As I said recently, I’ve been writing less here for a number of reasons. One is that I’ve been asked to write on other sites. Another, a sobering factor, as that after years of study, I’ve concluded that the American healthcare system has tied itself in a fatal knot. The post shown here, on the Patient Power blog, is an example of both.
It’s about my conclusion that while all the many, many great doctors and nurses and administrators do their best to save people like me, the system has become lethal. I don’t say that lightly, but I truly believe that you and I need to understand this, because it is killing people despite the best efforts of good medical professionals. While good people work hard at the local level, at the system level the incentives are perverse. When your turn comes to get good care, you need to understand these pressures, because all hope is not lost, but you need to know what you’re dealing with.
[UPDATE: 3 hours later this 4 minute comedy video appeared on Facebook,
very accurately portraying one big part – but only part – of the problem.]
That guest post, American healthcare: a malignant tumor that can’t stop killing its host, links to several others I’ve written this year and in the past. Here’s the first paragraph, and the headings in the post, and the conclusion.
As someone whose life was saved 10 years ago by the best of healthcare, I find it bizarre that we have arrived in an era where—only in America—there’s a new medical concept called “financial toxicity.” Google it. Or read this ASCO interview on CancerNetwork.com. (Or for a deep, deep dive, far beyond oncology, try the sobering 2017 book An American Sickness.)
Headings, each linked to another post:
- The system wants to grow, and is good at it.
(“Remind you of anything? Reminds me of a tumor. I’m not kidding.” It links to the inexorable growth curve I’ve blogged about here (which has continued unabated for three years since first posting.))
- It’s not necessarily getting the job done
(Links to my post on the e-patient blog about “amenable mortality”)
- Bottom line, price and value are out of whack. Result: toxicity.
(Links to my post on the severe disconnect between health costs and outcomes, with the graphic shown here.)
My single biggest tip, combining all of this, derives from the now-well-accepted discipline of SDM (shared decision making), in which providers have accepted that the right choice of treatment cannot be made without knowing the patient’s priorities. So express yourself:
“I know there are a range of options, and the right choice depends on what’s important to us as a patient and family. We are really concerned about financial toxicity. How can we learn about that issue for each option, and make it part of our decision process?”
This positions you as an informed, thinking person, savvy about an important issue. And perhaps most importantly, it opens the door for providers to help you get what you want: “My patient asked for this information—what can we tell them?”
See what I mean? All the things I’ve been learning and observing have come together in what is frankly a pretty nasty picture. It’s not at all that doctors are gouging us; it’s the US for-profit health system. Every health system in the world has challenges of various sorts, but none has the problems we face here.
Don’t believe me? Go look at this Facebook post and see what an American living in Australia recently paid for three days in the hospital: $27. For the meds.
We can do better, folks.
But what to do? Others are working at restructuring incentives, but if you need help now, that’s no use. Until things change, see the conclusion of the Patient Power post for my recommendation: learn how to express your belief that while you love good healthcare, costs are important too.
See, I’ve also learned that if we don’t speak up, they say “My patients aren’t worried about this, so leave us alone.”
bev M.D. says
Good post. I have been thinking in recent days about emailing my (democrat) senators that the dems have a real opportunity to make health care their signature issue in 2018/2020 -NOT how to pay for it, but how to make the system work better for us. I think that would resonate with every person who’s ever interacted with this ‘system.’ (Not that I have any illusions it would have any effect whatsoever, but it would make me feel better to send it)
e-Patient Dave says
I say go for it. If nothing else, it’s hard to deny that we’re in unstable times, and you never know what might happen.
Besides, I believe in expressing ourselves!
Brenda Denzler says
Does my heart good to see you both acknowledge the skill and commitment of the doctors who saved your life (as mine have saved mine — twice), while at the same time shining a big spotlight on the systemic ills of our health care institutions. Preach it, Dave!!!!
William Hernandez says
US health care costs 17% of GDP, a staggering $3.2 trillion or $10k per year per person. Costs are twice as much as those of other developed nations and the results are worse, Americans live 4% less, and are in worse health than citizens of other OECD countries. Health care is unevenly distributed, many have no access or poor access to it and it is extremely expensive and unpredictable. My 5 year old fell in the bath tub in Miami, Florida, he needed 8 stitches, a simple procedure, but our wait was five hours and our bill at the Miami Children Hospital emergency room turned out to be $14,700
e-Patient Dave says
That’s appalling and all too unsurprising. Did you get an itemized bill for the $14,700 that could be posted somewhere for people to see?
I keep encouraging people to ask “What will this cost me?” and not take “We don’t know” for an answer. Sooner or later it will get ugly and the upsets will lead to SOME change – even though it might be the worst case, where hospitals start hiring security guards to fight off money questions.
So sorry you (especially your son) had to go through that.
William Hernandez says
Thank you Dave I wish I’d still have the bill to show you here but we only paid
$3k and the rest was paid for by the insurance.