Brainstorming Health Care Change

I have done more than my share of complaining about how broken our health care system is, and have made the claim that health care reform has been my personal #1 issue when I vote. I've bemoaned the failure of the Clinton Administration's attempt to reform our system, and done my share of criticizing the 2010 Affordable Health Care Act. At the same time, I've also been vocal about my relief that we're at least doing SOMETHING.

All of that is rather vanilla opinion that probably isn't detailed enough for someone who takes comfort in the fact that I work in a Community Health Center. As I've been reading about efforts within the environmental movement to create change from the ground up, I've decided to explore, at minimum, what I really think health care should look like. At the same time, I want to welcome comments from friends and colleagues so that my views can grow. The hope is that I can form a vision for an intentional practice in the future, and perhaps all who enter here might help each other develop a more nuanced conception of our mutual problem.

So I start with some really basic observations from the exam room.

1. Patient priorities and provider priorites are quite different. Patients seek out care for pain and illness, hoping to be relieved of suffering. Providers / doctors want to diagnose and treat. Obviously there is a lot of overlap, but it is extremely common for my time in the exam room to involve me wanting to optimize blood pressure and blood sugars while the patient wants their chronic knee pain fixed.

2. Neither one of us really wants to deal with the money. Patients rarely know the details of their coverage, and I also avoid learning specific formularies, copay structures, etc. Always looming is the expectation that care is payer blind but in reality almost every single patient encounter is affected by cost.

3. Most everyone feels overwhelmed and powerless. The pressure to see more patients with less cost leaves both provider and patient unhappy. Patients know that their access to most modern healthcare technology must go through a trained gatekeeper. I hate being a gatekeeper. I would rather be an advisor and a guide.

So I'm sitting here staring at this list, just another bit of complaining. The inspiration for this blog was reading a book (NO IMPACT MAN) where a guy who was really upset about a problem just jumped off to try to make his part better.

What can I do today? Now?

After staring at the screen for 15 minutes, I realized that what I want most of all is to have meaningful encounters. Where I walk out and the patient walks out feeling something was accomplished. Time well spent.

So this afternoon, I am going to ask myself for each visit. Do I feel satisfied with that encounter? Do I think the patient did? Why?

We'll see where it leads.