We Need Our Captain Back!

The healthcare industry is continuously evolving and rapidly growing. The last ten years or more, have seen a rapid development of new technologies and surgency of multispecialty approach to patient care. It has come with some advantages but at the same time has resulted in the fragmentation of delivery of healthcare. In this process the Ship of healthcare has lost its Captain, leaving patients with confusion, frustration, disappointment, and not to mention the erosion of personalized quality care. It is not unusual these days, that almost every patient, particularly the elderly has multiple healthcare providers with little or no coordination and communication amongst them. There was a time when a primary care physician acted as an anchor and custodian, who took care of most of the healthcare needs of the patient. Referral to a specialist was only made when necessary. It has all changed now!

Many reasons are cited for this change. Liability concerns, patient demand, the constraint of time, poor reimbursement, and the need to increase income are the most commonly thought of reasons to justify this change. This approach now has become a “standard of care” across this nation. In other words, we have created artificial standards of care, which many physicians have accepted for whatever reason, and find it hard to deviate from. This has resulted in over-testing, unnecessary, and often duplicate testing, and time lost from work, causing a massive increase in the healthcare cost. The cost will continue to escalate at a rapid pace unless something is done about it. Society as a whole has to demand change and put pressure on our political leaders and healthcare organizations to work together, to turn it around before we go bankrupt.

So, what is a patient, with limited or no medical knowledge, supposed to do? Having been in private practice for many years as a specialist, I have observed these changes, having some positive but mostly negative impacts on patient care. Having personally experienced the impact of these changes, I make this humble attempt, to suggest all patients, seriously consider the following.

1. Learn about your health issues as much as you can, by reading online, discussing with someone in the family or friends who could give you some basic information about your problems. This way, when you visit your healthcare provider, you are better prepared to ask relevant questions and become an equal partner in your healthcare.

2. If any invasive procedure is advised, make sure, you fully understand it, its risks, alternatives, and possible complications and downside. Go home, think it through, talk it over with your family before giving your consent. There is a desire to use new technology, but it may not be the best option for you. Technical procedures are very much operator dependent. So, do not hesitate to ask the doctor about his or her skills and experience. It is the moral and ethical obligation of the doctor to openly discuss this with you. If uncomfortable, you may want to consider a second opinion.

3. Make a healthcare folder at home for yourself. File your medical records including health issues, medications, allergies, test results, and reports of all procedures and operations. Review them from time to time to keep yourself well informed.

4. Respectfully, ask your primary care physician if he or she will be willing to treat your conditions, without you having to also see the specialist at the same time. Your primary care provider may want to get a one-time consultation, which may be helpful. Quite often, patients are seeing more than one physician concurrently for the same problem. Patients may be under the illusion that they are getting the best of the care, whereas, it may not be so. I have seen patients seeing a Primary Care Physician, a Cardiologist, and a Nephrologist for a simple problem of uncomplicated High Blood Pressure. This results in too many doctor visits, over-testing, and sometimes overmedication, resulting in unnecessary side effects and extra cost. Patients are often confused because they keep getting reminder letters from these doctors for follow up office visits. High blood pressure is only one example and there are many other health care issues that are being managed by too many doctors. In my opinion, regular visits with the Primary care physician are important and essential but routine visits with the specialists are not warranted.

5. Do not neglect the recommendations of your Primary care doctor and make sure you keep your follow up appointments. Remember, doctors and medications can only do so much! You must do your part in order to achieve the best possible outcome for you.

6. An ounce of prevention is always better than a pound of cure. Most of us are living a sedentary lifestyle with poor eating habits and undue exposure to tobacco and alcohol, leading to obesity and associated health problems. Only you can fix that.

So, as we start the New Year, let us all promise to take care of ourselves and others, especially in this time of Pandemic. Together, we will overcome and make our nation the healthiest in the world. God bless and have a happy and healthy New Year.

Arain Nawaz, MD., FACG