug.

Did you get that?

The physician has to convince a non-medical person what the best treatment for that patient is.
Many of these applications are rejected, and some people get sicker and die because of that. I saw it a lot and will continue to see it. All doctors, nurses and pharmacists in America see it and feel it every single day and it has become very frustrating.

It gets much worse. Most hospitals now have hospitalists. Hospitalists are physicians who work for medical groups. These medical groups are only after business. They hire a big number of hospitalists, sometimes hundreds of them, to make contracts with different hospitals in town to send their physicians there. They wouldn't send their hospitalists to any hospital unless a large profit was guaranteed. Fair enough. But how do they make money?

They keep a very high turnover of patients, so they tell the hospitalists to admit and discharge the largest number of patients everyday to and out of the hospital. They don't give a shit about their patients' health. If a patient stays longer than 48 hours in the hospital they start bugging the physician about it. It gets worse. They can form some "grading" system to see which physician generated the most money for the group. They hope to indirectly force the physician to start adopting policies in his/her work that can generate the most money instead of practising sound medicine that will help his patients. These hospitlists are now practising medicine that is in the best interest of their group instead of the best interest of their patients.

Drug companies have a lot of money. In one year (I think it was 2004) they spent 5.5 billion dollars in meals and gifts (pens, books...etc) to health care workers. No company would spend that amount of money if they didn't know it was going to affect the prescriptions physicians will write for, and physicians (me included) always welcome these drug representatives. Everyone likes free stuff, and they don't ask us for anything in return. They probably saved me a 100 bucks of pens, and hundreds to a few thousand dollars in books, and registration for conferences. I'm sitting now in my office and on the table there is a FAMVIR stapler, Mycamine pens, a book by Wyeth, and I'm wiping my Pfeizer stethoscope with the Noxafil tissues and looking at those little wireless Avelox mouses on the bench.

All the people I'm talking about are those with decent health insurance plans who have to fight with their companies whenever they get sick. There is another group of people, a very large group. That includes Americans who do not have a health insurance, and the 6 million or so who lost their health insurance under the current administration. Many of those people are hard-working people. They are either self-employed like my friend who works 7 days a week from early morning to late night, sometimes driving 4 hours a day to his place of work. There are others who work for companies that does not provide them with health insurance. If you want to purchase health insurance on your own in the US, you have to pay close to a 500 dollars a month. I have a friend who had cancer (is cured now) who will have to pay 6000 dollars a month if he wanted to purchase his own health insurance, so he's now stuck in a job that he hates so much just because they provide him with a less expensive insurance.

Take this.... the number one reason for bankruptcy in the US is medical bills. This is the country that has contributed to medicine more than any other country in the 20th century and it can
not treat many of its own sick people. This is America, stacks of money and stacks of sick people.


mab3oos said...

sabran al hareega
17 more days

KJ said...

This is utterly disturbing.

But medicine has become a sort of business in other parts of the world too. "Give the patient what they think they want and charge astronomical amounts for it"

My friend's dad has liver cancer and they're using chemo and other stuff for treatment. It costs him around 3000 dollars every fortnight.

Why? I thought in this day and age (and cancer and chemo have been around for SO long) that medicines should actually be cheaper.

Heck, even meds for common cold and flu have spiked up prices.

It's truly ridiculous and insrance companies don't seem to cover the important stuff.

Anonymous said...

Drug companies, as you stated and malpractice insurance are two huge components in this problem.

My brother lives in England. Socialized medicine is worse, people die before they even see a doctor. He pays for private care, up the nose, as well as paying for taxes for his gov provided health care.

In Holland, older folks won't even go to the doctor as they are afraid of being told it is time for them to be 'put down'. Involuntary mercy-killing.

If all socialized medical care was like Sweden, great. But until pharmacuticals and malpractice are taken care of in the US, it will just be incorporated into the problem.

Anonymous said...

That is so sad, I know exactly what you're talking about!
My company pays upward of $1000 per month for my family's health insurance. And if people think that's too much, consider that 3 visits to the doctor for anything will easily go above that. Not to mention the price of medications which I'm lucky to get for free, but I'm the exception. I even feel guilty at times.

This has to change, people shouldn't be denied health care based on their income or insurance. It's so sad to see it like that!
But, there are also other parts of the world who don't have access to anything, not even the bloated system that is siphoning money from people who need it the most!

It's so so sad!
Excellent, touching and very insightful post Hareega

Anonymous said...

Thanks for the post as you only confirm what is going on in Arizona's back yard. We recently posted a piece after watching Michael Moore's "Sicko".

I understand from my UK friend that Michael Moore oversold the UK system. Nonetheless, we have a big problem here in the U.S. and besides voting on November 4, people need to get to know who represents them in the local, state and federal government. So, my advice to everyone out there is to stop wasting time with the Nintendo and Wii devices and instead, chat up your representatives and senators -- let them know what you want them to do for you. We need to get them to realize that they represent the people, not corporations. If there's one thing politicians need more than lobbyist dollars, it is our votes. Our standard of living is going down the tubes and the only way we can change it is if our priorities change and become active participants. Namaste.

Anonymous said...

how SAD is this...
im just speechless :S

Anonymous said...

I never knew until I joined... and then I saw the sick mentality and how everything is business.

After allll this, last minute when the patient is dying, I start getting massive amounts of scripts for random x-rays to be done and I know its down to business. so I hold off for 30 minutes to let the patient die and spare the family some medical payments. Sick sick!

Now you, as a physician... How do you accommodate between business reputation and patient care?

Gosh, whatever happened to the oath?!

Hareega said...

maf3oos, i doubt that any candidate will significantly change things

kj... some patients even get denied coverage for chemotherapy. Many citizens need to have 2 tyoes of insurance in order to decrease the copay on a lot of medical services they receive

kinzi... I agree that blindly applying socialized medicine won't be efficient, i keep imagining all hospitals will be run like the VA hospitals will be run and that's a bit scary. But speaking of deaths, there were 300 people only in Arizona last year who died because they waited in ERs too long before being seen quick enough. Emergeny rooms are insanely crowded, and that's the case almost everywhere.

Qwaider... there's a system and it's a bad system. In Jordan it's worse: there's no system.

Podchicks... thank you for your input. I hope the next president will do something about it.

Well, nothing in what most physicians are doing is against the oath, except for a few of them who really get "rewards" when they write more scripts of a certain drug.

Anonymous said...

is this in hospital? was it nonformulary? why wasn't it caught sooner? where the cultures/susceptability tests at?
what about the pharmacy department catching it? I smell a lawsuit!!!

"The physician has to convince a non-medical person what the best treatment for that patient is. "

actually, it is a pharmacist and a medical doctor that review prior authorizations for medications.I used to think the same way.. a 19-year-old-GED diploma-call-center low-paid-representitive of an insurance company is hassling me over a pharmacy claim that they know nothing about and barely can pronounce the drug name they are rejecting. how dare they!!!!
but then when I worked for a national insurance company did I uncover the darkside and realize there is more clinical expertise than meets the eye. Yes those that work for these companies are biased after all the more cost effective they are and save insurance company money the more job security they have. We hope they are ethically and morally sound to not have their decisions bought and approve the proper therapy. Most of the medical directors I worked with were specialists and it is actually a greuling process to get an approval but I hope they do not sacrifice therapy for cost only.

My advice for Dr. Hareega
If you call an insurance company, ask to speak to the clinical department more specifically the clinical pharmacist or medical director..clinical pharmacist is more accessible and I would start there. After my brief time with insurance and knowing who I need to address, it has tremendously saved me time and received a quicker response/approval. call reps will connect you if you push it (most MDs and pharmacies are unaware of this process)

it's funny how i went into the health profession not knowing that it would shape me into a lawyer, defending and fighting for the sick and frail. you win some you lose some.

America's healthcare does have its problems what nation does it? But at least they dont turn you away at the emergency room or demand payment before service. if a patient comes in they must be seen by a physician. how many are saved because of that?
I've been to other countries and read the stories and would tell myself "this wouldn't happen in the states" despite the flaws in the healthcare system. with the current US status and its spiraling out of control, it will soon follow other nations and reject the less fortunate.

sorry for the rambling...too much caffeine and I haven't ranted on blogs for a very longtime.

Anonymous said...

Dr. Hareega, busy man saving lives, just want to say Mabruuk It Toot!!