It’s The System, Stupid (I)

Yesterday my wife called me in two kinds of distress: terrible coughing and frustration. She tried to use our so-called health care system but couldn’t get through. Trying to talk with the doctor, she got an interminable phone tree. On her second call, accessing the appropriate number on the phone tree got her a dead end. She eventually got a human who did not know what to do. My wife then called back a fourth time and finally made contact with a triage nurse who immediately put her on hold.

When she called me, she had been on hold continuously for 25 minutes. I had to call our physician using the “doctors only” emergency communication system in order to get my wife help for a bad cold.

In Massachusetts, a private for-profit company called MinuteClinics wants to set up outpatient urgent care clinics in various retail stores and shopping malls. Boston Mayor Menino has opposed the move saying that this action “jeopardizes patient safety” and that “allowing retailers to make money off of sick people is wrong.”

If MinuteClinics were here, my wife would not have needed to use my pull to get the care she needed. And if she were not married to a doctor, she might not have gotten care at all.

There are five important points to take away from the stories above.

1) Health care services mean that sick people need to be served (cared for) when they are sick, not at the convenience of the servers or as delayed as possible because delay in care makes money.

2) Where is the proof that MinuteClinics endanger patients? Without evidence, one should not make such statements. If I did that as a doctor – make a recommendation without any scientific proof – I would be sued, rightly, for malpractice.

3) Is it wrong for retailers to make money “off of sick people” but right for Blue Cross, HCA, your hospital, or your physician? I eagerly await a reasonable answer to that one.

4) Blaming Mayor Menino of Boston or the CEO of MinuteClinics is unfair. They are responding to a system that does not work. Healthcare sucks because it is contradictory; dangerous; and cost INeffective. The system is not poorly designed: it was never designed at all!

5) Everything described above are signs and symptoms. To cure anything, you have to treat causes. What caused the need for MinuteClinics? Why is there no evidence that patients are in jeopardy? Why do lots of people make money off of sick people? The answers are causes, and we need to treat them, not the symptoms.

To paraphrase James Carville’s famous campaign phrase, used over and over by then Presidential candidate Bill Clinton,

It’s the system [rather than the economy], stupid!

Thanks to Bruce of No Looking Backwards for his insight.

System MD

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2 comments ↓

#1 Resist Blaming Or Nothing Will Improve — Medical Malprocess on 10.25.09 at 3:39 am

[...] is usually placed on the wrong person or group. The problem is the system, not the insurance agent. It feels good to blame a specific person with a name badge, pocket [...]

#2 Healthcare Needs a Old Fashioned Country Doctor, Part II of II. — Medical Malprocess on 10.30.09 at 10:39 pm

[...] Secretly, we have been hoping for a magic potion, the silver bullet, or an ancient secret witches’ chant, which in today’s world is a catchy new phrase grandly announced on a radio talk show or TV interview by some self-styled expert in healthcare and available in his or her latest book. Do we really think a some simple cutesy phrase can cure healthcare? Please say no! You cannot wave a magic wand and have a new system. [...]

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