Wednesday, April 12, 2006

Saving money: What is the effect on patients?

Everyone is talking about administrative decisions to save money on health care. What upsets and frightens me is that I see precious little discussion about patients and how the administrative decisions affect them.

The fact is that heathcare "administration" has made healthcare worse for patients. I'm not just talking about the administrative nightmare that is healthcare, although that is extremely burdensome. I'm talking about the fact that you can't get a nurse to help you in a hospital unless you are having a cardiac arrest. I'm talking about the fact that seeing patients more "efficiently" means spending less time with them, time that would be spent answering questions, consoling, etc. The patient experience is demonstrably worse, and we haven't controlled the cost of healthcare or increased access.

Shouldn't we insist that healthcare administrators view their decisions through the prism of ethics? Is it ethical for administrators to insist that patients be processed faster, leaving less time for physicians to answer questions or to simply console in the case of bad news? Is it ethical to decrease the number of nurses in a hospital and leave the patients to fend for themselves? Medical ethics is a broad field of study. Is there a similar field of healthcare ethics?

4 Comments:

Blogger Flea said...

It would save us a ton of money if we saw fewer patients.

90% of the "sick" visits in my office are not actually sick enough to see a doctor, and I'm actively trying to keep the worried well at home!!!

How much worse do you think it is in a normal flea's office?

best,

Flea

2:23 PM  
Blogger Amy Tuteur, MD said...

That's a problem for gynecologists as well. Most visits are not for strictly medical reasons.

Remember Ann Landers? I used to read her column religiously. I couldn't understand, though, why she was always advising people to discuss their serious psychological issues with their doctor. Most of us are not trained to deal with such issues. Evidently, people took Ann Landers seriously and a medical appointment would turn into a counseling session of sorts.

I attribute this partly to the stigma of mental health problems. When people discuss serious mental health issues (like spousal abuse, for example) with the gynecologist, they can convince themselves that it is not a psychological issue.

This problem has been rendered more serious by healthcare administrators because talk therapy is frowned upon as drug therapy is often so much cheaper.

3:26 PM  
Anonymous Anonymous said...

At a large hospital near me, every patient has to fill out a medical history form. It includes a question along the lines of "Are you a victim of domestic abuse? Would you like to speak to your health professional about this?"

I've seen this quesion on the history form when I was sent to see a cancer surgeon. I've also seen it when I was sent to a neurosurgeon. The whole thing, though well-intentioned I'm sure, seems ridiculous. BTW, the last person I would want to discuss domestic abuse with is a neurosurgeon.

5:38 PM  
Blogger Flea said...

Amy,

Do your blog a favor and enable word verification or some sort of comment modification.

Flea

5:47 AM  

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