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When I'm working in the hospital, I always find it interesting talking to patients about their medical history and experiences with outpatient physicians. I recently wrote about our . In fact, I'll be stronger than that: Our primary care system is a tragedy, and it's reflected in the comments I receive from patients. This is despite the best efforts of an amazingly dedicated number of doctors, who are faced with a really impossible job in today's healthcare system.
The feedback I get about patients' experiences with specialists is a little bit better -- but still yields a number of common complaints. Interestingly, I rarely hear patients complain to me about personal costs (even though they may have every reason to) or say they are upset that a certain test or procedure may not be covered by insurance. It's always about their experiences with the healthcare system on a human level.
Here are the top three reasons I hear about why people are unhappy:
1. "My appointments are either impossible to get or too rushed." Faced with enormous demand on outpatient clinics and ever-increasing bureaucratic requirements, doctors everywhere are finding it extremely difficult to spend adequate time with patients. That's if and when patients are actually able to get timely appointments in the first place. Sadly, this becomes an even bigger problem when dealing with aging and more medically complex patients. There's no easy answer if there's simply not enough supply of doctors or incentives for graduates to go into said specialty. But the doctors that are left to see patients have to find a way to make the most out of the time available. We always need to utilize good communication skills such as ensuring adequate eye contact (assuming in-person visits, which patients overwhelmingly prefer post-COVID) and empathetic active listening techniques. No staring at the screen when we should be looking at our patient!
2. "I keep seeing a different clinician." This is one of the saddest things I keep hearing, especially from patients with a long list of medical problems. Patients are "officially" assigned to one doctor, but at each visit will see a different doctor, nurse practitioner, or physician assistant. Patients desperately need one go-to clinician to be the captain of the ship. But resources are scarce, and this isn't possible. Hence what I call a merry-go-round of new doctor encounters with the same patient. This is very easy for me to spot on the electronic medical record and is suboptimal to good clinical care.
3. "My doctor doesn't seem to care, and the office rarely returns my calls." Whenever I hear this, it always hits me hard. To be clear, only a very small number of people say something like this -- but it's one of the worst things any patient can think. Of course, I don't know the background to this. There could be an unreasonable demand, a personality clash, or any number of other reasons. However, I do see people who seem like very reasonable folk give this feedback. If that truly is what any patient thinks, I only have one piece of advice for them: Find another doctor ASAP! In fact, I often go further than that, and even hand them contact information for other doctors in the area. Your health is simply too important for you to feel like your doctor is not on your side.
I believe that all the problems we face within our healthcare system -- that I so frequently wrote about for several years pre-COVID -- are all right there beneath the surface. These problems are a simmering volcano waiting to erupt as soon as we come out of the pandemic. There is a shortage of physicians, a lack of focus on primary care and prevention, mind-numbing bureaucracy, and the pain of dealing with third parties.
The nation's overall health continues to decline with chronic disease and polypharmacy, while the costs of the system continue to escalate.
It doesn't take an Einstein to work out that those two things are incompatible, and that the system will reach a complete breaking point in the not-too-distant future.
, is an internal medicine physician, an author, and a co-founder of . He can be reached at his self-titled site, , and on .
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