It is with mixed emotions that I introduce this piece by my colleague Dr. Katie Sharff, an infectious disease expert physician and researcher. The piece is about cancer striking in her own family, and the challenges of navigating the US health care system. Having been both sides of it— as a doctor and a patient—her concerns resonate.
This is exactly why I went into nursing and we desperately need it now more than ever before. Thank your for sharing this story .. I hope your family member is blessed with many of them on her journey.
Thanks, Katie. I think that there are great truths in anecdotal stories. I was recently hospitalized for a small stroke associated with mild but dense right lower extremity weakness. I was taking low dose aspirin faithfully for years which likely made the mild fall from my road bicycle with helmet in place worse than it would have been. Work-up was relatively efficient with the obligatory CT scan followed by the inevitable MRI. I am recovering but the healthcare system has done me no favors. The case manager assured me that she was referring me to an agency for in-home physical therapy. It never happened. I contacted the consulting neurologist's office for a referral -- no answer. I contacted the PT department of the hospital's suburban branch and left a message on the answering machine that was never returned. Finally, I asked my previous neurologist to make a PT referral. which got done. PT started TWELVE days after the stroke! Not ideal.
Believe it or not, there is more pressure on reducing healthcare costs over against delivering quality and timely healthcare. In 2022, patients with new onset strokes are supposed to be prioritized for rapid assessment so that urgent intervention with IV TPA can be instituted before there is permanent damage. Even though I presented at our leading hospital's ED with classic symptoms of a stroke, it was an hour before I saw a physician and 90 minutes before a head CT scan showed a hemorrhagic as opposed to thrombotic stroke.
I will have a cerebral angiogram in a couple more weeks. The nurse practitioner who saw me in Neurology Clinic recommended a six week follow-up with the director of vascular neurology but he had no openings for 11 weeks. Of course, he will want an MRI scan when I see him. There is little real consideration of the potential benefits of serial MRIs in the minds of well-trained neurologists despite the costs. Just another story of the short-cuts and time priorities in our modern healthcare system. By the way, it will only get worse over time.
First and foremost I wish to express my condolences on multiple fronts, the cancer that has affected your mom and the stress our medical system has placed on her and your family.
Nurses can pick up the slack in helping restate confusing medical verbiage so people can understand. We can also help point you in the right direction to get x, y, or z. But we can not replace the doctor. For many and most senior citizens people have grown up and/or been taught the doctor is the end all of end alls. From God's lips to the doctor's ear. People tend to respect and listen to a doctor.
Who has really seen a doctor's face recently? I see their head bowed while sitting, standing and even walking while they click the boxes and write on their iPads. There is just never enough documentation to satisfy CMS, insurance companies, the state, and medical directors.
A lack of hospital beds should not be an issue. We've come to the point where we churn out patients. What would've been a 3 day stay 30 years ago is a one night stay at the very most. Usually an outpatient procedure. This is continuing despite the threat of red flags when that patient returns, like a boomerang, to the ER with similar symptoms as the last visit, or more severe symptoms from the original problem.
I got really good at what I do because I have worked on all sides. I've been a patient. I've been a family member. I've been middle management. I've been in the trenches. I've been involved with finances. In order to lead you must have knowledge. Knowledge doesn't always come from books. Being a doctor or nurse is nothing like what we experienced when in training. One has to live it and be affected by it to get it.
It's not only the medical system it's the state of finances. When an ordinary football player can make on the average $2.7million for 27 weeks per year and an ordinary (non-specialized) doctor makes an average of 3/4 less than the football player for 50-52 weeks per year, where and who determines priorities.
I'm so sorry that there is not enough doctors and nurses. And frankly, if I were a college student and truly understood what the government was doing, I wouldn't want to be one either. Between California trying to control what doctors say to medical boards harassing osteopathic doctors, I don't know why anyone would want to go into medicine anymore.
So much said in so few words. I recently went to get inflixumab for late onset crohns and the sign in assumes one has a smartphone to open the camera to click on the square that takes you to the website login. Redundant and time wasting for me, I refuse to use it because part of the ritual of my own care is to INTERACT with Belinda, the wonderful woman behind the desk who dislikes the system as well. I like to get there, share words and a few pics of the grands, give a token of appreciation in the form of deer summer sausage from my hunt, and jabber for a minute or two. If connects the human component of reducing my own anxiety, and she likes the interaction with all of her patients (I’ve asked) as well. I was also in healthcare (chronic pain and addiction) and left the field entirely when it became profit driven. As a person who started as a patient (myelomeningocele and 57 subsequent surgeries) and one who tried for two decades to do what’s right for people, I’ve watched profit driven healthcare’s focus go from caring for the patient to caring for the bottom line. Isn’t the first order of caring for patients actually to CARE FOR THE PATIENT? I will keep the author and her family in my thoughts through the holidays and beyond.
The fundamental problem here, in many ways, is the governmentization and corporatization of health care (using the word loosely). When doctors were in practice for themselves (I have been there) they were primarily concerned for and about their patients. It showed.
Now virtually all doctors are tools of large health care organizations, whether academic or private. They all answer to everyone EXCEPT the patient. The patient does not pay his or her own bills, so they really have no economic input into the transaction whatsoever either.
Those who pay the bills do not care whether patients sit on hold for hours. Makes no difference to their revenue streams. They just insert automation because it makes more money. What happens to patients is irrelevant.
The most egregious example of this is electronic medical records. Having practiced through both systems, I can vouch that in most ways, care was far better rendered using the paper chart and focused providers. It used to be that the nurses cared for the most needful patients while the aides did all the non-care work. Now aides provide almost all care while the nurses sit in the hallway punching data into Epic that not a soul will ever use/read except, perhaps, some lawyer, somewhere, sometime.
There is no money to be made in finding a home health helper for elderly patients who need them, so it is not happening. Those same people enriching themselves by forcing covid spikeshots on hundreds of millions of people that do not need them and never did are also enriched by the antineoplastic that extends a (miserable from side effects) life by two months. That's where the money will go.
Until there is a fundamental change in how health care is financed (and no, government paying for it all is not the solution -- Vinay should practice in Canada sometime like I have) this is not going to get any better and, in fact, can just be expected to get worse.
The most chilling prose in the post: "This is medicine in 2022. This is medicine in 2022 for a patient who comes from a medical family. My heart goes out to the patient who does not have the knowledge to navigate our complex system".
I would encourage the author to explore alternative treatments for cancer. chrisbeatcancer.com has incredible stories and the Truth about Cancer is a mind-blowing (and also controversial) docu series. Humility and curiosity may pave a path to survival.
This is exactly why I went into nursing and we desperately need it now more than ever before. Thank your for sharing this story .. I hope your family member is blessed with many of them on her journey.
Thanks, Katie. I think that there are great truths in anecdotal stories. I was recently hospitalized for a small stroke associated with mild but dense right lower extremity weakness. I was taking low dose aspirin faithfully for years which likely made the mild fall from my road bicycle with helmet in place worse than it would have been. Work-up was relatively efficient with the obligatory CT scan followed by the inevitable MRI. I am recovering but the healthcare system has done me no favors. The case manager assured me that she was referring me to an agency for in-home physical therapy. It never happened. I contacted the consulting neurologist's office for a referral -- no answer. I contacted the PT department of the hospital's suburban branch and left a message on the answering machine that was never returned. Finally, I asked my previous neurologist to make a PT referral. which got done. PT started TWELVE days after the stroke! Not ideal.
Believe it or not, there is more pressure on reducing healthcare costs over against delivering quality and timely healthcare. In 2022, patients with new onset strokes are supposed to be prioritized for rapid assessment so that urgent intervention with IV TPA can be instituted before there is permanent damage. Even though I presented at our leading hospital's ED with classic symptoms of a stroke, it was an hour before I saw a physician and 90 minutes before a head CT scan showed a hemorrhagic as opposed to thrombotic stroke.
I will have a cerebral angiogram in a couple more weeks. The nurse practitioner who saw me in Neurology Clinic recommended a six week follow-up with the director of vascular neurology but he had no openings for 11 weeks. Of course, he will want an MRI scan when I see him. There is little real consideration of the potential benefits of serial MRIs in the minds of well-trained neurologists despite the costs. Just another story of the short-cuts and time priorities in our modern healthcare system. By the way, it will only get worse over time.
I hope and pray your mom has a good response to her treatment
Dr. Sharff’s analysis found myocarditis in 1 in 1,800 young males in her medical network (Kaiser).
The same system that found this signal is the same system that mandated shots is the same system that keeps cancer patients on hold for four hours.
Or in my dads case, rescheduled his heart surgery morning of, twice in a row, then never followed up to reschedule.
Sending my best wishes.
First and foremost I wish to express my condolences on multiple fronts, the cancer that has affected your mom and the stress our medical system has placed on her and your family.
Nurses can pick up the slack in helping restate confusing medical verbiage so people can understand. We can also help point you in the right direction to get x, y, or z. But we can not replace the doctor. For many and most senior citizens people have grown up and/or been taught the doctor is the end all of end alls. From God's lips to the doctor's ear. People tend to respect and listen to a doctor.
Who has really seen a doctor's face recently? I see their head bowed while sitting, standing and even walking while they click the boxes and write on their iPads. There is just never enough documentation to satisfy CMS, insurance companies, the state, and medical directors.
A lack of hospital beds should not be an issue. We've come to the point where we churn out patients. What would've been a 3 day stay 30 years ago is a one night stay at the very most. Usually an outpatient procedure. This is continuing despite the threat of red flags when that patient returns, like a boomerang, to the ER with similar symptoms as the last visit, or more severe symptoms from the original problem.
I got really good at what I do because I have worked on all sides. I've been a patient. I've been a family member. I've been middle management. I've been in the trenches. I've been involved with finances. In order to lead you must have knowledge. Knowledge doesn't always come from books. Being a doctor or nurse is nothing like what we experienced when in training. One has to live it and be affected by it to get it.
It's not only the medical system it's the state of finances. When an ordinary football player can make on the average $2.7million for 27 weeks per year and an ordinary (non-specialized) doctor makes an average of 3/4 less than the football player for 50-52 weeks per year, where and who determines priorities.
I'm so sorry that there is not enough doctors and nurses. And frankly, if I were a college student and truly understood what the government was doing, I wouldn't want to be one either. Between California trying to control what doctors say to medical boards harassing osteopathic doctors, I don't know why anyone would want to go into medicine anymore.
So much said in so few words. I recently went to get inflixumab for late onset crohns and the sign in assumes one has a smartphone to open the camera to click on the square that takes you to the website login. Redundant and time wasting for me, I refuse to use it because part of the ritual of my own care is to INTERACT with Belinda, the wonderful woman behind the desk who dislikes the system as well. I like to get there, share words and a few pics of the grands, give a token of appreciation in the form of deer summer sausage from my hunt, and jabber for a minute or two. If connects the human component of reducing my own anxiety, and she likes the interaction with all of her patients (I’ve asked) as well. I was also in healthcare (chronic pain and addiction) and left the field entirely when it became profit driven. As a person who started as a patient (myelomeningocele and 57 subsequent surgeries) and one who tried for two decades to do what’s right for people, I’ve watched profit driven healthcare’s focus go from caring for the patient to caring for the bottom line. Isn’t the first order of caring for patients actually to CARE FOR THE PATIENT? I will keep the author and her family in my thoughts through the holidays and beyond.
The fundamental problem here, in many ways, is the governmentization and corporatization of health care (using the word loosely). When doctors were in practice for themselves (I have been there) they were primarily concerned for and about their patients. It showed.
Now virtually all doctors are tools of large health care organizations, whether academic or private. They all answer to everyone EXCEPT the patient. The patient does not pay his or her own bills, so they really have no economic input into the transaction whatsoever either.
Those who pay the bills do not care whether patients sit on hold for hours. Makes no difference to their revenue streams. They just insert automation because it makes more money. What happens to patients is irrelevant.
The most egregious example of this is electronic medical records. Having practiced through both systems, I can vouch that in most ways, care was far better rendered using the paper chart and focused providers. It used to be that the nurses cared for the most needful patients while the aides did all the non-care work. Now aides provide almost all care while the nurses sit in the hallway punching data into Epic that not a soul will ever use/read except, perhaps, some lawyer, somewhere, sometime.
There is no money to be made in finding a home health helper for elderly patients who need them, so it is not happening. Those same people enriching themselves by forcing covid spikeshots on hundreds of millions of people that do not need them and never did are also enriched by the antineoplastic that extends a (miserable from side effects) life by two months. That's where the money will go.
Until there is a fundamental change in how health care is financed (and no, government paying for it all is not the solution -- Vinay should practice in Canada sometime like I have) this is not going to get any better and, in fact, can just be expected to get worse.
The most chilling prose in the post: "This is medicine in 2022. This is medicine in 2022 for a patient who comes from a medical family. My heart goes out to the patient who does not have the knowledge to navigate our complex system".
I would encourage the author to explore alternative treatments for cancer. chrisbeatcancer.com has incredible stories and the Truth about Cancer is a mind-blowing (and also controversial) docu series. Humility and curiosity may pave a path to survival.