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What's Wrong with the U.S. Healthcare System?

Michael Hertz: Most American doctors (the ENT doctor was an exception) are too busy except to give “shoot from the hip” diagnoses and they really won't look at anything produced for the patient by other doctors. They don't have time.

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I'd always believed that the U.S. healthcare system was a good one. But in the past year, I've discovered otherwise. Let me give you one example.

I am having significant gastrointestinal problems and have been living in Mexico. (It probably arose from medication I took in Mexico). I've seen specialists in Los Angeles (Cedar Sinai), Bellingham, Washington, and Tucson, Arizona. When I went to see the first one in Los Angeles, he listened to my story and concluded (without giving any tests) that I have “irritable bowel syndrome.” He told me to take Miralax (even though I had no constipation). Many of the other doctors at Cedar Sinai gave me tests, but he did not.

Months later, the Bellingham doctors gave me an enteroscopy exam and did do stool and other tests. They also gave me photos of what they saw. But they refused to do any follow up or communicate with my primary in Mexico and gave virtually no information on what I should do with the results that they found.

Six months later I left Mexico for Tucson and saw another gastrointestinal doctor (“Bill”). He hardly looked at the records I gave him, let me talk, and then announced that I had a “classic case.” Basically, he said that the medication I took in Mexico probably caused a major problem in my digestive system. He prescribed a proton pump inhibitor for my GERD and a very expensive pro biotic for my “irritable bowel syndrome.” Needless to say, none of what Bill gave me has worked.

I even went to see a different GI doctor. He seemed very overworked, said he couldn't think of anything to do beyond what Bill was doing, promised to looked at the records I gave him but never tried to communicate with me after I hand-delivered a copy to his office.

Today was the best example. I'm scheduled to see Bill Wednesday. In the meantime, I've developed a sore throat and had a lot of mucus and blood in my nose and a bit in my mouth. (I told Bill's assistant about this and his knee-jerk reaction was for me to get a chest x-ray). So I went to see my ENT doctor, and he did a lengthy physical and exploratory exam and concluded that I had a serious problem with my sinuses. (That ends Bill's prescription of an x-ray). And he prescribed an anti-biotic, which with previously I would have no problem, but now I wonder whether it might exacerbate my intestinal problem.

So I tried to contact Bill. I phoned his assistant and left a message, and then found out that she was with Bill at his other office and I couldn't phone him. I want to take the medication, but I need to wait because I can't contact him about an issue that is central to his diagnosis of my gastrointestinal condition.

Most American doctors are too busy except to give “shoot from the hip” diagnoses and they really won't look at anything produced for the patient by other doctors. They don't have time.

My conclusion is this: most American doctors (the ENT doctor was an exception) are too busy except to give “shoot from the hip” diagnoses and they really won't look at anything produced for the patient by other doctors. They don't have time. They are barricaded in their offices with assistants and receptionists and schedulers to block access to them. You can't call them or email them. Basically, the only time you can get information is when you are sitting face to face, and you get very little then and really no follow-up.

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Let me contrast that with doctors in Mexico and Canada. The Mexican doctors will talk to you on the phone and in most instances will email with you. They will give you advice by phone and emails. The Canadian doctors will respond to emails. They will send records by email without any problem, if it's required.

I really don't think that U.S. doctors can respond to every email they get. But they could set up a system in their office with an “email nurse” who could handle communications from patients, and the doctor could answer the ones that really required the doctor's attention. He could answer or suggest an office visit, depending on the problem

There is an inaccurate rumor that says that email communications between doctors and patients is illegal. But more important is that the way that medical insurance is set up, doctors cannot get compensation for the time spent communicating with patients outside office visits. These are serious problems that probably require legislation to correct.

The legislation should provide that, notwithstanding any other law, doctors and their staff may communicate with patients by email so long as the patient wants that and understands that there is some risk that health information is not 100% secure over the Internet. The patient just signs a consent form.

The legislation should also provide the doctors must be compensated for the time spent communicating with patients in the same way that lawyers do when communicating with clients.

Both of these changes are apolitical and would save tons of money overall. If doctors could email, then they could get information in concise form. If they needed to follow up with a phone call or an office visit, fine. But office visits take a lot of time for something that email might do better.

Suppose that little Nellie has a sore throat. She is taken to see the doctor who prescribes a medication. Five days later, the medication isn't working, so Nellie's mother emails the doctor to let her know the situation. The doctor's staff emails back and gives the mother a slot for calling by phone and talking to the doctor, which she does. The doctor can then decide if another visit is required, or maybe a different prescription or something else. So instead of having to drive miles with Nellie in the car, instead of having Nellie in the office (possibly giving her illness to other people in the waiting room), it may all be solvable with an email and a phone call. And why shouldn't the doctor's time be compensated?

Access to emailing one's physician would avoid the sort of situation I faced with Bill. In an emergency situation I could email him and his staff would pick right up on the problem. Such a system would save time and money overall, assure real communication, and might save lives and complications.

If doctors could be compensated for phone and email work, they would have more time to concentrate on past records and thinking about their clients' needs. Why shouldn't they be able to? Lawyers do that. They charge by the hour for writing, thinking, phoning, and so on. Why shouldn't doctors?

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Michael Hertz